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April 6, 2022

Psychopharmacology and Explanatory Pluralism

Author Affiliations
  • 1Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
  • 2South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
JAMA Psychiatry. 2022;79(6):522-523. doi:10.1001/jamapsychiatry.2022.0470

In recent decades, there has been increasing appreciation that understanding psychopathology requires explanations referring to mechanisms and processes residing at multiple levels of organization, such that higher-level explanations cannot be reduced to lower-level explanations.1 This appreciation is also underway in the area of psychopharmacology, where there has historically been a tendency to explain mechanisms of actions of psychotropics predominantly in terms of receptor actions and neurotransmitter changes. Psychopharmacological research has already begun to remedy that by incorporating the potential explanatory role of higher-level mechanisms and processes and investigating how psychotropics produce a cascade of effects that links neurotransmitters to neural networks to complex behaviors. A pluralistic approach to psychopharmacology makes these developments explicit and recognizes that a restricted focus on interactions between psychotropic effects and disorder mechanisms at a molecular level ignores vital questions. This Viewpoint reaffirms pluralistic developments in psychopharmacology that embrace interactions at multiple levels via multiple pathways with top-down and bottom-up causal influences. Three key points are as follows.

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1 Comment for this article
Doesn’t this transcend all of healthcare?
Steven Merahn, MD | Union In Action Inc
In 1977, University of Rochester Medical School professor Dr. George Engel, published an article
in the prestigious journal Science entitled “The Need for a New Medical Model” which raised
the specter of reductionism in medicine and advocated for a more inclusive scientific model, if,
“physicians in the future are to apply the same scientific rigor to the approach and
understanding of patients and their care as they customarily apply to the diagnosis and
treatment of disease”.

This idea of pluralism as a basic science concept certainly seems to transcend psychopharmacology. Isn’t
it equally true for all of our “molecular pharmacology”? It’s not what’s happening at the receptor level, but the person-level!