Philosophy of psychiatry: theoretical advances and clinical implications

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Addressing challenges related to the professional practice of abortion post-Roe

The landmark Roe vs Wade Supreme Court decision in 1973 established a constitutional right to abortion. In June 2022, the Dobbs vs Jackson Women's Health Organization Supreme Court decision brought an end to the established professional practice of abortion throughout the United States. Rights-based reductionism and zealotry threaten the professional practice of abortion. Rights-based reductionism is generally the view that moral or ethical issues can be reduced exclusively to matters of rights. In relation to abortion, there are 2 opposing forms of rights-based reductionism, namely fetal rights reductionism, which emphasizes the rights for the fetus while disregarding the rights and autonomy of the pregnant patient, and pregnant patient rights reductionism, which supports unlimited abortion without regards for the fetus. The 2 positions are irreconcilable. This article provides historical examples of the destructive nature of zealotry, which is characterized by extreme devotion to one's beliefs and an intolerant stance to opposing viewpoints, and of the importance of enlightenment to limit zealotry. This article then explores the professional responsibility model as a clinically ethically sound approach to overcome the clashing forms of rights-based reductionism and zealotry and to address the professional practice of abortion. The professional responsibility model refers to the ethical and professional obligations that obstetricians and other healthcare providers have toward pregnant patients, fetuses, and the society at large. It provides a more balanced and nuanced approach to the abortion debate, avoiding the pitfalls of reductionism and zealotry, and allows both the rights of the woman and the obligations to pregnant and fetal patients to be considered alongside broader ethical, medical, and societal implications. Constructive and respectful dialogue is crucial in addressing diverse perspectives and finding common ground. Embracing the professional responsibility model enables professionals to manage abortion responsibly, thereby prioritizing patients' interests and navigating between absolutist viewpoints to find balanced ethical solutions.

Uncovering the determinants of brain functioning, behavior and their interplay in the light of context

Notwithstanding the huge progress in molecular and cellular neuroscience, our ability to understand the brain and develop effective treatments promoting mental health is still limited. This can be partially ascribed to the reductionist, deterministic and mechanistic approaches in neuroscience that struggle with the complexity of the central nervous system. Here, I introduce the Context theory of constrained systems proposing a novel role of contextual factors and genetic, molecular and neural substrates in determining brain functioning and behavior. This theory entails key conceptual implications. First, context is the main driver of behavior and mental states. Second, substrates, from genes to brain areas, have no direct causal link to complex behavioral responses as they can be combined in multiple ways to produce the same response and different responses can impinge on the same substrates. Third, context and biological substrates play distinct roles in determining behavior: context drives behavior, substrates constrain the behavioral repertoire that can be implemented. Fourth, since behavior is the interface between the central nervous system and the environment, it is a privileged level of control and orchestration of brain functioning. Such implications are illustrated through the Kitchen metaphor of the brain. This theoretical framework calls for the revision of key concepts in neuroscience and psychiatry, including causality, specificity and individuality. Moreover, at the clinical level, it proposes treatments inducing behavioral changes through contextual interventions as having the highest impact to reorganize the complexity of the human mind and to achieve a long-lasting improvement in mental health.

From cause and effect to causes and effects

It is now-at least loosely-acknowledged that most health and clinical outcomes are influenced by different interacting causes. Surprisingly, medical research studies are nearly universally designed to study-usually in a binary way-the effect of a single cause. Recent experiences during the coronavirus disease 2019 pandemic brought to the forefront that most of our challenges in medicine and healthcare deal with systemic, that is, interdependent and interconnected problems. Understanding these problems defy simplistic dichotomous research methodologies. These insights demand a shift in our thinking from 'cause and effect' to 'causes and effects' since this transcends the classical way of Cartesian reductionist thinking. We require a shift to a 'causes and effects' frame so we can choose the research methodology that reflects the relationships between variables of interest-one-to-one, one-to-many, many-to-one or many-to-many. One-to-one (or cause and effect) relationships are amenable to the traditional randomized control trial design, while all others require systemic designs to understand 'causes and effects'. Researchers urgently need to re-evaluate their science models and embrace research designs that allow an exploration of the clinically obvious multiple 'causes and effects' on health and disease. Clinical examples highlight the application of various systemic research methodologies and demonstrate how 'causes and effects' explain the heterogeneity of clinical outcomes. This shift in scientific thinking will allow us to find the necessary personalized or precise clinical interventions that address the underlying reasons for the variability of clinical outcomes and will contribute to greater health equity.

