Following previous entries in which summarize different texts about the vision of psychosis as syndrome or structure, we turn now to the vision of psychosis as a disease. Luque and Villagrán continue in his already cited work descriptive psychopathology: New trends .
One of the many approaches to the concept of disease is one that conceptualizes as a injury. The development of pathology and histology during the nineteenth century provided a range of evidence that the disease is accompanied by structural alterations. As increased knowledge of physiology and biochemistry, the concept of lesion was extended to include biochemical and physiological alterations without changes in the basic statement: the disease necessarily involves a demonstrable physical abnormality. In this context, it was almost inevitable that they consider essential attribute of the disease the presence of an identifiable lesion. This definition has been maintained for years and is the fundamental basis of known biological or medical model of disease which, without doubt, has a number of advantages: it provides a definition of disease that is not subject to social or fashion therapeutic as well as an explanation, though not always complete, the patient's symptoms. However, it also involves a number of drawbacks: the process of their physical condition is unknown can not, strictly speaking, be considered diseases do not distinguish between minor and serious illnesses or disabling, in some cases it difficult to establish where normality ends and pathology begins where, as there is a vast structural variability that can be tolerated by the human body without detection of any biological or clinical change, and it is becoming increasingly clear that the old concept of a single cause, necessary and sufficient for each disease, is not applicable and instead there are a number of factors acting together and determine the onset of the disease.
The vision of psychosis as a biological disease (and only biological) is the most common nowadays in professional or lay, whether explicitly or implicitly. This vision undoubtedly part of the concept of disease as injury that we have discussed and is part of the medical paradigm, dominant in psychopathology and psychiatry in a way that some feel stifling and impoverishing, possibly due to different causes, some of which , as Kuhn would say, are much more social than scientific, in relation to professional interests or commercial , perhaps not fully aware and certainly not at all confessable. Let us now come in a few words about this medical paradigm that dominates, and psychotic professionals alike (or perhaps more willingly than we them.)
As Luque and Villagrán remind us, the medical paradigm (organic, biological, mechanical or biophysical) model is based on the anatomo-clinical disease that appears in the nineteenth century and extending until today. To this paradigm, psychopathology is considered a form of medical description of two fundamental principles: mental disorders are diseases and the conceptualization and study of mental illness must be fundamentally biological. The medical paradigm health equates total absence of symptoms and abnormal behavior considered a result of physical and chemical changes that usually occur in the brain. The disease is defined as the qualitative deviation of the statistical norm and the damage it causes to the individual. In psychiatry, this paradigm was championed by Kraepelin to be used as general paresis medical paradigm. In this defense influenced a number of facts: influence of anatomical-clinical method, the discovery of Treponema pallidum as the cause of syphilis and, consequently, the application of the infection in psychiatry, and the current influx of taxonomist, from previous centuries and other branches of science such as botany and zoology, which generated a movement in medicine that reached nosology in psychiatry. The medical paradigm for Maher (1974), implies: the person who shows some changes with respect to the traits considered normal in a population is ill, the disease is caused by a demonstrable etiology (or are supposed to be evident in the future) is in principle and by definition, biological or organic (the possibility of psychological or sociological is only allowed where it is found that is not organic, the organic nature of the cause may be at different levels (tissue injury or biochemical genetic disorder, metabolic , endocrine, infectious, etc..) organic etiology produces a series of signs and symptoms, along with complementary examinations, can reach a diagnosis and identified the disease, symptomatic treatment can be established, and ideally etiological, and assumed a course determined disease, allowing a prediction rule. This medical concept requires a series of successive steps to be taken before stating that mental illness belongs to the medical domain as the other disease entities. These stages are: description of symptoms and the main features of the disorder (clinical syndrome), identification of the underlying pathology, ie structural or biochemical changes that cause the disease natural history of the syndrome and determination of the causes . As a result of this process, the patient takes the sick role in society, with all the positives and negatives that entails. On the one hand, enjoys certain advantages and may require certain labor and social privileges, on the other, you are required to comply with the conditions involving the sick role.
Work on brain structure and function, facilitated by advances in medical technology, have revealed abundant evidence of biological abnormalities in different psychiatric disorders budgets that support the medical paradigm. However, it also has been some criticism of a draft. In general, the medical paradigm has been identified with a reductionist and biologist for which mental illness is caused by a biological disorder that do not translate into physical-chemical terms. Moreover, although the biological model of disease may be central, can not provide a complete description thereof. Therefore, the best futile and at worst leads to a distorted and unacceptable human. For these critical biological phenomena must be explained in terms of biological mechanisms, but diseases are not only biological entities. They do not only in biological organisms but also in humans. Another set of criticisms are epistemological break, noting that the medical paradigm seeks causal explanations, and they are not suitable for the study of psychopathological behavior. However, as stated by Luque and Villagrán, this assertion of a concept of causal explanation particularly close, inherited from the empiricist tradition, Hume and association or subject to hempeliana of universal rules, and forget, for example, the teleological explanation. For our authors, it is difficult to imagine a scientific endeavor with care and medical aspect of Psychiatry that investigates the causes. Causal explanatory activity, common currency in clinical practice from any paradigm, is denied in the epistemological level by advocates of the autonomy of the behavioral sciences, proponents of the exclusive pursuit of reasons or meanings that infuse sense of deviance. However, just as there are anomalies in a system is when the causal inquiry finds its raison d'etre. realistic vision of science has to accept that causal relations between events are objective features of the world we see, not just ideas in the mind of the observer. The scientific realist has to accept a generative theory of causation why we say that X causes Y if X contributes to Y through some mechanism. This theory, which in psychiatry should be applied to individual cases, no precise terms such as cause necessary and sufficient , and envisages a complex causal amounts to the sum of factors that produce the observed behavior. The psychiatrist must determine what factors are not redundant (an indispensable part of complex causal) and which are redundant or accessories, and this already requires interpretative activity.
must say, after this vision of the approach of Luque and Villagrán the medical paradigm, which, by definition, considers psychosis as a biological disease, which unfortunately often in our environment we are professionals and pundits since the pulpit, and on behalf of the medical paradigm and scientism, which really do is get away from the positivist scientific position and think they want or defend. An abundance of confusing information about genetics and neurochemistry fills many of those considered prestigious publications in psychiatry, with, in our opinion, a little (perhaps impossible) job of integrating in any coherent theory to account for reality. Guidelines are criticized as psychoanalysis for not being scientific , based on the sacred model of Newtonian physics and evidence of falsification of Popper, and possibly with some justification, but the science of selling (and with good benefits) rests about faith in a coming Messiah to come to the gene or the neurotransmitter of schizophrenia under his arm and a final remedy shaped molecule in phase III study in a world-class laboratory. The medical paradigm has contributed much to medicine and, we believe, not least in psychiatry, but it presents two dangers, at least from our point of view: the risk of being exclusive and not allow other potentially enriching visions (risk, moreover, shared with any other paradigm, including psychoanalysis), and the risk that said, taking his name in vain use it to carry out good business without respect for our discipline and care to our patients.
0 comments:
Post a Comment