Thesis (DPhil)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: The use of psychiatric medication is an important part of modern medical and
psychiatric practice. Clinical psychopharmacology raises a broad range of philosophical
issues, including metaphysical, epistemological, and moral questions. This dissertation
attempts to provide a conceptual framework for addressing several of these questions,
and for formulating a conceptual basis for psychiatry in general and clinical
psychopharmacology in particular.
The dissertation begins by heuristically contrasting two broad approaches towards
a range of questions in the philosophy of science, language, and medicine. A classical
position takes an essentialist and objective view of categories while a critical position
emphasizes that categories are often metaphoric and subjective. A synthetic or integrated
position might be possible, in which radial categories are often based on metaphoric
extensions of basic-level sensorimotor-affective experience, and are embodied in the
brain-mind and in social practices.
Rather than attempt to defend an integrated position in purely conceptual terms,
the dissertation supports this view of categories using data from the cognitive-affective
sciences. An important category for philosophy of medicine is disorder, and the
dissertation argues that certain universal considerations explain agreement about
prototypical disorders. Extensions of disorder metaphors are theory-driven and valueladen,
and although disagreement about atypical conditions is likely, reasonable debate is
possible. The dissertation then considers several conceptual questions, namely the nature of
psychotropics, of emotion, and of the self. In each case, a classical position which
attempts an essentialist definition is contrasted with a critical position which emphasizes
that these constructs are socially constructed and crucially subjective. Cognitiveaffective
data is then employed to support an integrative position which emphasizes the
embodiment of complex brain-mind phenomena in the brain-mind and in social practices.
Explanatory questions considered are how best to explain pharmacotherapy and
psychotherapy, how to account for placebo responses, and the relevance of evolutionary
explanations of disorder. It is argued that a functionalist account fails to explain
psychopharmacological phenomena, including pharmacotherapy and placebo effects.
Instead, an account which emphasizes how psychobiological mechanisms produce
complex brain-mind phenomena is needed. Evolutionary explanations add to this
account, but cannot by themselves differentiate disorder from non-disorder.
Ethical questions include the question of whether psychiatric disorders should be
treated, whether such disorders should be treated with psychotropics, and whether
psychotropics should be used to enhance. The cognitive-affective sciences support the
treatment of typical disorders. In more atypical cases, pharmacotherapy, psychotherapy,
and non-medical interventions should be considered on an individual basis. As
technologies expand, considerations about the value of accepting fate versus the value of
attempting to improve life by a range of methods, will need to be weighed carefully.
In summary, this dissertation puts forward a philosophy of psychopharmacology
which argues that psychiatry practice can be viewed, naturalistically, as based on the
natural and human sciences. At the same time, good psychiatric practice involves an engagement with the complex realities of the human condition, including a consideration
of individuals’ suffering. Good psychopharmacological practice requires integrating the
objective and the subjective, considering both explanation and understanding, and
providing a balanced view of the good and bad of psychotropics that avoids both
unrealistic optimism and undue pessimism. / AFRIKAANSE OPSOMMING: Die gebruik van psigiatriese medikasie maak belangrike deel uit van moderne
mediese en psigiatriese praktyk. Psigofarmakologie bring wye reeks filosofiese
kwessies ter sprake, met inbegrip van metafisiese, epistemologiese, en morele vrae.
Hierdie proefskrif poog om konseptuele raamwerk te verskaf ten einde verskeie van
hierdie vrae die hoof te bied, en na die formulering van konseptuele basis vir psigiatrie
in die algemeen en kliniese psigofarmakologie in die besonder om te sien.
Die proefskrif begin deur twee algemene benaderings ten opsigte van reeks vrae
in die filosofie van wetenskap, taal en geneeskunde te kontrasteer. Klassieke posisie
huldig essensialistiese en objektiewe siening van kategorieë, terwyl kritiese posisie
klem daarop lê dat kategorieë dikwels metafories en subjektief is. Sintetiese of
geïntegreerde posisie is dalk moontlik, met radiale kategorieë wat dikwels op metaforiese
uitbreidings van konsepte op basiese vlak sensorimotor-affektiewe ervaring gebaseer
word, en in die bewussyn-brein en in sosiale gebruike vergestalt word.