How collectively integrated are ecological communities?

Beyond abiotic conditions, do population dynamics mostly depend on a species' direct predators, preys and conspecifics? Or can indirect feedback that ripples across the whole community be equally important? Determining where ecological communities sit on the spectrum between these two characterizations requires a metric able to capture the difference between them. Here we show that the spectral radius of a community's interaction matrix provides such a metric, thus a measure of ecological collectivity, which is accessible from imperfect knowledge of biotic interactions and related to observable signatures. This measure of collectivity integrates existing approaches to complexity, interaction structure and indirect interactions. Our work thus provides an original perspective on the question of to what degree communities are more than loose collections of species or simple interaction motifs and explains when pragmatic reductionist approaches ought to suffice or fail when applied to ecological communities.

Precision public health in the making: examining the becoming of the "social" in a Swiss environmental health population-based cohort

Expanding the concept of "precision" or "personalized" medicine, personalized health and precision public health designate the use of various kinds of data-genomic, other omics, clinical, or those produced by individuals themselves through self-tracking-to optimize health interventions benefiting the whole population. This paper draws on an ethnography of the implementation of a population-based environmental health cohort to shed light on the reconfigurations brought about by the "personalization" of public health in Switzerland. Combining human biomonitoring and molecular epidemiology, this cohort aims to advance the science of the exposome, a notion referring to the totality of exposures to which individuals are subjected over their lifecourse. Addressing the tension between holism and reductionism, this paper points to the important gap between the promissory horizon of the exposome and the realities of practices. Situations of reductionism are defined as moments of friction and negotiation between different rationales and values, exposing what makes the science of the exposome, including its material, economic, institutional, and methodological constraints, as well as its imaginaries and values. Rather than opposing holism and reductionism, I emphasize that they constitute two sides of the same coin, as they both pragmatically enable action and produce situated versions of the social. This empirical case shows how reductionism operates at the chemical, biological, and populational levels to produce public health scientific and social values. It thus contributes to contextualizing the pragmatic and strategic choices made by scientists, as well as the values they favor, in a research environment marked by the predominance of biomedicine over public health. It shows how the reductionism of the "social environment" was made for a better social integration of the cohort into the Swiss political and scientific landscape of public health. Bringing together actors involved in public health and questions of environmental exposures, this cohort can be interpreted as a biomedicalization of public health research, as well as an attempt to socialize it through the broad category of the exposome.

Digital technologies for step counting: between promises of reliability and risks of reductionism

Step counting is among the fundamental features of wearable technology, as it grounds several uses of wearables in biomedical research and clinical care, is at the center of emerging public health interventions and recommendations, and is gaining increasing scientific and political importance. This paper provides a perspective of step counting in wearable technology, identifying some limitations to the ways in which wearable technology measures steps and indicating caution in current uses of step counting as a proxy for physical activity. Based on an overview of the current state of the art of technologies and approaches to step counting in digital wearable technologies, we discuss limitations that are methodological as well as epistemic and ethical-limitations to the use of step counting as a basis to build scientific knowledge on physical activity (epistemic limitations) as well as limitations to the accessibility and representativity of these tools (ethical limitations). As such, using step counting as a proxy for physical activity should be considered a form of reductionism. This is not per se problematic, but there is a need for critical appreciation and awareness of the limitations of reductionistic approaches. Perspective research should focus on holistic approaches for better representation of physical activity levels and inclusivity of different user populations.

