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Brain disorders? Not really: Why network structures block reductionism in psychopathology research

  • Denny Borsboom (a1), Angélique O. J. Cramer (a2) and Annemarie Kalis (a3)
Abstract

In the past decades, reductionism has dominated both research directions and funding policies in clinical psychology and psychiatry. The intense search for the biological basis of mental disorders, however, has not resulted in conclusive reductionist explanations of psychopathology. Recently, network models have been proposed as an alternative framework for the analysis of mental disorders, in which mental disorders arise from the causal interplay between symptoms. In this target article, we show that this conceptualization can help explain why reductionist approaches in psychiatry and clinical psychology are on the wrong track. First, symptom networks preclude the identification of a common cause of symptomatology with a neurobiological condition; in symptom networks, there is no such common cause. Second, symptom network relations depend on the content of mental states and, as such, feature intentionality. Third, the strength of network relations is highly likely to depend partially on cultural and historical contexts as well as external mechanisms in the environment. Taken together, these properties suggest that, if mental disorders are indeed networks of causally related symptoms, reductionist accounts cannot achieve the level of success associated with reductionist disease models in modern medicine. As an alternative strategy, we propose to interpret network structures in terms of D. C. Dennett's (1987) notion of real patterns, and suggest that, instead of being reducible to a biological basis, mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders.

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Abramowitz, J. S., Khandker, M., Nelson, C., Deacon, B. J. & Rygwall, R. (2006) The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: A prospective study. Behaviour Research and Therapy 44:1361–74.
Adam, D. (2013) Mental health: On the spectrum. [Editorial]. Nature 496:416–18.
Aizawa, K. & Gillett, C. (2009) The (multiple) realization of psychological and other properties in the sciences. Mind and Language 24:181208.
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). American Psychiatric Association.
Andreasen, N. C. (1984) The broken brain: The biological revolution in psychiatry. Harper and Row.
Anonymous. (2013) No dishonour in depression. [Editorial]. Nature 498: article 137. (Posted on 12 June, 2013). Available at: http://www.nature.com/news/no-dishonour-in-depression-1.13170.
Baker, L. R. (1995) Explaining attitudes: A practical approach to the mind. Cambridge University Press.
Barabási, A.-L. (2012) The network takeover. Nature Physics 8:1416. doi:10.1038/nphys2188.
Beard, C., Millner, A. J., Forgeard, M. J., Fried, E. I., Hsu, K. J., Treadway, M. T., Leonard, C. V., Kertz, S. J. & Björgvinsson, T. (2016) Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychological Medicine 46:3359–69.
Bechtel, W. & Mundale, J. (1999) Multiple realizability revisited: Linking cognitive and neural states. Philosophy of Science 66:175207.
Beck, A. T. (2008) The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry 165:969–77.
Bentall, R. (2003) Madness explained: Psychosis and human nature. Penguin.
Bickle, J. (1998) Psychoneural reduction: The new wave. MIT Press.
Borsboom, D. (2008) Psychometric perspectives on diagnostic systems. Journal of Clinical Psychology 9:10891108.
Borsboom, D. (2017) A network theory of mental disorders. World Psychiatry 16(1):513. doi:10.1002/wps.20375.
Borsboom, D. & Cramer, A. O. J. (2013) Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9:91121.
Borsboom, D., Epskamp, S., Kievit, R. A., Cramer, A. O. J. & Schmittmann, V. D. (2011) Transdiagnostic networks: A comment on Watkins and Nolen-Hoeksema. Perspectives on Psychological Science 6:610–14.
Bortolotti, L. (2010) Delusions and other irrational beliefs. Oxford University Press.
Boschloo, L., van Borkulo, C. D., Rhemtulla, M., Keyes, K. M., Borsboom, D. & Schoevers, R. A. (2015) The network structure of symptoms of the diagnostic and statistical manual of mental disorders. PLoS ONE 10:e0137621. doi:10.1371/journal.pone.0137621.
Boyd, R. (1991) Realism, antifoundationalism and the enthusiasm for natural kinds. Philosophical Studies 61:127–48.
Boyd, R. (1999) Homeostasis, species, and higher taxa. In: Species: New interdisciplinary essays, ed. Wilson, R. A., pp. 141–85. MIT Press.
Brentano, F. (1874) Psychology from an empirical standpoint. Routledge & Kegan Paul.
