Philosophy Psychiatry & Psychology最新文献

{"title":"Philosophers, Carers, and Psychodramatic Games","authors":"Corinne Gal, Alexandre Chapy, Marielle Fau, Muriel Guaveia","doi":"10.1353/ppp.2023.a908274","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908274","url":null,"abstract":"Philosophers, Carers, and Psychodramatic Games Corinne Gal (bio), Alexandre Chapy (bio), Marielle Fau (bio), and Muriel Guaveia (bio) Dear Jonathan D. Moreno, Thank you for the honor of taking the time to comment on the work we do. It is very meaningful for us to be able to talk with you. We, too, see a big difference between philosophers and carers (in the broadest sense) who deal with the suffering of patients and try to find methods to help them. But, if theory is at the service of the clinic, it becomes a formidable asset to refine our therapeutic methods and better understand what is happening to our patients. Indeed, patients suffering from psychosis, severe neurosis … are difficult to accompany and “recalcitrant to therapy by word alone” to use your terms. It is on this point that Ludwig Binswanger distanced himself from psychoanalysis. Binswanger ran a sanatorium in Switzerland (the Bellevue Clinic) and took in patients suffering from this type of psychological pathology. Aware that “the divan” and the analysis of the transference (unconscious) made little progress, he sought other ways of understanding his patients. The work of Edmund Husserl, the founder of the phenomenological movement, and then the work of Martin Heidegger1 fascinated him because they attempted to answer fundamental questions about being. The patients we work with ask themselves and us the same question: What is being? How can we feel existence within ourselves? Binswanger then created daseinsanalysis as an analysis of existence in which he was able to develop, among other dimensions, what he called “artists’ gestures,” including the possibility of (physical) contact with the patients. The body regained existential importance in the therapy. There are also strong similarities between psychiatric phenomenology and the work of Jacob Levy Moreno (2014, p. 214). We would like to quote your work: “ Nonetheless, there were links between them. Heidegger and J.L. shared preoccupation with personal authenticity and meaning [End Page 230] just enough to be considered part of the trends that led to postwar existentialism and fueled the new humanistic psychology, NTL, and encounter groups.” Jacob Levy Moreno’s working methods are much more powerful, allowing us to work as closely as possible with bodily feelings, since the body involved in the action is so present in psychodrama. Because, to this question of being posed by our patients, is linked the body as a felt, sensing body: the body that I am (which differs from the object body). Schizophrenic patients often express, and this is a terrible suffering, that they no longer feel anything, that they no longer feel they exist, that they no longer feel emotions or feelings. They do not know how to be in the world and with others. For us it is a fundamental symptom, as much as hallucinations. We link it to the loss of natural evidence (Blankenburg, 1991), the loss of contact with reality (Minkowski, 1929). Most of the time, in psyc","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding First: Exploring Its Scope and Testing Its Limits","authors":"Marga Reimer","doi":"10.1353/ppp.2023.a908268","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908268","url":null,"abstract":"Understanding First: Exploring Its Scope and Testing Its Limits Marga Reimer, PhD (bio) I thoroughly enjoyed reading and reflecting on this provocative, engagingly written, and persuasively argued paper. My commentary focuses on the authors’ “understanding first” principle. I begin by exploring that principle’s scope by appeal to aesthetic analogues to the moral cases of Pete and Jacob; I then explore its limits by appeal to cases involving agents struggling with maladaptive traits that are more self-destructive than antisocial. According to the authors, when attempting to eliminate or reduce a maladaptive trait, it is important that the agent begin with a non-moralizing understanding of that trait’s “root cause.” In this way, the agent avoids some of the epistemically distorting and otherwise counterproductive effects associated with an approach that begins with a moralizing assessment of the problematic trait. They can then proceed with a reason-based “dispensation” of that trait. The cases of Pete and Jacob make these points vivid and lend them considerable credence. Moreover, the authors’ “understanding first principle” arguably exemplifies a more general, and no less plausible, principle concerning the remediation of virtually any problem. Who would deny that an objective, non-normative, understanding of a problem’s “root cause” might be useful in addressing that problem? Who would deny that normativizing a problem before understanding its origin might prevent a deeper understanding of that problem and therewith its maximally effective “treatment”? One way to showcase the intuitiveness of the authors’ “understanding first” principle would be to explore the applicability of an analogous principle to problems beyond those involving “moral matters.” Problems involving aesthetics