This post is by Elly Vintiadis (The American College of Greece Deree College) on her recent paper "Mental Disorders as Processes: A More Suited Metaphysics for Psychiatry" (2022, Philosophical Psychology). (This is an updated version of her previous post in 2019.)
In most discussions about the mind and mental disorders, the metaphysical framework within which they take place is rarely questioned. It is however, important to check our metaphysical beliefs – including our beliefs about what the world is made up of - because whether they are held consciously or not, they affect the way we understand the world and how we approach it scientifically.
For this reason, in my recent work I explore what a metaphysical framework that puts at its center the notion of a process can add to our understanding of the mind and its disorders. I contend that seeing the world as fundamentally ‘processual’ in nature rather than in terms of substances and things, provides the best explanation of what we know about the mind and mental disorders while also allowing us to sidestep the problems of essentialism, reductionism and dualism in psychiatry. In addition, pragmatically it opens up the way for better treatment and prevention options.
Traditional metaphysics has seen the world as made up of things that are in turn made up of smaller things - and so on all the way down. In contrast, according to process metaphysics the world is made up of processes that can be understood as occurrences that take place in time and that essentially involve change. That is, the world is made up of a hierarchy of intertwining processes that exist at different time scales– and whatever stability we experience in the world is the result of processes in dynamic interaction. Viewing brains and minds within a processual framework – and therefore as dynamic and physically, socially and historically situated - can not only make better sense of the plasticity and complexity of our brains but also allows us to give pivotal importance to the self-organization - through constant feedback and feed forward loops with their environment - of the brain and the mind.
In addition, process metaphysics can ground criticism of both the familiar biomedical and the biopsychosocial model of mental disorders while also allowing us to improve the latter. If the world is, indeed, fundamentally made up of processes rather than things, the biomedical model of mental disorders, like any reductionist model, cannot do justice to the complexity of a world that is inherently processual. On the other hand, though the biopsychosocial model incorporates the interplay of biological, psychological and environmental factors when trying to understand mental disorders, in practice - and, I argue, in virtue of the metaphysical framework within which it is embedded – it remains static and fragmented.
The conventional dichotomies of nature vs. nurture, and biology vs. culture, are ingrained in this model, despite the fact that it tries to highlight the importance of their interaction. In contrast, because processes have no hard boundaries, but flow into one another multidirectionally and sustain each other dynamically, there is no level that is ontologically primary so such dichotomies are not available in a process framework.
I argue that reconceptualising mental disorders as the products of complex changing processes that are extended in time can do justice to the influence that past occurrences have on the present mind and can better explain the fact that mental disorders are often multicausal and causally heterogeneous. At the same time, because on a process view a person is historically and socially situated and is the product of an ongoing developmental process throughout her life, such a view can add a more dynamic aspect to the biopsychosocial model thereby helping to improve it.