Bringmann, L. F., Vissers, N., Wichers, M., Geschwind, N., Kuppens, P., Peeters, F., Borsboom, D. & Tuerlinckx, F. (2013) A network approach to psychopathology: New insights into clinical longitudinal data. PLoS ONE 8(4):e60188.
Campbell, J. (2009) What does rationality have to do with psychological causation? Propositional attitudes as mechanisms and as control variables. In: Psychiatry as cognitive neuroscience: Philosophical perspectives, ed. Broome, M. & Bortoletti, L., pp. 137–49. Oxford University Press.
Clark, A. & Chalmers, D. (1998) The extended mind. Analysis 58:719.
Cramer, A. O. J., Kendler, K. S. & Borsboom, D. (2011) Where are the genes? The implications of a network perspective on gene hunting in psychopathology. European Journal of Personality 25:270–71.
Cramer, A. O. J., van Borkulo, C. D., Giltay, E. J., van der Maas, H. L. J., Kendler, K. S., Scheffer, M. & Borsboom, D. (2016) Major depression as a complex dynamic system. PLoS ONE 11:e0167490. doi:10.1371/journal.pone.0167490.
Cramer, A. O. J., Waldorp, L. J., van der Maas, H. L. J. & Borsboom, D. (2010) Comorbidity: A network perspective. Behavioral and Brain Sciences 33:137–50; discussion 150–93.
Davidson, D. (1984) Inquiries into truth and interpretation. Clarendon Press.
Deboer, T., Détári, L. & Meijer, J. H. (2007) Long-term effects of sleep deprivation on the mammalian circadian pacemaker. Sleep 30:257–62.
Dennett, D. C. (1987) The intentional stance. MIT Press.
Dennett, D. C. (1991) Real patterns. The Journal of Philosophy 88:2751.
Dennett, D. C. (1997) Kinds of minds. Towards an understanding of consciousness. Basic Books.
Dori, G. A. & Overholser, J. C. (1999) Depression, hopelessness, and self-esteem: Accounting for suicidality in adolescent psychiatric inpatients. Suicide and Life-Threatening Behavior 29:309–18.
Dretske, F. I. (1997) Naturalizing the mind. MIT Press.
Elton, M. (2003) Daniel Dennett. Reconciling science and our self-conception. Polity Press.
Endicott, R. P. (1993) Species-specific properties and more narrow reductive strategies. Erkenntnis 38(3):303–21.
Epskamp, S., Maris, G., Waldorp, L. J. & Borsboom, D. (2018) Network psychometrics. In: Handbook of Psychometrics, ed. Irwing, P., Hughes, D. & Booth, T., pp. 953–87. Wiley.
Eronen, M. I. (2013) No levels, no problems: Downward causation in neuroscience. Philosophy of Science 80:1042–52.
Eronen, M. I. (2017) Interventionism for the intentional stance: True believers and their brains. Topoi. (Published Online, 2nd December, 2017). Available at: https://doi.org/10.1007/s11245-017-9513-5.
Fodor, J. A. (1974) Special sciences (or: The disunity of science as a working hypothesis). Synthese 28:97115.
Francken, J. C. & Slors, M. (2014) From commonsense to science, and back: The use of cognitive concepts in neuroscience. Consciousness and Cognition 29:248–58. Available at: https://doi.org/10.1016/j.concog.2014.08.019.
Franić, S., Dolan, C. V., Borsboom, D. & Boomsma, D. I. (2012) Structural equation modeling in genetics. In: Handbook of structural equation modeling, ed. Hoyle, R. H., pp. 617–35. Guilford Press.
Fried, E. I., Bockting, C., Arjadi, R., Borsboom, D., Amshoff, M., Cramer, A., Epskamp, S., Tuerlinckx, F., Carr, D. & Stroebe, M. (2015) From loss to loneliness: The relationship between bereavement and depressive symptoms. Journal of Abnormal Psychology 124:256–65.
Fried, E. I. & Cramer, A. O. J. (2017) Moving forward: Challenges and directions for psychopathological network theory and methodology. Perspectives on Psychological Science 12(6):9991020. Available at: https://doi.org/10.1177/174569161770589 and at: http://journals.sagepub.com/doi/abs/10.1177/1745691617705892.
Fried, E. I., van Borkulo, C. D., Cramer, A. O. J., Boschloo, L. B., Schoevers, R. A. & Borsboom, D. (2017) Mental disorders as networks of problems: A review of recent insights. Social Psychiatry and Psychiatric Epidemiology 52:110.
Gillett, C. (2003) The metaphysics of realization, multiple realization and the special sciences. Journal of Philosophy 100:591603.
