ABSTRACT
How does the clinical concept of psychopathology outlined in the previous chapter relate to existing models of mental disorder?
The chapter begins by discussing the clinically oriented stress-diathesis model. This model is categorical in the description and identification of disorder and bears resemblance with dimensional and systems models in diagnostic formulation. Conceptual issues with respect to this approach are the chasm between clinical and scientific operationalizations of dispositions and the circularity and explanatory vacuity of dispositional terms.
Next, scientific models of mental disorder are discussed. Most of these models are based on one or another variant of the natural kind approach (which sees psychiatric disorder as an “essence”) or on the idea that psychiatric disorder is determined by an “underlying” dysfunction. Hopes have disappeared that it will be possible to reduce clinical syndromes to either essences (natural kinds) or dysfunctions on a 1:1 basis. The question is addressed whether this conclusion must also extend to RDoC and “precision medicine,” efforts in which large amounts of data (genetic, brain imaging, epidemiological) are combined to deliver more fine-grained and sophisticated patterns of predictability about symptom clusters.
Finally, recent developments point in various directions: to a plurality of kinds, to mechanistic property clusters representing “patchy” causal patterns, and to networks of causally related symptoms and context-related factors without reference to underlying dysfunctions or factors. It is uncertain which of these promising approaches will do justice to a really self-relational and context-sensitive approach to psychopathology.
