Diagnosis and causal explanation in psychiatry

Abstract

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves.

The complex neurobiology of resilient functioning after childhood maltreatment

“…Single traumatic experiences and repeated trauma can be quite distinct with regard to the neurobiological sequelae, healing and recovery [189]; the importance of understanding and differentiating repetitive trauma from other types of trauma is also reflected in the recent inclusion of 'Complex Post-Traumatic Stress Disorder' as a separate diagnostic entity in the ICD-11 [190,191]. Nevertheless, it is also important to appreciate the possibility that such disorders may not be possible to define aetiologically at a single level, but rather require considering the causal processes that interact across levels [192]. Threatening (sexual, physical abuse) versus depriving (neglect) experiences may impact on differential brain mechanisms [193].…”

Implications of an Autism Spectrum Disorder Diagnosis: An Interview Study of How Physicians Experience the Diagnosis in a Young Child

“…In general indeed, the process of classification is often considered fundamental (and thus positive) to any science. In medical practice, a particular diagnosis is viewed as leading to a particular cause and cure [ 47 , 48 ]. It is usually beneficial to treat the root cause of a disease—for example, removing an infectious agent.…”

“…Much of the success of modern medicine is based on the disease model [ 49 ], where a specific diagnosis identifies a specific cause. In psychiatry however, current evidence underscores that a diagnostic category can have very heterogeneous causes [ 48 ]. Nevertheless, psychiatric diagnoses are also considered useful in clinical practice, for example when choosing a cure or giving a perspective on prognosis [ 50 ].…”

Näkökulma laajenee, mielenterveysstigma vähenee

“…Tällä hetkellä käytössä olevat psykiatriset diagnoosit eivät kuitenkaan auta kunnolla ymmärtämään mistä havaitut tai koetut ongelmat johtuvat, sillä kyse on pitkälti oirekuvauksista (6). Havaitut oireet taas ovat oletettavasti seurausta yksilöllisistä ruumiillisis ta, psyykkisistä ja sosiaalisista prosesseista, joi den haitallisuus on määrittynyt tilanteen ja siitä tehtyjen tulkintojen mukaan (7). Psykiatristen diagnoosien voidaan katsoa näin kuvaavan enemmän seurausta kuin syytä, vaikka ihmiset toisinaan pyrkivätkin näiden avulla omaa ja muiden toimintaa selittämään.…”

“…Toistaiseksi ei ole olemassa luotettavia keino ja erotella normaaleja ja patologisia psyykkisiä tai sosiaalisia ilmiötä toisistaan (10), ja psykiat riset diagnoosit on eri yhteyksissä todettu tieteel lisesti epätyydyttäviksi (6,7,8,10). Pyrkimys vä hentää stigmaa rinnastamalla moniulotteiset psyykkiset ja sosiaaliset ilmiöt lääketieteellisten sairauksien kanssa saattaa entisestään heikentää psykiatristen diagnoosien erottelu ja ennusteky kyä, mikäli esimerkiksi elämäntilanteeseen näh den normaaleja reaktioita aletaan mieltämään lääketieteellistä hoitoa vaativien sairauksien oi reiksi (10,11).…”