Physicochemical origins of prokaryotic and eukaryotic organisms

figure legend The continuity of Earth's chemical and Darwinian evolutions. Microbial life on Earth was created by diurnal (cycling) forces and gradients arising from the rotation of the Sun-irradiated Earth. On a colloidal level, prokaryotic life emerged from carbonaceous, geochemical inclusions in the sediments of Usiglio-type pools, which were cyclically energized by chemical reactions and tidal phase separations ("purifications"). Fusions and rehydrations of prokaryotes (natural genetic engineering) initiated the evolution of eukaryotes during the Precambrian supereon. This article is protected by copyright. All rights reserved.

Holistic Framework to Contextualize Dietary Quality Assessment: A Critical Review

Numerous dietary quality indices exist to help quantify overall dietary intake and behaviors associated with positive health outcomes. Most indices focus solely on biomedical factors and nutrient or food intake, and exclude the influence of important social and environmental factors associated with dietary intake. Using the Diet Quality Index- International as one sample index to illustrate our proposed holistic conceptual framework, this critical review seeks to elucidate potential adaptations to dietary quality assessment by considering-in parallel-biomedical, environmental, and social factors. Considering these factors would add context to dietary quality assessment, influencing post-assessment recommendations for use across various populations and circumstances. Additionally, individual and population-level evidence-based practices could be informed by contextual social and environmental factors that influence dietary quality to provide more relevant, reasonable, and beneficial nutritional recommendations.

Irreducibly Social: Why Biocriminology's Ontoepistemology is Incompatible with the Social Reality of Crime

Professing interactionist bio + social terminology, contemporary biocriminology asserts a break from its biologically essentialist past. Assurances notwithstanding, whether biocriminology has undergone a decisive paradigm shift rejecting notions of biological criminals and bad brains remains uncertain. Unfortunately, discussions of biocriminology's assumptions are mired in politics, obscuring important scientific issues. Motivated to clarify misunderstanding, I address the ontoepistemology of biocriminology from a scientific realist perspective. Drawing on familiar notions of crime as a social construction, I explain how and why biocriminology's ontoepistemology is inconsistent with the social reality of crime for scientific not ideological reasons. I explain that recognizing crime is a social construction does not imply that crime is not real or objective and cannot be studied scientifically. On the contrary, the irreducibly social nature of crime requires that scientific realists reject assumptions of 'biological crime' as well as the biologically reductionist epistemology on which biocriminology depends.

Research strategies in nutrition in health and disease: The failure of mechanistic research

This paper critically evaluates different research methods in order to assess their value for establishing which dietary changes are most effective for protecting health and preventing disease. The evidence demonstrates that the combined use of observational studies (mainly cohort studies) and randomized controlled trials (RCTs) is the most successful strategy. Studies of the details of body mechanisms in health and disease (mechanistic research) is another commonly used research strategy. However, much evidence demonstrates that it is a far less successful strategy. In order to support the above conclusions research studies from the following areas are discussed: obesity and dietary fat; heart disease and saturated fat; the Mediterranean diet and cardiovascular disease; type 2 diabetes and dietary fiber; and cancer and micronutrients. While mechanistic research has a poor track record in nutrition, it has achieved some success in other areas of biomedical science. This is shown by examining the role of mechanistic research in the discovery of new drugs.

