Hostname: page-component-7dd5485656-jtdwj Total loading time: 0 Render date: 2025-10-30T09:55:31.691Z Has data issue: false hasContentIssue false
  • English
  • Français

The Classification and Explanation of Depression

Published online by Cambridge University Press:  26 February 2019

Samuel Clack  and
Tony Ward
Samuel Clack*
Affiliation:
Victoria University of Wellington, Wellington, New Zealand
Tony Ward
Affiliation:
Victoria University of Wellington, Wellington, New Zealand Ghent University, Ghent, Belgium
*
*Corresponding author: Samuel Clack, School of Psychology, Victoria University of Wellington, PO Box 600, Wellington, New Zealand. Email: samuel.clack@vuw.ac.nz
Get access

Abstract

In the field of psychopathology there is still a lack of consensus on how mental disorders, such as depression, should be classified and explained. Many of our current classifications suffer from disorder heterogeneity and are conceptually vague. While some researchers have argued that mental disorders are better explained from a biological perspective, others have made the case for pluralistic and integrative explanations. Using depression as an extended example, we explore the challenges in classifying and explaining psychopathology. We begin by evaluating the current approaches to classification, including frameworks for what we consider a mental disorder. This is followed by a detailed summary of current explanatory perspectives in psychiatry. The relationship between classification and explanation presents unique theoretical challenges in understanding mental disorders. We suggest that by adjusting our focus from understanding syndromes to clinical phenomena we can advance our understanding of mental disorders.

