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This chapter explores philosophical issues pertaining to medicine broadly with a focus on integrative medicine and mental health care. The discussion begins with a brief review of the disparate philosophical origins of Western medicine and non-Western systems of medicine, and the significance of the resulting philosophical “gap.” Western medicine and non-Western systems of medicine rest on disparate metaphysical assumptions about the nature of reality, causality, and time. Among scientists there is no consensus that any single theory provides more complete explanations of phenomenal reality than any other theory. Most psychological models rest on dualist assumptions about a physical brain and a non-physical mind. Biomedical psychiatry avoids philosophical problems inherent in dualism by claiming that all mental functions are reducible to discrete neurobiological processes. The role of causality in medicine is examined. Underlying causes of self-reported cognitive, affective, or behavioral symptoms are seldom identified because existing technologies are not able to characterize or confirm the existence of many postulated causes or verify their causal relationships with symptoms or disorders. Different concepts of evidence are discussed, and unresolved philosophical problems in psychiatric classification and diagnosis are briefly reviewed. Different systems of medicine conceptualize evidence in different ways reflecting disparate assumptions about the nature of phenomenal reality. The evidence that a particular treatment results in a beneficial outcome is related to assumptions of causality embedded in the system of medicine in which the treatment is used. The problem of deriving a typology of treatment approaches addressing cognitive, affective, and behavioral symptoms is discussed.
The Diagnostic and Statistical Manuel (DSM) represents the efforts of research psychiatrists to derive a theory-neutral way of classifying symptoms into discrete disorders on the basis of expert consensus on descriptions of symptom patterns.
KeywordsWestern systems of medicine Non-western systems of medicine Philosophical assumptions about medicine Causality and evidence in disparate systems of medicine Psychiatric classification and diagnosis
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