Does the current state of biomarker discovery in autism reflect the limits of reductionism in precision medicine? Suggestions for an integrative approach that considers dynamic mechanisms between brain, body, and the social environment

Over the past decade, precision medicine has become one of the most influential approaches in biomedical research to improve early detection, diagnosis, and prognosis of clinical conditions and develop mechanism-based therapies tailored to individual characteristics using biomarkers. This perspective article first reviews the origins and concept of precision medicine approaches to autism and summarises recent findings from the first "generation" of biomarker studies. Multi-disciplinary research initiatives created substantially larger, comprehensively characterised cohorts, shifted the focus from group-comparisons to individual variability and subgroups, increased methodological rigour and advanced analytic innovations. However, although several candidate markers with probabilistic value have been identified, separate efforts to divide autism by molecular, brain structural/functional or cognitive markers have not identified a validated diagnostic subgroup. Conversely, studies of specific monogenic subgroups revealed substantial variability in biology and behaviour. The second part discusses both conceptual and methodological factors in these findings. It is argued that the predominant reductionist approach, which seeks to parse complex issues into simpler, more tractable units, let us to neglect the interactions between brain and body, and divorce individuals from their social environment. The third part draws on insights from systems biology, developmental psychology and neurodiversity approaches to outline an integrative approach that considers the dynamic interaction between biological (brain, body) and social mechanisms (stress, stigma) to understanding the origins of autistic features in particular conditions and contexts. This requires 1) closer collaboration with autistic people to increase face validity of concepts and methodologies; (2) development of measures/technologies that enable repeat assessment of social and biological factors in different (naturalistic) conditions and contexts, (3) new analytic methods to study (simulate) these interactions (including emergent properties), and (4) cross-condition designs to understand which mechanisms are transdiagnostic or specific for particular autistic sub-populations. Tailored support may entail both creating more favourable conditions in the social environment and interventions for some autistic people to increase well-being.

Neurobiological reduction: From cellular explanations of behavior to interventions

Scientific reductionism, the view that higher level functions can be explained by properties at some lower-level or levels, has been an assumption of nervous system analyses since the acceptance of the neuron doctrine in the late 19th century, and became a dominant experimental approach with the development of intracellular recording techniques in the mid-20th century. Subsequent refinements of electrophysiological approaches and the continual development of molecular and genetic techniques have promoted a focus on molecular and cellular mechanisms in experimental analyses and explanations of sensory, motor, and cognitive functions. Reductionist assumptions have also influenced our views of the etiology and treatment of psychopathologies, and have more recently led to claims that we can, or even should, pharmacologically enhance the normal brain. Reductionism remains an area of active debate in the philosophy of science. In neuroscience and psychology, the debate typically focuses on the mind-brain question and the mechanisms of cognition, and how or if they can be explained in neurobiological terms. However, these debates are affected by the complexity of the phenomena being considered and the difficulty of obtaining the necessary neurobiological detail. We can instead ask whether features identified in neurobiological analyses of simpler aspects in simpler nervous systems support current molecular and cellular approaches to explaining systems or behaviors. While my view is that they do not, this does not invite the opposing view prevalent in dichotomous thinking that molecular and cellular detail is irrelevant and we should focus on computations or representations. We instead need to consider how to address the long-standing dilemma of how a nervous system that ostensibly functions through discrete cell to cell communication can generate population effects across multiple spatial and temporal scales to generate behavior.

Psychoanalysis and Neuropsychological Explanations

Psychoanalysis is an explanatory science, and if our aim is to develop accurate theories of the mind, psychoanalysis would benefit from integrating explanations developed by psychology and neuroscience. The main part of the essay shows how psychoanalysis can be integrated with neuroscience and psychology. The concept of integration is defined in terms of six criteria, and the author argues that no matter how tight the integration is, it does not entail that neuropsychological explanations can replace psychoanalytic theory.

Sperm RNA-mediated epigenetic inheritance in mammals: challenges and opportunities

Emerging evidence now shows that in addition to delivering a haploid DNA, the mammalian sperm also carry various types of RNAs that respond to the paternal environment, which can mediate the intergenerational transmission of certain phenotypes to the offspring relating to the paternal environmental exposures (e.g. diet, mental stress). Improved analytical tools are beginning to decipher the complexity of sperm RNAs, RNA modifications and their spatial compartmentalisation, which support the concept of 'sperm RNA code' in programming specific offspring phenotypes during embryonic development. In this commentary article, I discuss the challenges and opportunities in solidifying the field of mammalian sperm RNA-mediated epigenetic inheritance, including the identification of the key sperm RNAs that are responsible for the paternal phenotype transmission, and the cellular and molecular events that are triggered by sperm RNAs during embryo development. I also discuss the translational application potential by harnessing the knowledge of sperm RNA code to improve farm animal production and human health.