might prove particularly illuminating in this regard insofar as aesthetics, like morality, is inherently normative and yet it lies beyond the scope of morality proper. If an “understanding first” principle can be shown to be applicable to certain types of aesthetic problems, then the authors’ already strong case for the applicability of such a principle to certain types of moral problems would be further strengthened. In the cases of Pete and Jacob, the problems are unambiguously moral: the patently antisocial behaviors of these two individuals are paradigmatically “bad” and their premature assessment as [End Page 205] such can be epistemically distorting and otherwise counterproductive. Consider now analogous cases involving aesthetic problems. Pete and Lucie are getting ready for the holidays and are expecting family from out of town. But there are a couple of problems. Pete notices an “ugly” stain on the living room carpet and Lucie notices a subtle but decidedly “nasty” odor permeating the entire house. Neither Pete nor Lucie know where the stain came from, nor where the odor is coming from. But both the stain and the odor are “pretty gross” and so they need to “get","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Limits of Self-Constitution","authors":"James Phillips","doi":"10.1353/ppp.2023.a908269","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908269","url":null,"abstract":"The Limits of Self-Constitution James Phillips, MD (bio) I am in general agreement with the authors that a psychoanalytic or psychodynamic approach is a good response to simple pruning procedures. That said, however, I do have questions about how they develop their argument. I was surprised at the very notion of pruning, and quite surprised that it is as popular as the authors suggest. The idea that Pete should deal with his inappropriate outbursts by erasing or pruning that aspect of his personality seems so ridiculous that it beggars belief. It leaves one wondering whether Pete, or anyone agreeing with this argument, is credulous enough to think you can just prune away an undesirable part of yourself. The authors write: Importantly, this expulsion is often thought to be a good thing not simply because the undesirable elements are morally wanting but because in some important sense, they are not really a part of the agent proper. This point many seem extravagantly wishful, but is intuitively plausible. Really, “intuitively plausible” that personality traits are not part of the agent? I can understand that the agent may not grasp his or her involvement in the undesirable trait, but to argue that the trait is in reality not part of agent is a very odd claim on the part of the authors. When the authors write that “It would be difficult to exaggerate the prominence of the pruning view of agential self-constitution in philosophy,” they are strongly connecting the notions of pruning and self-constitution. I am aware that self-constitution is a major theme for philosophers like Korsgaard. The authors strongly embrace this principle in drawing out their arguments. In a footnote to their article the authors claim that various notions of a “true self” imply a pruned self. For Winnicott, an originator of the “true self,” this note of pruning does not hold. Winnicott contrasts the true self, a sense of self based on spontaneous authentic experience and a feeling of being alive, with a false self, a defensive veneer without the vivacity of the true self. The notion of pruning simply does not belong in this discussion. What the authors and their supporting philosophers leave out are two limitations to self-constitution. For the first, let me invoke another philosopher, Martin Heidegger, and his notion of “thrownness”—Geworfenheit. We are “thrown” into the world in the particular circumstances of our birth. We do not self-constitute our beginnings; we are plunged into them. The question then becomes what we make of these beginnings. [End Page 209] If they are undesirable, we can brood over them, or we can attempt to overcome them. And as we all know, if the beginnings are bad enough, we may not be able to overcome them. The second limitation to self-constitution resides in the “self.” Does the individual constitute him or her self, or is it more a matter of the self developing out of dialogic relationship of self and other? Here I invoke another philosopher, P","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Notes on Psychodramatic Treatment of a Person with Schizophrenia","authors":"Jonathan D. Moreno","doi":"10.1353/ppp.2023.a908272","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908272","url":null,"abstract":"Notes on Psychodramatic Treatment of a Person with Schizophrenia Jonathan D. Moreno, PhD (bio) I have enjoyed reflecting on Mr. Chapy’s account of work in psychodrama with a patient with schizophrenia. Although at one time many years ago I was interested in phenomenological psychiatry, and especially the writings of Ludwig Binswanger and Medard Boss, I am not an authority on dasein-analysis, so I have nothing to add to the discussion. I should say, however, that my father had little interest in this approach, which was far too abstract for his taste. He proceeded from the standpoint of the theater, of action and enactment. He believed that the drama itself