The persistence of mind-brain dualism in psychiatric reasoning about clinical scenarios.

Full Abstract

OBJECTIVE:
Despite attempts in psychiatry to adopt an integrative biopsychosocial model, social scientists have observed that psychiatrists continue to operate according to a mind-brain dichotomy in ways that are often covert and unacknowledged and suggest that the same intuitive cognitive schemas that people use to make judgments of responsibility lead to dualistic reasoning among clinicians. The goal of this study was to confirm these observations.

METHOD:
Self-report questionnaires were sent to the 270 psychiatrists and psychologists in the Department of Psychiatry at McGill University. In response to clinical vignettes, the participants rated the level of intentionality, controllability, responsibility, and blame attributable to the patients, as well as the importance of neurobiological, psychological, and social factors in explaining the patients' symptoms.

RESULTS:
A total of 136 faculty members (50.4%) responded, and 127 were included in the analysis. Factor analysis revealed a single dimension of responsibility regarding the patients' illnesses that correlated positively with ratings of psychological etiology and negatively with ratings of neurobiological etiology. Psychological and neurobiological ratings were inversely correlated. Multivariate analyses of variance supported these results.

CONCLUSIONS:
Mental health professionals continue to employ a mind-brain dichotomy when reasoning about clinical cases. The more a behavioral problem is seen as originating in "psychological" processes, the more a patient tends to be viewed as responsible and blameworthy for his or her symptoms; conversely, the more behaviors are attributed to neurobiological causes, the less likely patients are to be viewed as responsible and blameworthy.

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Author information

Author/s: Miresco, Marc J (MJ); Kirmayer, Laurence J (LJ);

Affiliation: Department of Psychiatry, McGill University, 1033 Pine Ave. West, Montreal, Que., Canada H3A 1A1. marc.miresco(-atsign-)mail.mcgill.ca

Journal and publication information

Publication Type: Comparative Study; Journal Article

Journal: The American journal of psychiatry (Am J Psychiatry), published in United States. (Language: eng)

Reference: 2006-May; vol 163 (issue 5) : pp 913-8

Dates: Created 2006/05/01; Completed 2006/06/12; Revised 2007/01/10;

PMID: 16648335, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Am J Psychiatry. 2006 Nov;163(11):2017; author reply 2017-8. (PMID: 17074962)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Algorithms
Brain - physiology; physiopathology
Confounding Factors (Epidemiology)
Female
Humans
Intention
Internal-External Control
Intuition - physiology
Judgment - physiology
Male

Mental Disorders - diagnosis; physiopathology; psychology
Mental Processes - physiology
Middle Aged
Models, Biological
Models, Psychological
Multivariate Analysis
Psychiatry
Psychology, Clinical
Psychophysiology
Questionnaires

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