What is episodic memory and how do we use it?

What are the neural and computational principles that give rise to episodic memory? Although memory is probably the most studied topic in psychology and cognitive neuroscience, most research has focused on learning at the micro-level. I outline the limitations of this approach and propose a 'molar' approach to tackle episodic memory at the scale of life.

The concept of Narcissistic Personality Disorder-Three levels of analysis for interdisciplinary integration

In this paper, I distinguish three different levels for describing, and three corresponding ways for understanding, deficient empathy as the core of NPD (Narcissistic Personality Disorder). On the macro level, deficient empathy can be explained as disturbed interpersonal functioning, and is understood as lack of recognition. On the meso-level, deficient empathy can be described as psychic disintegration, and can be understood specifically in its dissocial aspects. Psychic disintegration in NPD correlates with somatic changes, i.e., dysfunctional affective empathy and mind-reading on the micro level of description, which is the third level. The "core-deficit-model of NPD" that I outline, while not rejecting reductionist approaches outright, argues in favor of integrating (top-down/bottom-up) functionalist descriptions of empathy into a wider conceptual framework of bio-psycho-social functioning. The "core-deficit-model of NPD" is interdisciplinary, can bypass monodisciplinary skepticism, and removes purported barriers between explaining and understanding the "lack" of empathy as the core of pathological narcissism.

Unhealthy mind in a healthy body: A criticism to eliminativism in psychopathology

In this article we criticize the thesis "The diseases we treat are diseases of the brain". A first criticism is against the eliminativist perspective and in favor of a perspective that is still reductionist but emergentist and functionalist. In a second part, we try to answer the question "under which conditions can we consider this statement legitimate?". We argue that only those mental disorders whose neural substrate has clearly neuropathological characteristics, i.e., anomalies with respect to the laws of good neural functioning, can be considered "brain diseases." We propose that it is not sufficient to observe a simple difference between the brains of people with psychopathology, that is, with anomalies with respect to the laws of good psychological functioning, and that of people without psychopathology. Indeed, we believe it is a categorical error to postulate a neuropathology starting from a psychopathology. Finally, we summarize some research that shows how purely psychological interventions can reduce or eliminate the differences between the brains of people with or psychopathology and those of people without.

Bridging the Divide between Reductionism and the Neurodiversity Movement

While Autism Spectrum Disorder as a label invites the idea of the heterogeneity of autism, within research we often adopt reductionist frameworks which are antithetical to heterogeneous presentations of autism. The neurodiversity movement provides insight into the vastness of the autistic experience and therefore might inform how we should restructure our research questions. Inviting sociocultural concepts of neurodiversity into the lab might better structure research to benefit the autistic community.

Why mental disorders are brain disorders. And why they are not: ADHD and the challenges of heterogeneity and reification

Scientific attempts to identify biomarkers to reliably diagnose mental disorders have thus far been unsuccessful. This has inspired the Research Domain Criteria (RDoC) approach which decomposes mental disorders into behavioral, emotional, and cognitive domains. This perspective article argues that the search for biomarkers in psychiatry presupposes that the present mental health categories reflect certain (neuro-) biological features, that is, that these categories are reified as biological states or processes. I present two arguments to show that this assumption is very unlikely: First, the heterogeneity (both within and between subjects) of mental disorders is grossly underestimated, which is particularly salient for an example like Attention Deficit/Hyperactivity Disorder (ADHD). Second, even the search for the biological basis of psychologically more basic categories (cognitive and emotional processes) than the symptom descriptions commonly used in mental disorder classifications has thus far been inconclusive. While philosophers have discussed this as the problem of mind-body-reductionism for ages, Turkheimer presented a theoretical framework comparing weak and strong biologism which is more useful for empirical research. This perspective article concludes that mental disorders are brain disorders in the sense of weak, but not strong biologism. This has important implications for psychiatric research: The search for reliable biomarkers for mental disorder categories we know is unlikely to ever be successful. This implies that biology is not the suitable taxonomic basis for psychiatry, but also psychology at large.

