Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA.
Psychol Med. 2011 Jun;41(6):1143-50. doi: 10.1017/S0033291710001844. Epub 2010 Sep 22.
This essay explores four answers to the question 'What kinds of things are psychiatric disorders?' Essentialist kinds are classes whose members share an essence from which their defining features arise. Although elegant and appropriate for some physical (e.g. atomic elements) and medical (e.g. Mendelian disorders) phenomena, this model is inappropriate for psychiatric disorders, which are multi-factorial and 'fuzzy'. Socially constructed kinds are classes whose members are defined by the cultural context in which they arise. This model excludes the importance of shared physiological mechanisms by which the same disorder could be identified across different cultures. Advocates of practical kinds put off metaphysical questions about 'reality' and focus on defining classes that are useful. Practical kinds models for psychiatric disorders, implicit in the DSM nosologies, do not require that diagnoses be grounded in shared causal processes. If psychiatry seeks to tie disorders to etiology and underlying mechanisms, a model first proposed for biological species, mechanistic property cluster (MPC) kinds, can provide a useful framework. MPC kinds are defined not in terms of essences but in terms of complex, mutually reinforcing networks of causal mechanisms. We argue that psychiatric disorders are objectively grounded features of the causal structure of the mind/brain. MPC kinds are fuzzy sets defined by mechanisms at multiple levels that act and interact to produce the key features of the kind. Like species, psychiatric disorders are populations with central paradigmatic and more marginal members. The MPC view is the best current answer to 'What kinds of things are psychiatric disorders?'
本文探讨了“精神障碍是哪类事物？”这一问题的四个答案。本质主义种类是指其成员共享某种本质的类别，而其定义特征则源自该本质。尽管这种模式对于某些物理（例如原子元素）和医学（例如孟德尔障碍）现象来说是优雅且合适的，但对于精神障碍来说却不适用，因为精神障碍是多因素的且“模糊的”。社会建构的种类是指其成员由其产生的文化背景定义的类别。这种模式排除了相同障碍在不同文化中可以通过相同的生理机制来识别的重要性。实用主义种类的倡导者回避了关于“现实”的形而上学问题，而专注于定义有用的类别。实用主义种类模型对于精神障碍，隐含在 DSM 分类学中，并不要求诊断基于共同的因果过程。如果精神病学试图将障碍与病因和潜在机制联系起来，那么一种首先为生物物种提出的机制属性聚类（MPC）种类模型可以提供一个有用的框架。MPC 种类不是根据本质而是根据因果机制的复杂、相互增强的网络来定义的。我们认为，精神障碍是心智/大脑因果结构中客观存在的特征。MPC 种类是通过在多个层次上起作用并相互作用以产生该种类的关键特征的机制来定义的模糊集。与物种一样，精神障碍是具有中心范例和更多边缘成员的群体。MPC 观点是目前对“精神障碍是哪类事物？”这一问题的最佳答案。