provided the insight. For the purposes of this response, I take it as a given that the patient in question has been accurately diagnosed, although in the description of the scene with his father he does not exhibit the usual symptoms, such as auditory hallucinations. People with schizophrenia often find it difficult to manage the voices they are hearing without substantial preparation for a psychodrama. According to psychodramatic method, one way to prepare them is to externalize the voices, allowing a different therapist to take the role of each one as the protagonist instructs them how to play that role. Chair may be set up so that each “voice,” personified by an auxiliary ego, can sit in each chair in an array. This preparation may require a number of sessions. If the scene is to be enacted with a significant other, like the father in this instance, the patient may not be able to warm up to a direct encounter, especially with all the different voices competing for his internal attention. So he may be directed to observe each voice in the encounter with his father, preferably played by a therapist of his choosing and trained for the role, usually by giving the father-player certain lines so that they can learn something about the father and the way he addresses his son. Or consider the patient whose illness manifests itself as delusions, often of a megalomaniac character. They may be a messiah, for example, or the rightful heir of a royal line whose identity is being suppressed by governmental forces. The patient might be invited to choose key therapists to play the roles of key members of their circle, [End Page 225] enacting critical scenes like the sermon on the mount or speeches to their oppressed followers. In this way the patient’s “act hunger” may be to some degree satiated and have a calming effect on their anxiety and irritation with the frustrating world around them that refuses to accept their “authentic” identity and belief system. In these ways, psychodrama therapy can take advantage of one of the remarkable advantages of this method for such patients, who are generally recalcitrant to talk therapy alone and for whom medication is at best modestly effective. Still, these disorders are among the most challenging for psychotherapists. Although the process of treating them may open ","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"30 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Diagnosis as Recognition in Disorder Identified Individuals","authors":"Chloe Saunders","doi":"10.1353/ppp.2023.a908279","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908279","url":null,"abstract":"Abstract: Psychiatric diagnoses are increasingly seen as viable categories around which self and social identities might be drawn. This introduces a new pressure on the “boundary problem” for psychiatry: when members of the public request diagnoses to affirm their self-identities how should we draw the line between mental disorder and normality? If psychiatrists have the authority to recognize and diagnose mental disorder, how can roles as diagnosers and gate-keepers be balanced in a post-stigma era of mental health care? Focusing on the disorder identified would-be patient who would not attract the diagnosis they seek were they not to seek it, this essay explores what it means to have an identity bound to a psychiatric diagnosis and considers a framework for psychiatrists to negotiate clinical encounters that involve the seeking of identity affirming diagnoses.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Existential Psychodrama: A Way to Incorporate Otherness and Open Up to Existence: A Clinical Approach of Psychosis","authors":"Corinne Gal, Alexandre Chapy, Marielle Fau, Muriel Guaveia","doi":"10.1353/ppp.2023.a908271","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908271","url":null,"abstract":"Abstract: The authors argue that Morenian-inspired existential psychodrama turns out to be a formidable lever for opening up existence as it allows schizophrenic patients to incorporate the experience of an “absolutely other” on which the foundation of any autonomous self is built. More precisely, by relying on their clinical experiences, the authors show how psycho-dramatic play goes along with an intense movement of original projection which carries psychotic patients externally in relation to themselves. Offset from their pathological world, these patients feel more inclined to “wear someone else’s shoes,” for the duration of the game, and they do so in a manner that is both sensorial and pathic. This surprising and creative “journey,” which allows them to return to the world better attuned to others and to themselves, is merely an enactment of a “true” intersubjective encounter: the very essence of existential psychodrama. By applying phenomenology to this psychodramatic method, notably by relying on the hypothesis of psychosis being a disorder of what Bin Kimura calls the “ aida ,” the authors hope to contribute to the advancement of psychosis’ psychotherapy.