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December 2, 2009

Meaningful Explanations vs Scientific Causality—Reply

JAMA. 2009;302(21):2320-2321. doi:10.1001/jama.2009.1749

In Reply: In response to Dr Luchins, meaningful connections are the center of individuals' humanity, and we did not intend to discredit their value in the understanding of patients' suffering. We did want to point out, however, that meaningful connections may contribute to delayed or ineffective patient care. Neglecting the causal role of meaningful connections in psychiatric illnesses is an equally profound problem. With the explosion in the diagnoses of such conditions as bipolar disorder and attention-deficit/hyperactivity disorder, many clinicians have fallen into what McHugh has termed the “trap of mechanism” (written communication, Paul McHugh, MD, Johns Hopkins University School of Medicine, July 23, 2009). By understanding the competing causal roles of meaning and disease, and selecting treatments based on the distinction between them, primary care physicians and psychiatrists may avoid falling into these and other traps.