Toward a philosophical structure for psychiatry

Am J Psychiatry. 2005 Mar;162(3):433-40. doi: 10.1176/appi.ajp.162.3.433.


This article, which seeks to sketch a coherent conceptual and philosophical framework for psychiatry, confronts two major questions: how do mind and brain interrelate, and how can we integrate the multiple explanatory perspectives of psychiatric illness? Eight propositions are proposed and defended: 1) psychiatry is irrevocably grounded in mental, first-person experiences; 2) Cartesian substance dualism is false; 3) epiphenomenalism is false; 4) both brain-->mind and mind-->brain causality are real; 5) psychiatric disorders are etiologically complex, and no more "spirochete-like" discoveries will be made that explain their origins in simple terms; 6) explanatory pluralism is preferable to monistic explanatory approaches, especially biological reductionism; 7) psychiatry must move beyond a prescientific "battle of paradigms" to embrace complexity and support empirically rigorous and pluralistic explanatory models; 8) psychiatry should strive for "patchy reductionism" with the goal of "piecemeal integration" in trying to explain complex etiological pathways to illness bit by bit.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biological Psychiatry / organization & administration
  • Biological Psychiatry / standards
  • Causality
  • Forecasting
  • Humans
  • Mental Disorders / etiology
  • Mental Disorders / psychology*
  • Mind-Body Relations, Metaphysical
  • Models, Psychological
  • Philosophy, Medical*
  • Psychiatry / organization & administration*
  • Psychiatry / standards
  • Psychiatry / trends