Abstract

In lieu of an abstract, here is a brief excerpt of the content:Aristotle Rules, OK?José M. Villagrán (bio) and Rogelio Luque (bio)KeywordsAristotle, causes, philosophy, psychiatry, psychopathologyPérez-Alvarez, Sass, and García-Montes (2008) propose a theoretical approach to the nature of mental disorders (MD) that attempts to explain the type of reality they constitute. In line with this approach, they argue that (1) MDs should be considered not from within psychology and psychiatry, but rather from the realm of philosophy, so as to avoid what they call the Charcot effect; (2) the resulting theoretical model is in contrast to naturalist models such as that of internal dysfunction, and involves “strong” constructivist assumptions from which they develop an anthropological perspective based on the clinician–patient situation; 3) this model is applicable, in principle, to all MDs (“at least to some extent”); and (4) it is based on the Aristotelian theory of the four causes.We would argue, however, that (1) it is precisely from within psychology and psychiatry that conceptual models accounting for MDs should be proposed; (2) the naturalist–constructivist dichotomy in these models should be deconstructed, and primacy given not to the ontological approach but to the epistemological one; (3) a theoretical model of this scope should account not only for MDs but also for physical disorders; and (4) only in this way would the Aristotelian theory of causes, understood as types of explanation (and therefore as epistemological approaches) be useful.Approaches from within and from WithoutFor Berrios (2006), the theoretical discourse in relation to the conceptualization of MDs in a particular sociocultural context can be formulated in two ways: on the one hand, in a centripetal fashion, using established philosophical systems (be it phenomenology [Jaspers 1977], logical empiricism [Hempel 1994], or analytic philosophy [Fulford, Thornton, and Graham 2006]). This centripetal approach can be used both by professional philosophers and by psychiatrists/psychologists. When developed by professional philosophers, such proposals, despite their possible brilliance, run the risk of being tangential to the psychiatric issues owing to a lack of first-hand experience of them (Murphy 2006). When developed by psychiatrists and psychologists, the majority of the proposals simply mix fragments of different philosophical systems, in either a kind of syncretism or collage that fails to take into account the contradictions between fragments, or a kind of pluralism that reflects, without entering into analysis, a sort of consensus among the different paradigms (Ghaemi 2003; Kendler 2005).A second way of formulating this theoretical discourse (according to Berrios) would employ a centrifugal approach from the very core of the disciplines, through the reflection of professionals (primarily, although not only, psychiatrists/psychologists with philosophical training) who would conceptualize the problems from within and develop a specific metalanguage for analyzing [End Page 265] them (Lanteri-Laura 1991; Reznek 1991; Sass 1992). Not all problems are of the same type. For those that are extrinsic to psychiatry/psychology (definition of the mental, the mind–body relationship, the distinction between causes and reasons, or interdisciplinary reduction), the methods common to the philosophy of science and of the mind can be used. However, issues intrinsic to the disciplines themselves (the nature of mental symptoms and how they are generated, how to explain their heterogeneity, what a MD is, how to diagnose and classify it, or how to implement a psychopathological project) cannot be dealt with using preestablished formulas, and require new and original proposals that take into account the nature of the disciplines and their object of study (Villagrán 2007).The authors of the target article base their preference for the centripetal approach for responding to one of the intrinsic questions of psychiatry (what MDs are) on the consequences of what they call the Charcot effect, a kind of variant of observer bias applied to psychiatric diagnosis. They offer as an example the classic diagnosis ad iuvantibus in its postmodern version, namely, the efficacy of the pharmaceutical industry in contributing to creating nosological entities for which their drugs are indicated. Consequently, clinicians are not only unable to surmount the substantial epistemological obstacles that hamper attempts to theorize, but also find themselves doomed to assuming an ingenuous essentialism that considers MDs as natural kinds (such as apples, trees, or dogs) determined...