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Despite widespread recognition that psychiatry would be better served by a classificatory system based on etiology rather than mere description, it goes without saying that much of the necessary work is yet to be done. Most of it will be empirical, but there are also theoretical issues that need to be addressed. In this chapter I take up the increasingly important question of how one particular brand of causal explanation, that of mechanistic explanation , fits into larger efforts to build a scientifically sound etiological and nosological framework. The focus here will be on the broad theoretical outlines of several key issues. I will not rehearse the details of the various critical exchanges stirred by publication of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association 2013), initiation of the Research Domain Criteria (RDoC; Insel et al. 2010; Insel 2013), and ongoing work on the International Classification of Diseases, eleventh revision (World Health Organization 2012; First et al. 2015). I primarily focus on mechanistic explanation, and address several challenges it faces in the context of psychiatric research, but many of these issues also have implications for classification. Mechanistic explanation is committed to the identification of the components that make up the workings of the mind, characterized at complementary levels of explanation. This is standard fare in the allied cognitive sciences, and there has been a noticeable shift toward including psychiatry in this alliance, with the implication that it should also be in the business of elucidating mechanisms (Murphy 2006; Kendler 2008). This has included calls for the identification of dysfunctional mechanisms in the service of research frameworks that may eventually provide the basis for classification, such as the RDoC (Insel et al. 2010; Cuthbert and Insel 2013; Cuthbert 2014a; Insel 2014). Perhaps unsurprisingly, though, there are a number of issues that arise when mechanistic assumptions are brought to bear on psychiatric conditions. 8 The Shift to Mechanistic Explanation and Classification Kelso Cratsley 164 Kelso Cratsley In what follows, I pay particular attention to the challenge of explaining conditions that do not appear to have stable surface features or involve discrete underlying dysfunction.1 Standard cognitive mechanisms are commonly thought to be relatively enduring structures with regular operations, the result of genetic and developmental effects. But if psychopathology is conceptualized as the product of the breakdown of specific, otherwise stable mechanisms, then a number of psychiatric symptoms appear to belie this notion, given their causal heterogeneity, substantial variability, and diversity of presentation. For example, the symptoms associated with psychotic disorders have been hypothesized to be the result of a staggering array of causal factors and tend to vary in timing and severity. Needless to say, this complicates efforts to identify impaired underlying structures. But as I will explain, there are ways in which a mechanistic framework can accommodate these features—at least for the most part. Briefly put, a relatively broad construal of mechanism allows for something less than the flawless execution of internal operations, appeals to the influence of contextual factors, and attends to organizational relations both within the mechanism and across the wider cognitive system. Such points of emphasis can help clarify how the mechanistic approach can be constructively applied to the study of psychopathology. Here is how I proceed. I begin by setting out some of the basics of mechanistic explanation, highlighting several key features of this approach, including the explanatory significance of causal regularity, levels of explanation, and network analysis. Following this, the remaining discussion is structured as a series of potential challenges to the application of mechanism to psychiatric research, most of which I suggest are relatively manageable. The first has to do with the fact that multifactorial models of psychopathology increasingly appeal to social and environmental influences , which raises issues for reductive explanation given that causal factors “cross levels.” I next consider a set of closely related difficulties encountered when attempting to identify and decompose the dysfunctional mechanisms at work in psychiatric conditions, including the transient nature of many symptoms, the complex organization of underlying systems, and the fact that many disorders are the product of a nonstandard developmental course. I conclude by considering several remaining issues that need to be addressed going forward. Mechanistic Explanation and Psychiatry Part of the appeal of mechanistic explanation is that it helps move theorizing away from an interest in discovering general laws toward a focus on [3.128.206.76] Project MUSE (2024-05-28 22:54 GMT) The Shift to Mechanistic Explanation...

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