Aetiological models before the nineteenth century

Hobbes and Bacon challenged the four Aristotelian definitions of cause and provided a new meaning for 'efficient cause'. Within medicine, starting with Sydenham and Willis and ending with Morgagni and Bichat, this new meaning led to a transformation of external causes into internal mechanisms. However, the old notion of antecedent, external, longitudinal, or diachronic cause did not disappear, and the two views are found side by side during the nineteenth century.

A second challenge to the old concept of cause came during the eighteenth century in the work of Hume, whose attack on the epistemological validity of 'efficient causes' set two logical requirements to future applications of the model: (!) that cause and effect were different entities, and (2) that the former occurred before the latter—'a cause is an object precedent and contiguous to another, and so united with it, that the idea of the one determines the mind to form the idea of the other, and the impression of the one to form a more lively idea of the other'.(9) This 'seriatim view' of causality governed the work of the early nineteenth-century alienists and many, such as Esquirol/1..® produced long lists of external (independent) causal events. Later, their interest shifted towards brain changes purportedly brought about by such external causes.

As neurosciences and chemistry developed during the second half of the nineteenth century, internal changes or mechanisms began to be considered as a new form of 'simultaneous', 'structural', or 'synchronic' causality. In contrast with this, and partly because no research was being done on 'external antecedents', the old causal lists became stereotyped and eventually lost most of their explanatory power (for a fuller account see Berrios (H) and Berrios and Porter(12>). However, this does not mean that they were abandoned. They were transformed into other theories and can be found surviving in psychodynamic theory, the concept of life events, and in the narrative component of case notes where they provide the rhetoric of bedside medical explanations. This is the reason why psychiatric textbooks continue listing the events preceding the onset of the disease as 'efficient causes'. Griesinger once referred to these as 'tables of physical and moral causes'. (1.3>

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