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首页> 外文期刊>JAMA psychiatry >From Many to One to Many-the Search for Causes of Psychiatric Illness
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From Many to One to Many-the Search for Causes of Psychiatric Illness

机译：从许多人到许多 - 寻找精神病疾病的原因

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摘要

The search for the causes of medical and psychiatric disorders has gone through 3 historical phases. First, up until the mid-19th century, causes of illness were anecdotally recorded from individual cases, resulting in long and diverse lists for all disorders. Second, in the latter half of the 19th century, with the use of microbiological methods, single causes were found for many infectious diseases that led to specific diagnostic tests, effective preventions, and, in some cases, treatments. Causal thinking in medicine shifted from the earlier multicausal approaches to monocausal theories of etiology. Indeed, proving monocausal etiology became a way to establish the legitimacy of a disorder. Through the writings of Kahlbaum and Hecker, psychiatry was deeply influenced by this monocausal perspective, the importance of which was substantially amplified by a twist of fate: the increasing clinical importance of general paresis of the insane throughout the 19th century and the eventual proof that it too was a monocausal condition. However, in the mid-20th century, the third phase began. With decreasing deaths from infectious diseases, epidemiology and clinical medicine shifted to a chronic disease model in which paradigmatic disorders, such as cancer and cardiovascular disease, were shown to be highly multicausal. Biostatistics evolved from deterministic to probabilistic models of disease risk factors. Paradoxically, at this time, biological psychiatry, then rising to dominance in American psychiatry, vigorously pursued monocausal theories, first of neurochemical origin and then of genetic origin. We were trying to establish the legitimacy of our field by pursuing an outmoded model-that "real" diseases are monocausal. Despite ample evidence to the contrary, monocausal thinking continues to influence our field, for example, in the popular but improbable view that we can, with a few key advances, move easily from descriptive to etiologically based diagnoses.
机译：寻找医疗和精神病患者的原因已经经历了3个历史阶段。首先，直到19世纪中叶，疾病的原因是从个体病例轶事，导致所有疾病的漫长而多样化的名单。其次，在19世纪后半叶，随着微生物方法的使用，对许多传染病的单一原因被发现导致特定的诊断测试，有效预防，以及在某些情况下，治疗。医学中的因果思维从早期的多种血管方法转移到病因的单核化学理论。实际上，证明单核病因成为建立疾病合法性的方式。通过Kahlbaum和Hecker的着作，精神病学受到这种单核视角的深受影响，其重要性被命运的扭曲基本上放大了：在整个19世纪疯狂的临床重要性越来越重要，并且最终证明单一的条件也是如此。然而，在20世纪中期，第三阶段开始了。随着传染病的死亡率降低，流行病学和临床医学转移到慢性疾病模型，其中癌症和心血管疾病如癌症和心血管疾病。生物统计学从决定性的疾病风险因素的概率模型演变。矛盾的是，此时，生物精神病学，然后升起美国精神病学，大力追求单子宫理论，首先是神经化学原产地，然后是遗传起源。我们试图通过追求过时的模型来建立我们领域的合法性 - “真实”疾病是单一的。尽管有充分的证据表明相反，但单会思维继续影响我们的领域，例如，在流行但不可能的观点中，我们可以在几个关键的进步中轻松移动到病因基于基于病因的诊断。

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