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The dappled nature of causes of psychiatric illness: replacing the organic–functional/hardware–software dichotomy with empirically based pluralism

Molecular Psychiatry volume 17, pages 377–388 (2012)Cite this article

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Abstract

Our tendency to see the world of psychiatric illness in dichotomous and opposing terms has three major sources: the philosophy of Descartes, the state of neuropathology in late nineteenth century Europe (when disorders were divided into those with and without demonstrable pathology and labeled, respectively, organic and functional), and the influential concept of computer functionalism wherein the computer is viewed as a model for the human mind–brain system (brain=hardware, mind=software). These mutually re-enforcing dichotomies, which have had a pernicious influence on our field, make a clear prediction about how ‘difference-makers’ (aka causal risk factors) for psychiatric disorders should be distributed in nature. In particular, are psychiatric disorders like our laptops, which when they dysfunction, can be cleanly divided into those with software versus hardware problems? I propose 11 categories of difference-makers for psychiatric illness from molecular genetics through culture and review their distribution in schizophrenia, major depression and alcohol dependence. In no case do these distributions resemble that predicted by the organic–functional/hardware–software dichotomy. Instead, the causes of psychiatric illness are dappled, distributed widely across multiple categories. We should abandon Cartesian and computer-functionalism-based dichotomies as scientifically inadequate and an impediment to our ability to integrate the diverse information about psychiatric illness our research has produced. Empirically based pluralism provides a rigorous but dappled view of the etiology of psychiatric illness. Critically, it is based not on how we wish the world to be but how the difference-makers for psychiatric illness are in fact distributed.

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Acknowledgements

Supported in part by NIH Grants R01MH41953, RO1MH068643, R37AA011408 and P20AA017828. Discussions with John Campbell, PhD contributed substantially to the ideas expressed in this essay. Peter Zachar, PhD provided very helpful comments on earlier versions of this essay.

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  1. Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA

    K S Kendler

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Correspondence to K S Kendler.

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Kendler, K. The dappled nature of causes of psychiatric illness: replacing the organic–functional/hardware–software dichotomy with empirically based pluralism. Mol Psychiatry 17, 377–388 (2012). https://doi.org/10.1038/mp.2011.182

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Keywords

  • alcohol dependence
  • dualism
  • etiology
  • major depression
  • psychiatric illness
  • schizophrenia

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