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Open Access Editorial

On the ontological assumptions of the medical model of psychiatry: philosophical considerations and pragmatic tasks

Tejas Patil1 and James Giordano234*

Author Affiliations

1 Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90089, USA

2 Center for Neurotechnology Studies, Potomac Institute for Policy Studies 901 N Stuart St, Suite 200, Arlington, VA 22203, USA

3 Wellcome Centre for Neuroethics, University of Oxford, OX1, 1PT, Oxford, UK

4 Uehiro Centre for Practical Philosophy, University of Oxford, OX1, 1PT, Oxford, UK

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Philosophy, Ethics, and Humanities in Medicine 2010, 5:3  doi:10.1186/1747-5341-5-3

Published: 28 January 2010


A common theme in the contemporary medical model of psychiatry is that pathophysiological processes are centrally involved in the explanation, evaluation, and treatment of mental illnesses. Implied in this perspective is that clinical descriptors of these pathophysiological processes are sufficient to distinguish underlying etiologies. Psychiatric classification requires differentiation between what counts as normality (i.e.- order), and what counts as abnormality (i.e.- disorder). The distinction(s) between normality and pathology entail assumptions that are often deeply presupposed, manifesting themselves in statements about what mental disorders are.

In this paper, we explicate that realism, naturalism, reductionism, and essentialism are core ontological assumptions of the medical model of psychiatry. We argue that while naturalism, realism, and reductionism can be reconciled with advances in contemporary neuroscience, essentialism - as defined to date - may be conceptually problematic, and we pose an eidetic construct of bio-psychosocial order and disorder based upon complex systems' dynamics. However we also caution against the overuse of any theory, and claim that practical distinctions are important to the establishment of clinical thresholds. We opine that as we move ahead toward both a new edition of the Diagnostic and Statistical Manual, and a proposed Decade of the Mind, the task at hand is to re-visit nosologic and ontologic assumptions pursuant to a re-formulation of diagnostic criteria and practice.