Aftab et al (2022) critique the philosophical and conceptual foundation of an article by Learn & Moncrieff (2022) about why medicine and ECT aren’t the reply for melancholy. I’ve sympathy with their argument that binary opposition between understanding melancholy as medical sickness and significant response to life occasions is problematic. Nevertheless, having detected this flaw, Aftab et al then justify not coping with, even dismissing, the primary focus of the Learn & Moncrieff article on the effectiveness and security of antidepressants and ECT.
Aftab et al clearly discover it tough to surrender hypotheses of antidepressants (and presumably ECT) correcting organic dysfunction, speculating that antidepressants could improve synaptic neuroplasticity. They don’t appear to completely recognize that enactive accounts of psychiatry, reminiscent of that by Sanneke de Haan (see earlier publish), present a philosophical and conceptual critique of naturalistic-reductive approaches to human understanding by specializing in the individual as embodied and alive (see eg. one other earlier publish). Aftab et al’s view is what Manschrek & Kleinman (1977) known as semi-critical because it doesn’t observe via sufficiently on its critique of the biomedical mannequin (see eg. my article). As I’ve been arguing all through this weblog, psychiatry wants to maneuver on from its eclectic biopsychosocial view (eg. see earlier publish and one other and yet one more) and return to Engel’s authentic idea of the biopsychopsychosocial mannequin, which was a critique of reductionism in psychiatry and medication normally (see eg. one other earlier publish). Important/relational psychiatry is explicitly anti-reductionist and anti-positivist whereas Aftab et al aren’t. Their strategy to psychiatry remains to be not sufficiently person-centred.