Keywords

classificationexplanationdepressionphenomenapsychopathology

Information

Type
Standard Paper
Information
Behaviour Change , Volume 36 , Issue 1 , April 2019 , pp. 41 - 55
Copyright
Copyright © The Author(s) 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Allen, NB and Badcock, PB (2003). The social risk hypothesis of depressed mood: Evolutionary, psychosocial, and neurobiological perspectives. Psychological Bulletin 129, 887–913. https://doi.org/10.1037/0033-2909.129.6.887Google Scholar
Alloy, L, Salk, R, Stange, JP and Abramson, L (2017). Cognitive vulnerability and unipolar depression. In DeRubeis, RJ & Strunk, DR (Eds.), Oxford Handbook of Mood Disorders (pp. 142–153). New York, NY: Oxford University Press.Google Scholar
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Beck, AT and Bredemeier, K (2016). A unified model of depression: Integrating clinical, cognitive, biological, and evolutionary perspectives. Clinical Psychological Science 4, 596–619. https://doi.org/10.1177/2167702616628523Google Scholar
Berenbaum, H (2013). Classification and psychopathology research. Journal of Abnormal Psychology 122, 894. https://doi.org/10.1037/a0033096Google Scholar
Bergner, RM (2004). Is it all really biological?. Journal of Theoretical and Philosophical Psychology 24, 30. http://dx.doi.org/10.1037/h0091236Google Scholar
Berrettini, W and Lohoff, W (2017). Genetics of bipolar and unipolar disorders. In DeRubeis, RJ & Strunk, DR (Eds.), The Oxford Handbook of Mood Disorders (pp. 111–119). New York, NY: Oxford University Press.Google Scholar
Bickle, J (2003). Philosophy and Neuroscience: A Ruthlessly Reductive Account. Boston, MA: Kluwer Academic.Google Scholar
Bolton, D (2012). Classification and causal mechanisms: A deflationary approach to the classification problem. In Kendler, KS & Parnas, J (Eds.), Philosophical Issues in Psychiatry II: Nosology (pp. 6–11). Oxford, UK: Oxford University Press.Google Scholar
Borsboom, D (2008). Psychometric perspectives on diagnostic systems. Journal of Clinical Psychology 64, 1089–1108. https://doi.org/10.1002/jclp.20503Google Scholar
Borsboom, D (2017). A network theory of mental disorders. World Psychiatry 16, 5–13. https://doi.org/10.1002/wps.20375Google Scholar
Borsboom, D, Cramer, A and Kalis, A (2018). Brain disorders? Not really … Why network structures block reductionism in psychopathology research. Behavioral and Brain Sciences, 1–54. https://doi.org/10.1017/S0140525X17002266Google Scholar
Capuron, L and Miller, AH (2004). Cytokines and psychopathology: Lessons from interferon-α. Biological Psychiatry 56, 819–824. https://doi.org/10.1016/j.biopsych.2004.02.009Google Scholar
Capuron, L and Miller, AH (2011). Immune system to brain signaling: neuropsychopharmacological implications. Pharmacology & Therapeutics 130, 226–238. https://doi.org/10.1016/j.biopsych.2004.02.009Google Scholar
Caspi, A, Sugden, K, Moffitt, TE, Taylor, A, Craig, IW, Harrington, H … Poulton, R (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science 301, 386–389. https://doi.org/10.1126/science.1083968Google Scholar
Clack, S, Wilshire, CE and Ward, T (2019). Explanations of Depression: Reflections on Beck and Bredemeier (2016). Manuscript in preparation.Google Scholar
Clark, LA, Cuthbert, B, Lewis-Fernández, R, Narrow, WE and Reed, GM (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health's Research Domain Criteria (RDoC). Psychological Science in the Public Interest 18, 72–145. https://doi.org/10.1177/1529100617727266Google Scholar
Colombetti, G (2014). The feeling body: Affective science meets the enactive mind. Cambridge, MA: MIT press.Google Scholar
Cooper, R (2012). Is psychiatric classification a good thing? In Kendler, KS and Parnas, J (Eds.), Philosophical Issues in Psychiatry II: Nosology (pp. 61–70). Oxford, UK: Oxford University Press.Google Scholar
Cowen, PJ (2017). Neuroendocrine and Neurochemical Processes in Depression. In DeRubei, RJ and Strunk, DR (Eds.), The Oxford Handbook of Mood Disorders (pp. 190–200). New York, NY: Oxford University Press.Google Scholar
Craver, C and Kaplan, DM (2018). Are more details better? On the norms of completeness for mechanistic explanations. The British Journal for the Philosophy of Science, axy015. https://doi.org/10.1093/bjps/axy015Google Scholar
Cuthbert, BN and Kozak, MJ (2013). Constructing constructs for psychopathology: The NIMH Research Domain Criteria. Journal of Abnormal Psychology 122, 928–937. https://doi.org/10.1037/a0034028Google Scholar
Drayson, Z (2009) Embodied cognitive science and its implications for psychopathology. Philosophy, Psychiatry and Psychology 16, 329–340. https://doi.org/10.1353/ppp.0.0261Google Scholar
Engel, GL (1977). The need for a new medical model: A challenge for biomedicine. Science 196, 129–136. https://doi.org/10.1126/science.847460Google Scholar
First, MB (2012). The National Institute of Mental Health Research Domain Criteria (RDoC) project: Moving towards a neuroscience-based diagnostic classification in psychiatry. In Kendler, KS and Parnas, J (Eds.), Philosophical Issues in Psychiatry II: Nosology (pp. 12–18). Oxford, UK: Oxford University Press.Google Scholar
Fuchs, T (2009). Embodied cognitive neuroscience and its consequences for psychiatry. Poiesis & Praxis 6, 219–233. https://doi.org/10.1007/s10202-008-0068-9Google Scholar
Gallagher, S (2017). Enactivist Interventions: Rethinking the Mind. Oxford, UK: Oxford University Press.Google Scholar
Ghaemi, SN (2009). The rise and fall of the biopsychosocial model. The British Journal of Psychiatry, 195(1) 3–4. https://doi.org/10.1192/bjp.bp.109.063859Google Scholar
Ghaemi, SN (2012). Taking disease seriously: Beyond ‘pragmatic’ nosology. In Kendler, KS and Parnas, J (Eds.), Philosophical Issues in Psychiatry II: Nosology (pp. 42–53). Oxford, UK: Oxford University Press.Google Scholar
Haig, BD (2014). Investigating the Psychological World: Scientific Method in the Behavioral Sciences. Cambridge MA: MIT Press.Google Scholar