Greenberg, G. (2013) The book of woe: The DSM and the unmaking of psychiatry. Penguin.
Guloksuz, S., Pries, L. K. & van Os, J. (2017) Application of network methods for understanding mental disorders: Pitfalls and promise. Psychological Medicine 47(16):2743–52. doi: 10.1017/S0033291717001350.
Guze, S. B. (1989) Biological psychiatry: Is there any other kind? Psychological Medicine 19:315–23.
Hacking, I. (1999) The social construction of what? Harvard University Press.
Haroz, E. E, Bolton, P., Gross, A., Chan, K. S, Michalopoulos, L. & Bass, J. (2016) Depression symptoms across cultures: An IRT analysis of standard depression symptoms using data from eight countries. Social Psychiatry and Psychiatric Epidemiology 51:981–91.
Haroz, E. E., Ritchey, M., Bass, J. K., Augustinavicius, J., Michalopoulos, L., Burkey, M. D. & Bolton, P. (2017) How is depression experienced around the world? A systematic review of qualitative literature. Social Science and Medicine 183:151–62.
Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S. J., van Hulzen, K. J. E., Medland, S. E., Shumskaya, E., Jahanshad, N., Zeeuw, P., Szekely, E., Sudre, G., Wolfers, T., Onnink, A. M. H., Dammers, J. T., Mostert, J. C., Vives-Gilabert, Y., Kohls, G., Oberwelland, E., Seitz, J., Schulte-Rüther, M., Ambrosino, S., Doyle, A. E., Høvik, M. F., Dramsdahl, M., Tamm, L., van Erp, T. G. M., Dale, A., Schork, A., Conzelmann, A., Zierhut, K., Baur, R., McCarthy, H., Yoncheva, Y. N., Cubillo, A., Chantiluke, K., Mehta, M. A., Paloyelis, Y., Hohmann, S., Baumeister, S., Bramati, I., Mattos, P., Tovar-Moll, F., Douglas, P., Banaschewski, T., Brandeis, D., Kuntsi, J., Asherson, P., Rubia, K., Kelly, C., Martino, A. D., Milham, M. P., Castellanos, F. X., Frodl, T., Zentis, M., Lesch, K. P., Reif, A., Pauli, P., Jernigan, T. L., Haavik, J., Plessen, K. J., Lundervold, A. J., Hugdahl, K., Seidman, L. J., Biederman, J., Rommelse, N., Heslenfeld, D. J., Hartman, C. A., Hoekstra, P. J., Oosterlaan, J., Polier, G. V., Konrad, K., Vilarroya, O., Ramos-Quiroga, J. A., Soliva, J. C., Durston, S., Buitelaar, J. K., Faraone, S. V., Shaw, P., Thompson, P. M. & Franke, B. (2017) Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: A cross-sectional mega-analysis. The Lancet Psychiatry 4:310–19.
Horgan, T. (1993) Nonreductive materialism and the explanatory autonomy of psychology. In: Naturalism: A critical appraisal, ed. Wagner, S. & Warner, R., pp. 295320. University of Notre Dame Press.
Hurn, J. D. (1998) The history of general paralysis of the insane in Britain 1830 to 1950. Doctoral dissertation. University College London. Available at: http://discovery.ucl.ac.uk/1349281/1/339949.pdf.
Hyland, M. E. (2011) The origins of health and disease. Cambridge University Press.
Insel, T. R. & Cuthbert, B. N. (2015) Brain disorders? Precisely. Science 348:499500.
Isvoranu, A. M., van Borkulo, C. D., Boyette, L. L., Wigman, J. T. W., Vinkers, C. H. & Borsboom, D. (2017) A network approach to psychosis: Pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin 43:187–96.
Jaspers, K. (1923/1963) General psychopathology. Manchester University Press.
Kalis, A. (2011) Failures of agency: Irrational behavior and self-understanding. Lexington Books.
Kalis, A. (2014) Mentale toestanden in de psychologie. [Mental states in psychology.] Algemeen Nederlands Tijdschrift voor Wijsbegeerte 106:197206.
Kendler, K. S. (2005) Toward a philosophical structure for psychiatry. American Journal of Psychiatry 162:433–40.
Kendler, K. S. (2008) Explanatory models for psychiatric illness. The American Journal of Psychiatry 165(6):695702. doi:10.1176/appi.ajp.2008.07071061.
