![]() Such evidence would typically be statements the person makes, actions taken, associated biological events, and contextual information I have about the reality basis of (as one patient told me) the Vaseline coating he applied to his radiator to block the efforts of the Soviets to spy on him. As a clinician using scientific methods in my service delivery, I do need to observe (public) evidence of a delusional conviction. I do not need to observe the conviction (I do not even need the conviction to be the sort of thing I could observe). I can decide that a person I talk with has a delusional conviction. I have no doubt that biological events unfold along with the psychological events, but the cognitive dysfunction, emotional dysregulation, and other symptoms are psychological. I nevertheless believe that biological events occur and that understanding them will prove essential in understanding, ameliorating, and preventing mental illness. My construal of a cluster of observed symptoms as evidence of psychosis does not arise from or depend on any assumptions about biological events. My belief that psychological symptoms occur is not based in the least on psychophysiological methods such as functional magnetic resonance (fMRI), magnetoencephalography (MEG), or electroencephalography (EEG) or on endocrine, genetic, immunological, or autonomic measures. I believe that cognitive dysfunction and emotional dysregulation contribute to and result from delusions, hallucinations, and a wide variety of other symptoms of mental illness. As will be developed below, psychological mechanisms are logically more proximal, in general, to psychopathology and warrant at least as much attention. The concept of mechanisms is itself controversial, but relevant here is that there is no need to confine the scope of mechanisms of mental illness to biological mechanisms (C. By “mechanisms,” I mean, most immediately, relevant psychological events. In part, I try to understand the mechanisms by which that observable behavior is produced. ![]() This belief is based not simply on patients’ statements and other overt behavior but on my interpretation of those data. Doing and supervising perhaps 2,000 assessments of acute psychiatric inpatients persuades me that delusions and hallucinations sometimes occur in the context of mental illness. ![]() ![]() This issue of psychology–biology relationships arises quite generally but is particularly important in psychopathology. Perhaps we should not be so certain about the fact or direction of causation without the mechanisms having been fully identified. But the evidence for these being causal relationships is only circumstantial. There are a host of demonstrations of experimental and natural manipulations that we think of as psychological apparently altering dependent measures that we think of as biological and a host of demonstrations of manipulations that we think of as biological apparently altering dependent measures that we think of as psychological. We tend to believe that we have strong presumptive evidence that such causal relationships exist. In fact, we know little about how (e.g., Rose, 2009) or whether (e.g., Miller, 1996) neural events drive psychological events, or the converse. To date, no fully developed demonstration of a mechanism by which psychology or biology affects the other has been offered. The problem extends well beyond psychopathology, although that is a domain with particularly high stakes, because the misconstrual is doing severe damage to clinical science, clinical practice, and public policy, including federal research-funding and health-care-policy priorities in the biobehavioral sciences, with consequences for fostering mental health and preventing and treating mental illness. That is, the scientific basis for it is far from adequate, and it can be argued that it could never be adequate. This construal is rampant in scholarly and public spheres, it is indefensible based on available theory and data, and it is at least very suspect on logical grounds. The headlong rush in recent decades to construe a host of psychological events as being biological events or being reducible to them is, at best, premature.
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