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could Understanding Harm?","authors":"Iskra Fileva, Linda A.W. Brakel","doi":"10.1353/ppp.2023.a908270","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908270","url":null,"abstract":"Could Understanding Harm? Iskra Fileva, PhD (bio) and Linda A.W. Brakel, MD (bio) We would like to thank the editors for organizing this symposium and our commentators—Marga Reimer and James Phillips—for the thought-provoking feedback. Although we had thought about the ideas we discuss from many different angles, our commentators raised several interesting issues we had not considered. We are grateful for the opportunity to continue the conversation. Reply to Reimer As Professor Reimer notes, we advocate an approach to self-constitution that we dub “understanding first.” On this approach, non-moral and non-normative understanding of the origin of maladaptive traits must precede moral evaluation and attempts to free oneself—or as we say “prune”—undesirable traits. Professor Reimer presents several interesting cases meant both to extend and test the limits of our proposal. We appreciate this approach and respond to each case in turn. Genes and Alcoholism Suppose Alejandro, an adult raised by adoptive parents, struggles with alcohol addiction. He learns that his biological parents died of alcoholic liver disease and comes to believe that his alcohol problem is caused by a genetic propensity toward alcohol abuse. One can ask: “Does an understanding first approach have the potential to undermine the sense of agency that is necessary for the effective treatment of maladaptive traits?” Answer: It can be explained to Alejandro that genetic proclivities are just that—proclivities—that can be overridden. In fact, behavior can alter our very genes—although not at the sequence level— changes known as “epigenetic.” And the liver disease of the biological parents can serve as a cautionary tale. If even in light of these considerations, Alejandro’s tendency to see genetic propensities as deterministic persists, it is worth asking why. There is no evidence that “genes are destiny,” so the disposition to see them that way must have a psychological explanation. What is the explanation? A self-destructive desire? Fear of freedom? This exploration can itself be empowering. [End Page 211] Adaptive Forgetting Suppose Beata, who has an eating disorder, was molested by her own father when she was a child. Subsequently, her father shot himself and now she has no recollection of the molestation. However, Beata’s eating disorder is largely a result of those experiences. It is quite possible that if Beata were to recall being molested, that would do more harm than good. In this connection, one can ask together with Reimer: “Does an understanding first approach have the potential to undermine an adaptive ‘forgetting’ of root causes of maladaptive traits?” Answer: Here, understanding the history, instead of forgetting it, might allow Beata to gain insight into and empathize with possible motives that may have led to becoming obese. For example, she might have the phantasy that if she had been obese and unattractive, she could have prevented the molestation—hence, become that ","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Criteria, Psychological Tests, and Ratings Scales: Extending the History","authors":"Peter Zachar","doi":"10.1353/ppp.2023.a908276","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908276","url":null,"abstract":"Diagnostic Criteria, Psychological Tests, and Ratings Scales: Extending the History Peter Zachar, PhD (bio) Le moigne narrates a history of the development of psychiatric ratings scales as hybrids between psychological tests and diagnostic categories. In his telling, psychological tests seek to quantify population-based traits on which every person has a position and which tend to be conceptualized as being stable. Personality traits are often conceptualized as dispositions. Diagnostic categories represent not trait-like properties of populations but episodic states consisting of clusters of symptoms experienced by individuals with disorders. Ratings, scales, he notes, are hybrids between the two. They are used to quantify psychiatric symptom clusters so that change over time can be measured. Le Moigne argues that these distinctions were initially suggested during the development of measures that could assess outcomes in psychopharmacological treatment studies. With respect to depression, Le Moigne writes that in the 1970s and 1980s something akin to depressive personality was reconceptualized as a temperament. A key move, somewhat reflective of Kraepelin’s notion of a depressive temperament, was to view a dysthymic temperament as both a predisposing factor and an attenuated form of depression. Thus, an episodic state commandeered the predisposing–dispositional role that was assigned to stable personality traits. This conceptual shift allowed test-like ratings scales to be seen as useful for quantifying not just stable traits, but salient features of episodic states that are potentially subject to change in response to interventions. To put it another way, in the development of a psychological test, one goal is to have high test-retest reliability (i.e., stability of measurement). With rating scales used to measure change, one wants the scores to not be as stable; ideally the scores on the later assessments will be lower. According to Le Moigne, when dysthymia was subsequently placed on axis I of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (as a syndrome) and segregated from