Harrison, NA, Brydon, L, Walker, C, Gray, MA, Steptoe, A and Critchley, HD (2009). Inflammation causes mood changes through alterations in subgenual cingulate activity and mesolimbic connectivity. Biological Psychiatry 66, 407–414. https://doi.org/10.1016/j.biopsych.2009.03.015Google Scholar
Hochstein, E (2016a). Giving up on convergence and autonomy: Why the theories of psychology and neuroscience are codependent as well as irreconcilable. Studies in History and Philosophy of Science Part A 56, 135–144. https://doi.org/10.1016/j.shpsa.2015.10.001Google Scholar
Hochstein, E (2016b). One mechanism, many models: A distributed theory of mechanistic explanation. Synthese 193, 1387–1407. https://doi.org/10.1007/s11229-015-0844-8Google Scholar
Horwitz, AV, Wakefield, JC and Lorenzo-Luaces, L (2017). History of depression. In DeRubeis, RJ and Strunk, DR (Eds.), The Oxford Handbook of Mood Disorders (pp. 11–23). New York, NY: Oxford University Press.Google Scholar
Hucklenbroich, P (2014, October). ‘Disease entity’ as the key theoretical concept of medicine. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 39, 609–633. https://doi.org/10.1093/jmp/jhu040Google Scholar
Hucklenbroich, P (2017). Medical theory and its notions of definition and explanation. In Schramme, T and Edwards, S (Eds.), Handbook of the Philosophy of Medicine (pp. 793–801). Dordrecht, NL: Springer.Google Scholar
Insel, T, Cuthbert, B, Garvey, M, Heinssen, R, Pine, DS, Quinn, K … Wang, P (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. https://doi.org/10.1176/appi.ajp.2010.09091379Google Scholar
Jablensky, A (2009). Endophenotypes in psychiatric research: Focus on schizophrenia. In Salzinger, K and Serper, MR (Eds.), Behavioral Mechanisms and Psychopathology (pp. 13–30). Washington DC: American Psychological AssociationGoogle Scholar
Jablensky, A (2012). The nosological entity in psychiatry: A historical illusion or moving target? In Kendler, KS and Parnas, J (Eds.), Philosophical Issues in Psychiatry II: Nosology (pp. 77–94). Oxford, UK: Oxford University Press.Google Scholar
Kendler, KS (2005). Toward a philosophical structure for psychiatry. American Journal of Psychiatry 162, 433–440. https://doi.org/10.1176/appi.ajp.162.3.433Google Scholar
Kendler, KS (2008). Explanatory models for psychiatric illness. American Journal of Psychiatry 165, 695–702. https://doi.org/10.1176/appi.ajp.2008.07071061Google Scholar
Kendler, KS, Gardner, CO and Prescott, CA (2006). Toward a comprehensive developmental model for major depression in men. American Journal of Psychiatry 163, 115–124. https://doi.org/10.1176/appi.ajp.163.1.115Google Scholar
Kendler, KS, Hettema, JM, Butera, F, Gardner, CO and Prescott, CA (2003). Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalized anxiety. Archives of General Psychiatry 60, 789–796. https://doi.org/10.1001/archpsyc.60.8.789Google Scholar
Kendler, KS, Zachar, P and Craver, C (2011). What kinds of things are psychiatric disorders? Psychological Medicine 41, 1143–1150. https://doi.org/10.1017/S0033291710001844Google Scholar
Kincaid, H and Sullivan, JA (2014). Classifying Psychopathology: Mental Kinds and Natural Kinds. Cambridge, MA: MIT Press.Google Scholar
Kotov, R, Krueger, RF, Watson, D, Achenbach, TM, Althoff, RR, Bagby, RM … Zimmerman, M (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology 126, 454. http://doi.org/10.1037/abn0000258Google Scholar
Lilienfeld, SO (2007). Cognitive neuroscience and depression: Legitimate versus illegitimate reductionism and five challenges. Cognitive Therapy and Research 31, 263–272. https://doi.org/10.1007/s10608-007-9127-0Google Scholar
Lilienfeld, SO and Treadway, MT (2016). Clashing diagnostic approaches: DSM-ICD versus RDoC. Annual Review of Clinical Psychology 12, 435–463. https://doi.org/10.1146/annurev-clinpsy-021815-093122Google Scholar
Maiese, M (2016). Embodied selves and divided minds. Oxford, UK: Oxford University Press.Google Scholar
Maletic, V and Raison, C (2017). The new mind-body science of depression. New York, NY: WW Norton & Company.Google Scholar
Millon, T (1991). Classification in psychopathology: Rationale, alternatives, and standards. Journal of Abnormal Psychology 100, 245–261.Google Scholar
Mitchell, SD (2003). Biological Complexity and Integrative Pluralism. Cambridge, UK: Cambridge University Press.Google Scholar
Mitchell, SD (2009). Unsimple Truths: Science, Complexity, and Policy. Chicago, IL: University of Chicago Press.Google Scholar
Murphy, D (2016). Psychiatry in the Scientific Image. Cambridge, MA: MIT Press.Google Scholar
Newman, BM, Bauer, IE, Soares, JC and Sheline, YI (2017). Neural structure and organisation of mood pathology. In DeRubeis, RJ and Strunk, DR (Eds.), The Oxford Handbook of Mood Disorders (pp. 214–226). New York, NY: Oxford University Press.Google Scholar
Paykel, ES (2008). Basic concepts of depression. Dialogues in Clinical Neuroscience 10, 279–289.Google Scholar
Pennington, BF (2014). Explaining Abnormal Behavior: A Cognitive Neuroscience Perspective. New York, NY: Guilford Publications.Google Scholar
Pincus, HA (2012). DSM-IV: Context, concepts and controversies. In Kendler, KS and Parnas, J (Eds.), Philosophical Issues in Psychiatry II: Nosology (pp. 145–160). Oxford, UK: Oxford University Press.Google Scholar
Potochnik, A (2017). Idealization and the Aims of Science. Chicago, IL: University of Chicago Press.Google Scholar
Pringle, A and Harmer, CJ (2017). Neuropsychological mechanisms of depression and treatment. In DeRubeis, RJ and Strunk, DR (Eds.), The Oxford Handbook of Mood Disorders (pp. 201–213). New York, NY: Oxford University Press.Google Scholar
Thagard, P (2016). Mind-Society: From Brains to Social Sciences and Professions (draft 3). University of Waterloo, Ontario, Canada.Google Scholar
Zachar, P and Kendler, KS (2007). Psychiatric disorders: A conceptual taxonomy. American Journal of Psychiatry 164, 557–565. http://dx.doi.org/10.1176/appi.ajp.164.4.557Google Scholar
Ward, T and Clack, S (2019). From symptoms of psychopathology to the explanation of clinical phenomena. New Ideas in Psychology 54, 40–49. https://doi.org/10.1016/j.newideapsych.2019.01.004Google Scholar