Rudnick Abraham
Department of Behavioral Sciences, Tel Aviv University School of Medicine, Tel Aviv 69978, Israel.
J Med Philos. 2002 Jun;27(3):287-96. doi: 10.1076/jmep.27.3.287.2979.
Biological psychiatry has been dominated by a psychopharmacologically-driven neurotransmitter dysfunction paradigm. The objective of this paper is to explore a reductionist assumption underlying this paradigm, and to suggest an improvement on it. The methods used are conceptual analysis with a comparative approach, particularly using illustrations from the history of both biological psychiatry and molecular biology. The results are that complete reduction to physicochemical explanations is not fruitful, at least in the initial stages of research in the medical and life sciences, and that an appropriate (non-reducible) integrative principle--addressing a property of the whole system under study--is required for each domain of research. This is illustrated in Pauling's use of a topological integrative principle for the discovery of the functioning of proteins and in Watson and Crick's use of the notion of a genetic code as an integrative principle for the discovery of the structure of genes. The neurotransmitter dysfunction paradigm addresses single molecules and their neural pathways, yet their interactions within the CNS as a whole seem most pertinent to mental disorders such as schizophrenia. The lack within biological psychiatry of an integrative principle addressing a property of the CNS as a whole may be responsible for the empirical failure of orthomolecular psychiatry, as well as for the central role that serendipity has played in the study of mental disorders, which is dominated by the neurotransmitter paradigm. The conclusion is that research in biological psychiatry may benefit from using, at least initially, some integrative principle(s) addressing a property of the CNS as a whole, such as connectionism or a hierarchical notion.
生物精神病学一直由精神药理学驱动的神经递质功能障碍范式主导。本文的目的是探讨这一范式背后的还原论假设，并提出改进建议。所采用的方法是运用比较法进行概念分析，特别是借鉴生物精神病学和分子生物学的历史例证。结果表明，完全还原为物理化学解释并无成效，至少在医学和生命科学研究的初始阶段是如此，而且每个研究领域都需要一个适当的（不可还原的）整合原则——涉及所研究的整个系统的一种特性。这在鲍林运用拓扑整合原则发现蛋白质功能以及沃森和克里克运用遗传密码概念作为整合原则发现基因结构中得到了体现。神经递质功能障碍范式关注单个分子及其神经通路，然而它们在整个中枢神经系统内的相互作用似乎与精神分裂症等精神障碍最为相关。生物精神病学缺乏一个涉及整个中枢神经系统特性的整合原则，这可能是正分子精神病学在实证上失败的原因，也是意外发现（偶然性）在以神经递质范式为主导的精神障碍研究中发挥核心作用的原因。结论是，生物精神病学的研究至少在初始阶段可能会受益于运用一些涉及整个中枢神经系统特性的整合原则，比如联结主义或层级概念。