personality disorders which were placed on axis II, personality traits were evicted from the conceptualization of depressive disorders. One perennial feature of psychiatry and psychology is that even if an older idea is superseded [End Page 253] in the view of some thinkers, it can still attract adherents. Indeed, interest in understanding a relationship between personality and attenuated states did not fully disappear. For example, based on research in genetics, the schizophrenia spectrum concept included not only schizophrenia, but also milder conditions such that were conceptualized as personality disorders; that is, schizotypal personality disorder and paranoid personality disorder (Kety, Rosenthal, Wender, & Schulsinger, 1971). During the development of the DSM-IV, some people wanted to add depressive personality disorder to the manual (Phillips, ","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding First: A Psychoanalytic Take on Self-Constitution","authors":"Iskra Fileva, Linda A.W. Brakel","doi":"10.1353/ppp.2023.a908267","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908267","url":null,"abstract":"Abstract: In this paper, we criticize what we dub the “pruning view” of self-constitution, championed widely by philosophers, mainly though not exclusively in the Kantian tradition, and instead defend an alternative view inspired by psychoanalysis. We argue that normative assessment comes much too early on the pruning view, so early that it interferes with achieving deeper self-understanding that can produce lasting change. On the proposal we advocate, self-constitution must begin with a non-moralizing attempt to truly understand why one has undesirable and unwanted propensities. We call this the “understanding first” principle. Only after deeper self-understanding has been achieved are attempts to liberate oneself from unwanted elements likely to succeed.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“What Is Actually Being Measured?”: Causality and Underlying Scientific Thinking Process in the Assessment of Depression","authors":"Greta Kaluzeviciute-Moreton","doi":"10.1353/ppp.2023.a908277","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908277","url":null,"abstract":"“What Is Actually Being Measured?”: Causality and Underlying Scientific Thinking Process in the Assessment of Depression Greta Kaluzeviciute-Moreton, PhD (bio) Depression is a complex mental health phenomenon due to its multifaceted nature. For one, depression is thought to have a significant genetic component, with studies suggesting that heritability is a significant factor in the development of the disorder (Sullivan, Neale, Kendler, 2000). In clinical psychology, environmental factors such as childhood trauma, chronic stress, social isolation and negative life events (e.g., the loss of a loved one) have been documented as significant risk factors for the development of depression or as trigger events for depressive episodes (Fu & Parahoo, 2009; Kendler, Kuhn, & Prescott, 2004; Neitzke, 2016). Despite this, causal theories of mental health conditions are often tricky and/or scarcely reflected in both diagnostic and rating scales. For instance, the Diagnostic and Statistical Manual of Mental Disorders classifies mental health disorders primarily based on observable symptoms and behaviors, rather than on the underlying psychological and neurobiological processes that may contribute to these symptoms (Kendler, 2006). Similarly, rating scales for depression are typically designed to assess the severity of symptoms, rather than their underlying causes, that is, most rating scales are used as screening tools to identify individuals who may require further evaluation and treatment. Some rating scales may include items related to causal factors, such as the Beck Depression Inventory-II (BDI-II) includes an item that asks about “loss of interest in sex,” which could be related to either biological or psychological factors. Several rating scales include items assessing risk factors for depression, such as family history of depression or personal history of trauma. This may be indicative of both genetic and environmental risk factors, such as the Patient Health [End Page 255] Questionnaire-9, includes an item that asks about family history of depression. However, while risk and causal factors are related, they are distinct in the assessment of depression. Risk factors refer to factors that increase the likelihood of developing depression, while causal factors refer to factors that directly contribute to the development of the condition. The presence of a risk factor does not necessarily mean that an individual will develop depression (Peterson & Seligman, 1984). However, the two are frequently blurred and equated in psychotherapy research (Westen & Bradley, 2005). As such, the historical issues of rating and diagnostic scales, aptly depicted by the Le Moigne (2023) as full of “composite, if not contradictory, heritage, weaving together the classificatory and discontinuous tradition of psychiatry, on the one hand, and the psychometric and continuous tradition of psychology, on the other” (p. XX<EQ>), suffer from an epistemological oversight when it comes ","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"2013 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}