The Elementary Particles of Quantum Fields

The elementary particles of relativistic quantum field theory are not simple field quanta, as has long been assumed. Rather, they supplement quantum fields, on which they depend on but to which they are not reducible, as shown here with particles defined instead as a unified collection of properties that appear in both physical symmetry group representations and field propagators. This notion of particle provides consistency between the practice of particle physics and its basis in quantum field theory.

Explaining Regeneration: Cells and Limbs as Complex Living Systems, Learning From History

Regeneration has been investigated since Aristotle, giving rise to many ways of explaining what this process is and how it works. Current research focuses on gene expression and cell signaling of regeneration within individual model organisms. We tend to look to model organisms on the reasoning that because of evolution, information gained from other species must in some respect be generalizable. However, for all that we have uncovered about how regeneration works within individual organisms, we have yet to translate what we have gleaned into achieving the goal of regenerative medicine: to harness and enhance our own regenerative abilities. Turning to history may provide a crucial perspective in advancing us toward this goal. History gives perspective, allowing us to reflect on how our predecessors did their work and what assumptions they made, thus also revealing limitations. History, then, may show us how we can move from our current reductionist thinking focused on particular selected model organisms toward generalizations about this crucial process that operates across complex living systems and move closer to repairing our own damaged bodies.

The Case for Whole-Person Integrative Care

Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for "Whole Health Veterans Administration," "integrative medicine," "integrative health," "complementary and alternative medicine," and, as they related to the outcomes, of "health outcomes," "cost-effectiveness," "cost reduction," "patient satisfaction," and "physician satisfaction." Additional studies were identified from an initial search and the authors' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.

The critique of psychiatry as we enter the third decade of the 21st century

SUMMARY

Critical psychiatry takes the position that 'mental illness' should not be reduced to 'brain disease'. Here I consider whether this particular stance is outdated in light of more recent exchanges on reductionism, which consider questions raised by new mental health sciences that seek truly integrative and specific biopsychosocial models of illness.

The End of Botany

Biologists unable to recognize common plants, and a decline in botany students, faculty, courses, university departments, and herbaria, highlight the current erosion of botany. How did we reach this crisis, knowing that plants form the basis for life? What are the causes? What can we do to reverse it?

Models of the Gene Must Inform Data-Mining Strategies in Genomics

The gene is a fundamental concept of genetics, which emerged with the Mendelian paradigm of heredity at the beginning of the 20th century. However, the concept has since diversified. Somewhat different narratives and models of the gene developed in several sub-disciplines of genetics, that is in classical genetics, population genetics, molecular genetics, genomics, and, recently, also, in systems genetics. Here, I ask how the diversity of the concept impacts data-integration and data-mining strategies for bioinformatics, genomics, statistical genetics, and data science. I also consider theoretical background of the concept of the gene in the ideas of empiricism and experimentalism, as well as reductionist and anti-reductionist narratives on the concept. Finally, a few strategies of analysis from published examples of data-mining projects are discussed. Moreover, the examples are re-interpreted in the light of the theoretical material. I argue that the choice of an optimal level of abstraction for the gene is vital for a successful genome analysis.

Information technologies in healthcare: Enhancing or dehumanising doctor-patient interaction?

