Kendler Kenneth S
Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA.
Am J Psychiatry. 2005 Mar;162(3):433-40. doi: 10.1176/appi.ajp.162.3.433.
This article, which seeks to sketch a coherent conceptual and philosophical framework for psychiatry, confronts two major questions: how do mind and brain interrelate, and how can we integrate the multiple explanatory perspectives of psychiatric illness? Eight propositions are proposed and defended: 1) psychiatry is irrevocably grounded in mental, first-person experiences; 2) Cartesian substance dualism is false; 3) epiphenomenalism is false; 4) both brain-->mind and mind-->brain causality are real; 5) psychiatric disorders are etiologically complex, and no more "spirochete-like" discoveries will be made that explain their origins in simple terms; 6) explanatory pluralism is preferable to monistic explanatory approaches, especially biological reductionism; 7) psychiatry must move beyond a prescientific "battle of paradigms" to embrace complexity and support empirically rigorous and pluralistic explanatory models; 8) psychiatry should strive for "patchy reductionism" with the goal of "piecemeal integration" in trying to explain complex etiological pathways to illness bit by bit.
本文旨在勾勒一个连贯的精神病学概念和哲学框架,面临两个主要问题:心智与大脑如何相互关联,以及我们如何整合对精神疾病的多种解释视角?文章提出并论证了八个命题:1)精神病学不可避免地基于精神层面的第一人称体验;2)笛卡尔实体二元论是错误的;3)副现象论是错误的;4)大脑对心智以及心智对大脑的因果关系都是真实存在的;5)精神障碍在病因学上很复杂,不会再有像发现螺旋体那样能用简单方式解释其起源的发现;6)解释多元论优于一元论的解释方法,尤其是生物还原论;7)精神病学必须超越前科学的“范式之争”,接受复杂性,并支持经验严谨且多元的解释模型;8)精神病学应努力实现“局部还原论”,目标是“逐步整合”,试图一点一点地解释复杂的疾病病因路径。