Reductionism, Eclecticism, and Pragmatism in Psychiatry: The Dialectic of Clinical Explanation

Abstract

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.

Psychophysical Causation and a Pragmatist Approach to Human Behavior

“…This kind of pluralism is consistent with the highly pragmatic challenges of their clinical endeavors. Psychiatric pragmatism, as I have defined it in my published work (Brendel 2003(Brendel , 2006, is rooted in the ideas of classical American pragmatists (including William James, John Dewey, and Charles Sanders Peirce) and contemporary pragmatic bioethicists (McGee 2003). At its core, I have argued, are the "four Ps" of pragmatism:…”

A Psychological Model of Mental Disorder

“…It has been powerfully argued 84,87,88 that pragmatism should be the benchmark for evaluating theoretical models of mental disorder. In this context, the psychological model has obvious utility in guiding thought.…”

Different Conceptions of Mental Illness: Consequences for the Association with Patients†

“…However, it has been criticized for being arbitrary and vague with regard to causal explanations of mental and behavioral disorders, and no rule exists for weighing the relevance of the various conceptions (Ghaemi, 2009). Therefore, the arbitrariness of the model should be reduced by focusing on scientifically proven concepts, to be tested for empirical evidence in the individual case, and taken as provisional in a longitudinal perspective (Brendel, 2003). Nevertheless, it may be helpful in two directions: at first, it should be used as a didactic tool to direct the psychiatrist toward a systematic exploration of the patient’s intern and extern context because the knowledge gained by this procedure may be helpful to guide the patient in overcoming his being ill; such preliminary trials to assess the complex texture of the disease at the clinical macro-level can deepened today at the micro-level: at second, the model encourages the psychiatrist to open his mind for real interdisciplinary considerations of the causal interchange between social, psychic, and neurobiological determinants of mental disorders which is hoped to be developed in the future as some stimulating findings indicate.…”