Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Mol Psychiatry. 2011 Jun;16(6):626-33. doi: 10.1038/mp.2011.22. Epub 2011 Mar 8.
We make sense of human behavior using reasons, which produce understanding via a subjective empathy-based first-person perspective and causes, which leads to explanations utilizing objective facts about the world assessed scientifically. We evaluate the common sense hypothesis that for episodes of major depression (MD), reasons act as causes. That is, individuals who have highly understandable depressive episodes will have, on average, fewer objective scientifically validated causes than those who have un-understandable episodes. The understandability of a MD as defined by the Diagnostic and Statistical Manual, 4th Edition (DSM IV) experienced in the past year in 630 personally interviewed twins from a population-based registry was rated, with high reliability, from rich contextual information. We predicted, from these understandability ratings, via linear and logistic regression, 12 validated risk factors for MD reflecting genetic and long-term environmental liability. No significant association was observed between 11 of these indices and the understandability of the depressive episode. The only significant finding-higher cotwin risk for MD associated with greater understandability-was opposite that predicted by the reasons-as-causes hypothesis. Our results do not support the hypothesis that reasons for MD act as causes. These findings, unlikely to result from low power, may be explicable from an empirical and/or philosophical perspective. Our results are, however, consistent with 'the trap of meaning' hypothesis, which suggests that understanding does not equal explanation and that while reasons may be critical to help us empathize with our patients, they are unreliable indices of objective risk factors for illness.
我们通过推理来理解人类行为，这种推理通过主观的同理心第一人称视角产生理解，通过科学评估的世界客观事实产生原因。我们评估了一个常识假设，即对于重度抑郁症（MD）发作，原因是结果。也就是说，那些具有高度可理解的抑郁发作的人，平均来说，其客观的科学验证的原因比那些不可理解的发作的人要少。通过对来自基于人群的登记处的 630 名接受个人访谈的双胞胎在过去一年中经历的第四版《精神障碍诊断与统计手册》（DSM-IV）定义的 MD 的可理解性进行评级，从丰富的上下文信息中获得了高度可靠的结果。我们通过线性和逻辑回归预测了这些可理解性评级，这些预测反映了 MD 的遗传和长期环境易感性的 12 个验证风险因素。这些指数中的 11 个与抑郁发作的可理解性之间没有观察到显著关联。唯一的显著发现是，与理解程度相关的 MD 同卵双胞胎风险更高，这与原因是结果的假设相反。我们的结果不支持 MD 的原因是结果的假设。这些结果不太可能是由于效力不足造成的，从经验和/或哲学的角度来看可能是可以解释的。然而，我们的结果与“意义陷阱”假设一致，该假设表明理解不等同于解释，尽管原因可能对我们同情患者至关重要，但它们是疾病客观风险因素的不可靠指标。