Since the very emergence of the information technologies in healthcare, a major concern has been raised about the potential of remote services to undermine the intimacy, immediacy and humanity intrinsic to conventional, face-to-face medical practice. By contrast, notable literature reports the benefits of information technology-mediated services and their potential to improve efficiency and economic convenience of healthcare systems. This article aims to shed light on this ambivalence by retracing the evolution of doctor-patient interaction in relation to the main technological advancements in healthcare, and in particular, to services mediated by information technologies. Consequently, the reduction of cues and clues associated with the use of these services is framed into the reductionism of the biomedical paradigm, which provides a key to interpret the nature, scope and features of this process of technological innovation, along with its potential and limits.

The structure of non-human cognitive neuroscience: an epistemological critique

Every scientific practice rests on implicit unrevised theoretical assumptions. Neuroscience, in particular, focuses on a very controversial object of study-the brain and is therefore prone to tacitly embrace philosophical positions in its everyday workings. It is thus, of utmost importance, to develop a critique of the structure of neuroscientific investigation so as to understand what the uncovered pillars of the field are, what pitfalls they may implicate and how we can correct them. In this paper, I gather the first critiques in animal cognitive neuroscience and hope to establish the first step in a continuous process of revision. By applying a conceptual division of neuroscience into cognitive, behavioral and neurobiological theories, I point out the main problems in articulating the three, based on actual scientific practice rather than purely theoretical reasoning. I conclude by proposing developments on behavioral theory and set an initial critique on assumptions on both cognitive and neurobiological theories.

Parkinson Diseases in the 2020s and Beyond: Replacing Clinico-Pathologic Convergence With Systems Biology Divergence

Parkinson disease has been considered for practical purposes a heterogeneous clinico-pathological entity. The operational definition requires clinical ascertainment of a levodopa-responsive parkinsonism with no "atypical" features, and pathological criteria based on the finding, usually at postmortem, of aggregates of α-synuclein in Lewy bodies and Lewy neurites. The underlying assumption has been that a molecular-biological disorder, targetable for disease modification as a whole, underlies this clinico-pathologic, convergent model of disease. The 2020s will be expected to mark the beginning of the end for this model, especially if therapeutic success in a specific molecular subtype, such as PD-GBA, is not translated to "sporadic PD". The complex and dynamic biological abnormalities of aging, which have informed the evolution of other fields in medicine into divergent, systems-biology models, will also provide the template for the development of disease modifying therapies for neurodegenerative disorders. In the 2020s and 2030s we will no longer ask whether any given molecule may be neuroprotective in early Parkinson disease but, rather, which subtype (which endophenotype) among the Parkinson diseases would be the best mechanistic recipient for such molecule and which would not. The next breakthrough in Parkinson's research will be conceptual: the recognition that discoveries in a subtype of PD will apply only or largely to that subtype and not construed to represent "a piece" that seamlessly inserts into, and helps explains, a unifying "Parkinson's puzzle". Successful neuroprotection for each PD subtype will likely require pharmacotherapeutic combinations ("drug cocktails") to harness synergistic potential benefits when more than the dominant pathogenic mechanism is targeted, as identified from forthcoming population-based unbiased biomarker discovery programs.

Degeneracy in hippocampal physiology and plasticity

Degeneracy, defined as the ability of structurally disparate elements to perform analogous function, has largely been assessed from the perspective of maintaining robustness of physiology or plasticity. How does the framework of degeneracy assimilate into an encoding system where the ability to change is an essential ingredient for storing new incoming information? Could degeneracy maintain the balance between the apparently contradictory goals of the need to change for encoding and the need to resist change towards maintaining homeostasis? In this review, we explore these fundamental questions with the mammalian hippocampus as an example encoding system. We systematically catalog lines of evidence, spanning multiple scales of analysis that point to the expression of degeneracy in hippocampal physiology and plasticity. We assess the potential of degeneracy as a framework to achieve the conjoint goals of encoding and homeostasis without cross-interferences. We postulate that biological complexity, involving interactions among the numerous parameters spanning different scales of analysis, could establish disparate routes towards accomplishing these conjoint goals. These disparate routes then provide several degrees of freedom to the encoding-homeostasis system in accomplishing its tasks in an input- and state-dependent manner. Finally, the expression of degeneracy spanning multiple scales offers an ideal reconciliation to several outstanding controversies, through the recognition that the seemingly contradictory disparate observations are merely alternate routes that the system might recruit towards accomplishment of its goals.

