| Archiver 2006-05-11, 11:11 am |
| Am J Psychiatry. 2006 May;163(5):913-8.
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The persistence of mind-brain dualism in psychiatric reasoning about
clinical scenarios.
Miresco MJ, Kirmayer LJ.
Department of Psychiatry, McGill University, 1033 Pine Ave. West,
Montreal, Que., Canada H3A 1A1. marc.mire...@mail.mcgill.ca.
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.
PMID: 16648335 [PubMed - in process]
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