Historical development of ideas about psychiatric aetiology

German E. Berrios

Cause and aetiology: words and concepts Aetiology, case notes, and narratives Aetiological models before the nineteen!h.ce.n?.u.ry The first half of the nineteenth century

Writers on 'efficient ..causes'..(or longitudinal,.. external,. .antecedent, or diachroniç. causality) The... secondhalf ofthe. nineteenth ..century

Writers. on. .'internal.. m,e£h.a.n,i„§.ms.'...as...cau.s.es. „(s.i.mMl.t.ansou„§.,.„strMct.uial,. .or.. s.ynchro.n.ic..c,aMsality)

Summaryand.. conclusions CMpterEeferences

This chapter chronicles the 'evolution of ideas about aetiology (i.e. the concept of causality) in psychiatry' and seeks to clarify the following:

• the meaning of cause, causality, and aetiology in general

• how these ideas came to influence views on mental disorder

• whether in their current state they are helping or hindering psychiatry.

Both 'mental disorder' and 'cause' have changed their meanings throughout time. 'Cause' and 'causality' are the two ancient concepts that underlie the fancy medical term 'aetiology'. The act of explaining in psychiatry will depend on how these two terms are defined. For example, according to seventeenth century physics, 'cause' and 'effect' were ontologically stable entities (e.g. a billiard ball hitting another and causing it to move). For as long 'disease' was considered to be a stable object, the physical model worked. However, by the middle of the nineteenth century, a dynamic view of disease as a shifting state resulting from altered physiology came to the fore. This led to a major revision of the definition of causality. (!2)

Mental disorder does not lend itself well to linear explanations of the following type: (a) a lesion causes a disorder of brain anatomy; (b) a disordered brain leads to disordered function; (c) disordered function (behaviour) dislocates psychosocial competence. Undue emphasis on (a), (b), or (c) leads to the so-called medical, psychological, and social 'models' of mental disease.(3) Apart from misusing the concept of 'model', such taxonomies fragment the causality process and render themselves sterile. It would be more useful to ask in what subtle way (a), (b), and (c) actually interact with one another to give rise to a mental illness.

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