Eerder as om te probeer om geïntegreerde posisie in suiwer konseptuele terme
te verdedig, steun die proefskrif hierdie siening van kategorieë met behulp van data uit
die kognitiewe-affektiewe wetenskappe. Belangrike kategorie vir die filosofie van
geneeskunde is steuring, en die proefskrif voer aan dat sekere universele oorwegings ’n
verklaring bied vir ooreenstemming ten opsigte van prototipiese steurings. Uitbreidings
van die steuring metafoor is teoriegedrewe en waardebelaai, en alhoewel daar
waarskynlik meningsverskil omtrent atipiese toestande kan voorkom, is redelike
bespreking haalbaar. Die proefskrif neem dan verskeie konseptuele vrae in aanmerking, naamlik die
aard van psigotropika, van emosie, en van die self. In elke geval word klassieke
posisie wat essensialistiese definisie aandurf, gekontrasteer met kritiese posisie wat
beklemtoon dat hierdie konstrukte sosiaal gekonstrueer en besonder subjektief is.
Kognitiewe-affektiewe data word dan aangewend om integratiewe posisie te handhaaf
wat die vergestalting van komplekse bewussyn-brein fenomene in die bewyssyn-brein en
in sosiale praktyke beklemtoon.
Verklarende vrae het aandag geskenk aan die beste wyse om farmakoterapie en
psigoterapie te verklaar, aan die wyse waarop placebo-reaksies verklaar kan word, en aan
die rol van proksimale en evolusionêre verklarings. Daar word aangevoer dat
funksionalistiese verklaring nie daarin slaag om psigofarmakologiese verskynsels, met
inbegrip van farmakoterapie en placebo-effekte, te verklaar nie. In plaas daarvan word
verklaring wat beklemtoon hoe psigobiologiese meganisme komplekse fenomene kan laat
ontstaan, benodig. Evolusionêre verklarings dra tot hierdie verklaring by, maar kan nie
op sigself steuring van niesteuring onderskei nie.
Etiese vrae sluit die vraag in of psigiatriese steurings behandel moet word, of
sodanige steurings met psigotropika behandel moet word, en of psigotropika gebruik
moet word om te verhoog. Die kognitief-affektiewe wetenskappe ondersteun die
behandeling van tipiese steuringe. In meer atipiese gevalle moet farmakoterapie,
psigoterapie, en nie-mediese intervensies op individuele basis oorweeg word.
Algaande tegnologieë uitbrei, moet ons oorwegings van die waarde van lotsaanvaarding
sowel as die waarde van ’n poging om ’n mens se lewe te verbeter, versigtig in ag neem. Ter opsomming, hierdie proefskrif stel filosofie van psigofarmakologie voor
wat aanvoer dat psigiatriese praktyk naturalisties verstaan kan word, soos gebaseer op die
natuur- en geesteswetenskappe. Terselfdetyd, behels goeie psigofarmakologiese praktyk
‘n verwantskap met die komplekse werklikhede van die menslike kondisie. Dit vereis ‘n
omvattende oorweeging van en omgang met individuele pasiënte se lyding. Goeie
psigofarmakologiese praktyk integreer die “objektiewe” en die “subjektiewe” aspekte van
die menslike bestaan, streef na sowel verklaring en verstaan, verskaf ‘n gebalanseerde
perspektief oor die goed en die sleg van psigiatriese medikasies, en middel tussen
onrealistiese optimisme en buitensporige pessimisme.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/21761 |
| Date | 03 1900 |
| Creators | Stein, Dan J. |
| Contributors | Van Niekerk, Anton A., Bolton, Derek, Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 336 leaves |
| Rights | Stellenbosch University |
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