Kendler, K. S. (2012a) Levels of explanation in psychiatric and substance use disorders: Implications for the development of an etiologically based nosology. Molecular Psychiatry 17:1121.
Kendler, K. S., Zachar, P. & Craver, C. (2011) What kinds of things are psychiatric disorders? Psychological Medicine 41:1143–50.
Kievit, R. A., Romeijn, J. W., Waldorp, L. J., Wicherts, J. M., Scholte, H. S. & Borsboom, D. (2011) Mind the gap: A psychometric approach to the reduction problem. Psychological Inquiry 22:6787.
Kim, J. (1982) Psychophysical supervenience. Philosophical Studies 41:5170.
Kim, J. (1984) Concepts of supervenience. Philosophy and Phenomenological Research 45:153–76.
Kraepelin, E. & Lange, J. (1927) Psychiatrie, vol. I, 9th edition. J. A. Barth.
Lacasse, J. R. & Leo, J. (2005) Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Medicine 2:e392. Available at: https://doi.org/10.1371/journal.pmed.0020392.
Ledford, H. (2014) Medical research: If depression were cancer. [Editorial]. Nature 515:182–84.
Lewis, D. K. (1966) An argument for the identity theory. The Journal of Philosophy 63:1725.
Ma-Kellams, C. (2014) Cross-cultural differences in somatic awareness and interoceptive accuracy: A review of the literature and directions for future research. Frontiers in Psychology 5: article 1379. (Online publication). doi: 10.3389/fpsyg.2014.01379. Available at: https://www.frontiersin.org/articles/10.3389/fpsyg.2014.01379/full.
Marmanidis, H., Holme, G. & Hafner, R. J. (1994) Depression and somatic symptoms: A cross cultural study. Australian and New Zealand Journal of Psychiatry 28:274–78.
Marsman, M., Borsboom, D., Kruis, J., Epskamp, S., van Bork, R., Waldorp, L. J., van der Maas, H. L. J. & Maris, G. K. J. (2017) An introduction to network psychometrics: Relating Ising network models to item response theory models. Multivariate Behavioral Research 7:121. doi:10.1080/00273171.2017.1379379.
McDowell, J. (1996) Mind and world. Harvard University Press.
McGinn, C. (1982) The character of mind. Oxford University Press.
McNally, R. J. (1990) Psychological approaches to panic disorder: A review. Psychological Bulletin 108:403–19.
McNally, R. J. (2002) Anxiety sensitivity and panic disorder. Biological Psychiatry 52:938–46.
McNally, R. J. (2016) Can network analysis transform psychopathology? Behaviour Research and Therapy 86:95104.
McNally, R. J., Heeren, A. & Robinaugh, D. J. (2017a) A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse. European Journal of Psychotraumatology 8 (Suppl. 3):e1341276. Available at: http://doi.org/10.1080/20008198.2017.1341276.
McNally, R. J., Mair, P., Mugno, B. & Riemann, B. (2017b) Co-morbid obsessive–compulsive disorder and depression: A Bayesian network approach. Psychological Medicine 47:1204–14. doi:10.1017/S0033291716003287.
Menary, R., ed. (2010) The extended mind. MIT Press.
Mölder, B. (2010) Mind ascribed: An elaboration and defence of interpretivism. John Benjamins.
Murphy, D. (2005) Psychiatry in the scientific image. MIT Press.
Nagel, E. (1961) The structure of science: Problems in the logic of scientific explanation. Routledge & Kegan Paul.
Nolen-Hoeksema, S. & Watkins, E. R. (2011) A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science 6:589609.
Nordenfeld, L. (2007) Rationality and compulsion. Oxford University Press.
Oppenheim, P. & Putnam, H. (1958) Unity of science as a working hypothesis. Minnesota Studies in the Philosophy of Science 2:336.
Partch, C. L., Green, C. B. & Takahashi, J. S. (2013) Molecular architecture of the mammalian circadian clock. Trends in Cell Biology 24:9099.
Putnam, H. W. (1967) Psychological predicates. In: Art, mind, and religion, ed. Capitan, W. H. & Merrill, D. D.. University of Pittsburgh Press.
Pylyshyn, Z. (1984) Computation and cognition. MIT Press.
Rachman, S. (1998) A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy 36:385401.
Redei, E. E., Andrus, B. M., Kwansy, M. J., Seok, J., Ho, J. & Mohr, D. C. (2014) Blood transcriptomic biomarkers in adult primary care patients with major depressive disorder undergoing cognitive behavioral therapy. Translational Psychiatry 4:e442. doi:10.1038/tp.2014.66. Available at; http://www.nature.com/articles/tp201466.
