Aftab et al clearly find it difficult to give up hypotheses of antidepressants (and presumably ECT) correcting biological dysfunction, speculating that antidepressants may enhance synaptic neuroplasticity. They do not seem to fully appreciate that enactive accounts of psychiatry, such as that by Sanneke de Haan (see previous post), provide a philosophical and conceptual critique of naturalistic-reductive approaches to human understanding by focusing on the person as embodied and alive (see eg. another previous post). Aftab et al’s view is what Manschrek & Kleinman (1977) called semi-critical as it doesn’t follow through sufficiently on its critique of the biomedical model (see eg. my article). As I have been arguing throughout this blog, psychiatry needs to move on from its eclectic biopsychosocial view (eg. see previous post and another and yet another) and return to Engel’s original concept of the biopsychopsychosocial model, which was a critique of reductionism in psychiatry and medicine in general (see eg. another previous post). Critical/relational psychiatry is explicitly anti-reductionist and anti-positivist whereas Aftab et al are not. Their approach to psychiatry is still not sufficiently person-centred.
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Psychiatric diagnosis is using a system of conceptual metaphors to essentially say this list of "symptoms" is that diagnosis. There is a failure to distinguish between the system of conceptual metaphors in psychiatric diagnosis and the problems or symptoms of the person.
The disconnect occurs with an unacknowledged assumption that there is an identical correspondence between the problems experienced and the organization of those "symptoms" in the diagnostic system. These symptoms ARE IDENTICAL to the diagnosis because the diagnostic system says so. This assumption is necessary if psychiatric diagnosis (and psychiatry itself) is to be seen as a medical, "scientific" process. But there are no objective tests to legitimize a psychiatric diagnosis as there are with medical issues.
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