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Meaning and Matter in Psychiatry: A Historical View and New Approach

Ketil Slagstad


In this article, I argue that a person-centered approach in psychiatry needs to pay attention to how mental illnesses are historically constituted and products of biological, social, psychological and cultural factors. Even if the ambition of the biopsychosocial model and the medical network model was to break with reductionist understandings of (mental) illness, I argue that these models risk stabilising, rather than deconstructing dichotomies between nature versus culture, brain versus mind, somatic versus mental or hard facts versus soft sciences. I rather propose to re-orient psychiatry as a form of “relational medicine” in which causes and reasons are treated as inseparable and where matter and meaning are entangled. A person-centered approach in psychiatry must start with the person including the embodied production of meaning in Society.


Biopsychosocial model, diagnostic classification, epistemology, network model, reductionism

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Pickstone, J.V. (2001). Ways of Knowing: A New History of Science, Technology and Medicine. Chicago: Chicago University Press.

Lawrence, C. & Weisz, G. (Eds). (1998). Greater Than the Parts: Holism in Biomedicine, 1920-1950. Oxford: Oxford University Press.

Greene, J.A. & Loscalzo, J. (2017). Putting the Patient Back Together - Social Medicine, Network Medicine, and the Limits of Reductionism. New England Journal of Medicine 377, 2493-2499.

Keating, P. & Cambrioso, A. (2003). Biomedical platforms : realigning the normal and the pathological in late-twentieth-century medicine. Cambridge: MIT Press.

Priebe, S., Burns, T. & Craig, T.K.J. (2013). The future of academic psychiatry may be social. British Journal of Psychiatry 202, 319-320.

Poland, J. & Tekin, S. (2017). Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research. Cambridge, Massachusetts. London, England: The MIT Press.

Kapur, S., Phillips, A.G. & Insel, T.R. (2012). Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Molecular Psychiatry 17 (12) 1174-1179.

Kendler, K.S. (2012). The dappled nature of causes of psychiatric illness: replacing the organic-functional/hardware-software dichotomy with empirically based pluralism. Molecular Psychiatry 17 (4) 377-388.

Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196 (4286) 129-136.

Kleinman, A. (1988). The illness narratives: suffering, healing, and the human condition. New York: Basic Books.

Heinz, A. (1015). Der Begriff der psychischen Krankheit. Berlin: Suhrkamp.

Walter, H. (2013). The third wave of biological psychiatry. Frontiers in Psychology 4, 582.

Foucault, M. (2006). History of Madness. London: Routledge.

Berrios, G.E. (2014). History and epistemology of psychopathology. In: Philosophical issues in psychiatry III. Kendler, K. & Parnas, J. (Eds). Oxford: Oxford University Press.

Greene, J.A. (2007). Prescribing by numbers: drugs and the definition of disease. Baltimore: Johns Hopkins University Press.

Healy, D. (2002). The Creation of Psychopharmacology. Cambridge, Massachusetts: Harvard University Press.

Kendler, K.S. (2015). The dopamine hypothesis of schizophrenia: an updated perspective. In: Philosophical issues in psychiatry III. Kendler, K.S. & Parnas, J. (Eds), pp. 283-294. Oxford: Oxford University Press.

Licinio, J. (1996). Molecular Psychiatry: the integration of molecular medicine and clinical psychiatry. Molecular Psychiatry 1996; 1 (1) 1-3.

Sotelo, J.L. & Nemeroff, C.B. (2017). Personalized medicine in psychiatry Depression as a systemic disease. Personalized Medicine in Psychiatry 1-2, 11-25.

Malt, E.A., Juhasz, K., Malt, U.F., et al. A Role for the Transcription Factor Nk2 Homeobox 1 in Schizophrenia: Convergent Evidence from Animal and Human Studies. Frontiers in Behavioral Neuroscience 10, 59.

Parnas, J. & Bovet, P. (2015). Psychiatry made easy: operation(al)ism and some of its consequences. In: Philosophical Issues in Psychiatry III. Kendler, K.S. & Parnes, J. (Eds). Oxford: Oxford University Press.

Hyman, S.E. (2011). Diagnosing the DSM: Diagnostic Classification Needs Fundamental Reform. Cerebrum: The Dana Forum Brain Science 2011, 6.

Parnas, J. & Gallagher, S. (2015). Phenomenology and the Interpretation of Psychopathological Experience. In: Re-Visioning Psychiatry : Cultural Phenomenology, Critical Neuroscience, and Global Mental Health. Kirmayer, L.J., Lemelson, R. & Cummings, C.A. (Eds). Cambridge: Cambridge University Press.

Kirkengen, A.L. (2001). Inscribed bodies: Health impact of childhood sexual abuse. Dordrecht: Kluwer.

Fuchs, T. (2014). Brain Mythologies. In: Karl Jaspers’ Philosophy and Psychopathology, pp. 75-84. New York, NY: Springer New York.

Wigman, J.T.W., van Os, J., Borsboom, D., Wardenaar, K.J., Epskamp, S., Klippel, A., MERGE, Viechtbauer, W., Myin-Germeys, I. & Wichers, M. (2015). Exploring the underlying structure of mental disorders: cross-diagnostic differences and similarities from a network perspective using both a top-down and a bottom-up approach. Psychological Medicine 45 (11) 2375-2387.

Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry 16, 5-13.

Silbersweig, D. & Loscalzo, J. (2017). Precision psychiatry meets network medicine: Network psychiatry. JAMA Psychiatry 74, 665-666.

Parnas, J. (2014). The RDoC program: psychiatry without psyche? World Psychiatry 13, 46-47.

Gadamer, H-G. (1975). Wahrheit und Methode. Tübingen: J.C.B Mohr.

Taylor, C. (2002). The Cambridge Companion to Gadamer. In: Cambridge Companion to Gadamer. Dostal, R.J. (Ed). Cambridge: Cambridge University Press.

Fricker, M. (2007). Epistemic injustice: power and the ethics of knowing. Oxford: Oxford University Press.

Matthews, E. (2007). Body-subjects and disordered minds. Oxford: Oxford University Press.

Kerry, R., Eriksen, T.E., Lie, S.A.N., Mumford, S.D. & Anjum, R.L. (2012). Causation and evidence‐based practice: an ontological review. Journal of Evaluation in Clinical Practice 18 (5) 1006-1012.

Kirkengen, A.L., Ekeland, T., Getz, L., Hetlevik, I., Schei, E., Ulvestad, E. & Vetlesen, A.J. (2016). Medicine’s perception of reality - a split picture: critical reflections on apparent anomalies within the biomedical theory of science. Journal of Evaluation in Clinical Practice 22 (4) 496-501.

Andreasen, N.C. (2007). DSM and the death of phenomenology in America: an example of unintended consequences. Schizophrenia Bulletin 33, 108-112.

Marková, I.S. & Berrios, G.E. (2012). Epistemology of Psychiatry. Psychopathology 45, 220-227.

Jaspers, K. (1923). Allgemeine Psychopathologie für Studierende, Ärzte und Psychologen. 3rd edn. Berlin, Heidelberg: Springer Verlag.

Parnas, J. & Sass, L.A. (2008). Varieties of Phenomenology. On Description, Understanding, and Explanation. In: Philosophical Issues in Psychiatry: Explanation, Phenomenology, and Nosology. Kendler, K.S. & Parnas, J. (Eds). Baltimore: Johns Hopkins University Press.

Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 13-23.

Heinz, A. & Schlagenhauf, F. (2010). Dopaminergic Dysfunction in Schizophrenia: Salience Attribution Revisited. Schizophrenia Bulletin 36, 472-485.

Taylor, C. (1989). Sources of the self: the making of the modern identity. Cambridge: Cambridge University Press.

Berrios GE, Marková IS. Toward a New Epistemology of Psychiatry. In: Kirmayer LJ, Lemelson R, Cummings CA (eds) Re-Visioning Psychiatry. Cambridge: Cambridge University Press; 2015

Merleau-Ponty, M. (1962). Phenomenology of Perception. New York: Routledge.

Fuchs, T. (2011). The Brain - A Mediating Organ. Journal of Consciousness Studies 18 (7-8) 196-221.

Kleinman, A. & Fitz-Henry, E. (2007). Experiential Basis of Subjectivity. In: Subjectivity. Biehl, J., Good, B. & Kleinman, A. (Eds). Berkely: University of California Press.

Foucault, M..(1977). Nietzsche, Genealogy, History. In: Language, Counter-Memory, Practice: Selected Essays and Interviews. Bouchard, D.F. (Ed.). Ithaca: Cornell University Press.

Barad, K. (2007). Meeting the universe halfway: quantum physics and the entanglement of matter and meaning. Durham: Duke University Press.

Haraway, D. (1991). Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective. In: Simians, Cyborgs, and Women: The Reinvention of Nature, pp. 183-201. New York: Routledge.

Haraway, D. (2003). The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others. In: The Haraway Reader, pp. 63-124. New York: Routledge.

Loughlin, M. & Miles, A. (2015). Psychiatry, objectivity, and realism about value. In: Alternative perspectives on psychiatric validation : DSM, IDC, RDoC, and Beyond. Zachar, P., St. Stoyanov, D., Aragona, M. & Jablensky, A. (Eds.), pp. 146-163. Oxford: Oxford University Press.

Kirkengen, A.L. (2018). From wholes to fragments to wholes-what gets lost in translation? Journal of Evaluation in Clinical Practice 24 (5) 1145-1149.

Kular, L. & Kular, S. (2018). Epigenetics applied to psychiatry: Clinical opportunities and future challenges. Psychiatry and Clinical Neurosciences 72, 195-211.

Lester, B.M., Conradt, E. & Marsit, C.J. (2014). Are epigenetic changes in the intrauterine environment related to newborn neurobehavior? Epigenomics 6, 175-178.

Barsaglini, A., Sartori, G., Benetti, S., Pettersson-Yeo, W. & Mechelli, A. (2014). The effects of psychotherapy on brain function: A systematic and critical review. Progress in Neurobiology 114, 1-14.

Mol, A. (2013). Mind your plate! The ontonorms of Dutch dieting. Social Studies of Science 43, 379-396.

Fuchs, T. (2017). Zwischen Psyche und Gehirn. Nervenarzt 88, 520-528.



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