Brendel David H
Department of Psychiatry, Harvard Medical School, Belmont, MA 02478, USA.
J Med Philos. 2003 Oct-Dec;28(5-6):563-80. doi: 10.1076/jmep.28.5.563.18814.
Explanatory models in psychiatry reflect what clinicians deem valuable in rendering people's behavior intelligible and thus help guide treatment choices for mental illnesses. This article outlines some key scientific and ethical principles of clinical explanation in twenty-first century psychiatry. Recent work in philosophy of science, clinical psychiatry, and psychiatric ethics are critically reviewed in order to elucidate conceptual underpinnings of contemporary explanatory models. Many explanatory models in psychiatry are reductionistic or eclectic. The former restrict options for diagnostic and therapeutic paradigm choice, while the latter lack a well-defined theoretical basis. These two methodological approaches stand in a dialectical relation to one another insofar as clinicians often move from one approach to its antithesis, ultimately seeking a synthesis of the two approaches that satisfies clinical needs. Pragmatic considerations can help to transcend the reductionism/eclecticism dialectic. In the absence of a completed science of mental disorders, psychiatrists must tolerate ambiguity and uncertainty as they strive to integrate diverse explanatory concepts in a rigorous and evidence-based fashion. A pragmatic explanatory model in clinical psychiatry must focus on favorable treatment outcomes for patients by respecting the pluralistic, participatory, and provisional nature of psychiatric explanation.
精神病学中的解释模型反映了临床医生认为在理解人们行为方面有价值的东西，从而有助于指导精神疾病的治疗选择。本文概述了21世纪精神病学临床解释的一些关键科学和伦理原则。对科学哲学、临床精神病学和精神病学伦理学方面的近期工作进行了批判性回顾，以阐明当代解释模型的概念基础。精神病学中的许多解释模型都是还原论的或折衷主义的。前者限制了诊断和治疗范式选择的选项，而后者缺乏明确界定的理论基础。这两种方法论方法彼此处于辩证关系之中，因为临床医生常常从一种方法转向其对立面，最终寻求一种满足临床需求的两种方法的综合。实用主义的考虑有助于超越还原论/折衷主义的辩证法。在精神障碍科学尚未完善的情况下，精神科医生在努力以严谨且基于证据的方式整合各种解释概念时，必须容忍模糊性和不确定性。临床精神病学中的实用主义解释模型必须通过尊重精神病学解释的多元性、参与性和临时性本质，关注患者的良好治疗结果。
