The dappled nature of causes of psychiatric illness: replacing the organic-functional/hardware-software dichotomy with empirically based pluralism.
The dappled nature of causes of psychiatric illness: replacing the organic-functional/hardware-software dichotomy with empirically based pluralism.
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DOI：
10.1038/mp.2011.182
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发表时间：
2012-04
影响因子：
11
通讯作者：
Kendler, K. S.
中科院分区：
文献类型：
--
作者：
Kendler, K. S.
我们以二分法和对立的术语看待精神疾病世界的倾向有三个主要来源：笛卡尔的哲学、十九世纪末欧洲的神经病理学状况（当时疾病被分为有和没有明显病理学的疾病，并分别标记为有机的和功能性的），以及计算机功能主义的有影响力的概念，其中计算机被视为人类心脑系统的模型（大脑=硬件，心智=软件）。这些相互强化的二分法对我们的领域产生了有害的影响，它们清楚地预测了精神疾病的“差异制造者”（又称因果危险因素）应如何在自然界中分布。特别是，像我们的笔记本电脑这样的精神疾病，当它们出现功能障碍时，是否可以清楚地分为软件问题和硬件问题？我从分子遗传学到文化提出了 11 类精神疾病的差异因素，并回顾了它们在精神分裂症、重度抑郁症和酒精依赖中的分布。在任何情况下，这些分布都与有机-功能/硬件-软件二分法所预测的分布相似。相反，精神疾病的病因多种多样，广泛分布在多个类别中。我们应该放弃笛卡尔和基于计算机功能主义的二分法，因为这种二分法在科学上是不充分的，并且阻碍了我们整合我们的研究产生的有关精神疾病的各种信息的能力。基于经验的多元论对精神疾病的病因学提供了严格但斑驳的观点。至关重要的是，它不是基于我们希望世界成为什么样子，而是基于精神疾病的影响因素实际上是如何分布的。
Our tendency to see the world of psychiatric illness in dichotomous and opposing terms has three major sources: the philosophy of Descartes, the state of neuropathology in late nineteenth century Europe (when disorders were divided into those with and without demonstrable pathology and labeled, respectively, organic and functional), and the influential concept of computer functionalism wherein the computer is viewed as a model for the human mind–brain system (brain = hardware, mind = software). These mutually re-enforcing dichotomies, which have had a pernicious influence on our field, make a clear prediction about how ‘difference-makers’ (aka causal risk factors) for psychiatric disorders should be distributed in nature. In particular, are psychiatric disorders like our laptops, which when they dysfunction, can be cleanly divided into those with software versus hardware problems? I propose 11 categories of difference-makers for psychiatric illness from molecular genetics through culture and review their distribution in schizophrenia, major depression and alcohol dependence. In no case do these distributions resemble that predicted by the organic–functional/hardware–software dichotomy. Instead, the causes of psychiatric illness are dappled, distributed widely across multiple categories. We should abandon Cartesian and computer-functionalism-based dichotomies as scientifically inadequate and an impediment to our ability to integrate the diverse information about psychiatric illness our research has produced. Empirically based pluralism provides a rigorous but dappled view of the etiology of psychiatric illness. Critically, it is based not on how we wish the world to be but how the difference-makers for psychiatric illness are in fact distributed.
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