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Top-Down Causation in Psychiatric Disorders: A Clinical-Philosophical Inquiry

Kendler, Kenneth and Woodward, James (2021) Top-Down Causation in Psychiatric Disorders: A Clinical-Philosophical Inquiry. Psychological Medicine, 51 (11). 1783 -1788.

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Psychiatry has long debated whether the causes of mental illness can be better explained by reductionist or pluralistic accounts. While the former relies on commonsense scientific bottom-up causal models, the latter (which typically include environmental, psychological, and/or socio-cultural risk factors) requires top-down causal processes often viewed with skepticism, especially by neuroscientists. We begin with four clinical vignettes which illustrate self-interventions wherein high-order psychological processes (e.g. religious beliefs or deep interpersonal commitments) appear to causally impact on the risk for or the course of psychiatric/behavioral disorders. We then propose a model for how to understand this sort of top-down self-causation. Our model relies centrally on the concept of a control variable which, like a radio tuning dial, can implement a series of typically unknown physical processes to obtain the desired ends. We set this control variable in the context of an interventionist account of causation that assumes that a cause (C) produces an effect (E) when intervening on C (by manipulating it) is associated with a change in E. We extend this framework by arguing that certain psychological changes can result from individuals intervening on their own mental states and/or selection of environments. This in turn requires a conception of the self that contains mental capacities that are at least partially independent of one another. While human beings cannot directly intervene on the neurobiological systems which instantiate risk for psychiatric illness, they can, via control variables at the psychological level, and/or by self-selection into protective environments, substantially alter their own risk.

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Item Type: Published Article or Volume
Keywords: top-down causation, control variable, intervening on one's mental states, mental illness
Subjects: General Issues > Causation
General Issues > Explanation
General Issues > Reductionism/Holism
Depositing User: Jim Woodward
Date Deposited: 24 Oct 2022 18:32
Last Modified: 24 Oct 2022 18:32
Item ID: 21299
Journal or Publication Title: Psychological Medicine
Publisher: Cambridge University Press
DOI or Unique Handle:
Subjects: General Issues > Causation
General Issues > Explanation
General Issues > Reductionism/Holism
Date: August 2021
Page Range: 1783 -1788
Volume: 51
Number: 11

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