Reise, S. P. & Waller, N. G. (2009) Item response theory and clinical measurement. Annual Review of Clinical Psychology 5:2748.
Reiss, S. (1991) Expectancy model of fear, anxiety, and panic. Clinical Psychology Review 11:141–53.
Robinaugh, D. J., LeBlanc, N. J., Vuletich, H. J. & McNally, R. J. (2014) Network analysis of persistent complex bereavement disorder in conjugally bereaved adults. Journal of Abnormal Psychology 123:510–22.
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., Reynolds, M. & Thorpe, S. (2000) Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy 38:347–72.
Schaffner, K. (1974) Reductionism in biology: Prospects and problems. Proceedings of the Biennial Meeting of the Philosophy of Science Association 32:613–32.
Schaffner, K. (2006) Reduction: The Cheshire cat problem and a return to roots. Synthese 151:377402.
Schaffner, K. F. & Tabb, K. (2014) Varieties of social constructionism and the problem of progress in psychiatry. In: Philosophical issues in psychiatry III: The nature and sources of historical change. Oxford University Press.
Scheffer, M., Bascompte, J., Brock, W. A., Brovkin, V., Carpenter, S. R., Dakos, V., Held, H., van Nes, E. H., Rietkerk, M. & Sugihara, G. (2009) Early-warning signals for critical transitions. Nature 461(7260):5359.
Searle, J. R. (1983) Intentionality. Cambridge University Press.
Searle, J. R. (1998) Mind language and society: Philosophy in the real world. Basic Books.
Solomon, A. (2014) The noonday demon. Scribner.
Tabb, K. & Schaffner, K. F. (2017) Causal pathways, random walks and tortuous paths: Moving from the descriptive to the etiological in psychiatry. In: Philosophical issues in psychiatry IV: Nosology, ed. Kendler, K. S. & Parnas, J., pp. 342–60. Oxford University Press.
Thornton, T. (2010) Psychiatric explanation and understanding. European Journal of Analytic Philosophy 6:95111.
Tolin, D. F., Brady, R. E. & Hannan, S. (2008) Obsessional beliefs and symptoms of obsessive–compulsive disorder in a clinical sample. Journal of Psychopathology and Behavioral Assessment 30:3142.
Van Borkulo, C. D., Borsboom, D., Epskamp, S., Blanken, T. F., Boschloo, L., Schoevers, R. A. & Waldorp, L. J. (2014) A new method for constructing networks from binary data. Scientific Reports 4: article 5918. Available at: https://www.nature.com/articles/srep05918.
Van de Leemput, I. A., Wichers, M., Cramer, A. O. J., Borsboom, D., Tuerlinckx, F., Kuppens, P., Van Nes, E. H., Viechtbauer, W., Giltay, E. J., Aggen, S. H., Derom, C., Jacobs, N., Kendler, K. S., Van der Maas, H. L. J., Neale, M. C., Peeters, F., Thiery, E., Zachar, P. & Scheffer, M. (2013) Critical slowing down as early warning for the onset and termination of depression. Proceedings of the National Academy of Sciences USA 111:8792. doi:10.1073/pnas.1312114110.
Van der Maas, H. L. J., Dolan, C. V., Grasman, R. P. P. P., Wicherts, J. M., Huizenga, H. M. & Raijmakers, M. E. J. (2006) A dynamical model of general intelligence: The positive manifold of intelligence by mutualism. Psychological Review 113:842–61.
Van Os, J. (2009) “Salience syndrome” replaces “schizophrenia” in DSM-V and ICD-11: Psychiatry's evidence-based entry into the 21st century? ACTA Psychiatrica Scandinavica 120:363–72.
White, K. S., Brown, T. A., Somers, T. J. & Barlow, D. H. (2006) Avoidance behavior in panic disorder: The moderating influence of perceived control. Behaviour Research and Therapy 44:147–57.
Wichers, M. (2014) The dynamic nature of depression: A new micro-level perspective of mental disorder that meets current challenges. Psychological Medicine 44(7):1349–60.
Wild, L. G., Flisher, A. J. & Lombard, C. (2004) Suicidal ideation and attempts in adolescents: Associations with depression and six domains of self-esteem. Journal of Adolescence 27:611–24.
Wimsatt, W. C. (2007) Re-engineering philosophy for limited beings: Piecewise approximations to reality. Harvard University Press.
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