A Deep Dive to Illuminate V4 Neurons

Neurons in the primate cortical area V4 have been recognized as being selective for intermediate-level visual features, including shape, texture, and color. But, there is no a priori reason why V4 neurons should respond to easily describable categories of visual stimuli. In a recent study Bashivan et al. (Science, 2019) used an artificial neural network to synthesize images that acted as 'super-stimuli' for recorded neurons in V4, pushing the boundaries of known neural responses in this brain region and raising broader questions about the potential for synergies between biological and artificial neural networks.

Toward Sustainable Chemical Engineering: The Role of Process Systems Engineering

Products from chemical engineering are essential for human well-being, but they also contribute to the degradation of ecosystem goods and services that are essential for sustaining all human activities. To contribute to sustainability, chemical engineering needs to address this paradox by developing chemical products and processes that meet the needs of present and future generations. Unintended harm of chemical engineering has usually appeared outside the discipline's traditional system boundary due to shifting of impacts across space, time, flows, or disciplines, and exceeding nature's capacity to supply goods and services. Being a subdiscipline of chemical engineering, process systems engineering (PSE) is best suited for ensuring that chemical engineering makes net positive contributions to sustainable development. This article reviews the role of PSE in the quest toward a sustainable chemical engineering. It focuses on advances in metrics, process design, product design, and process dynamics and control toward sustainability. Efforts toward contributing to this quest have already expanded the boundary of PSE to consider economic, environmental, and societal aspects of processes, products, and their life cycles. Future efforts need to account for the role of ecosystems in supporting industrial activities, and the effects of human behavior and markets on the environmental impacts of chemical products. Close interaction is needed between the reductionism of chemical engineering science and the holism of process systems engineering, along with a shift in the engineering paradigm from wanting to dominate nature to learning from it and respecting its limits.

Perspective: The promises of a holistic view of proteins-impact on antibody engineering and drug discovery

The reductionist approach is prevalent in biomedical science. However, increasing evidence now shows that biological systems cannot be simply considered as the sum of its parts. With experimental, technological, and computational advances, we can now do more than view parts in isolation, thus we propose that an increasing holistic view (where a protein is investigated as much as a whole as possible) is now timely. To further advocate this, we review and discuss several studies and applications involving allostery, where distant protein regions can cross-talk to influence functionality. Therefore, we believe that an increasing big picture approach holds great promise, particularly in the areas of antibody engineering and drug discovery in rational drug design.

How new concepts become universal scientific approaches: insights from citation network analysis of agent-based complex systems science

Progress in understanding and managing complex systems comprised of decision-making agents, such as cells, organisms, ecosystems or societies, is-like many scientific endeavours-limited by disciplinary boundaries. These boundaries, however, are moving and can actively be made porous or even disappear. To study this process, I advanced an original bibliometric approach based on network analysis to track and understand the development of the model-based science of agent-based complex systems (ACS). I analysed research citations between the two communities devoted to ACS research, namely agent-based (ABM) and individual-based modelling (IBM). Both terms refer to the same approach, yet the former is preferred in engineering and social sciences, while the latter prevails in natural sciences. This situation provided a unique case study for grasping how a new concept evolves distinctly across scientific domains and how to foster convergence into a universal scientific approach. The present analysis based on novel hetero-citation metrics revealed the historical development of ABM and IBM, confirmed their past disjointedness, and detected their progressive merger. The separation between these synonymous disciplines had silently opposed the free flow of knowledge among ACS practitioners and thereby hindered the transfer of methodological advances and the emergence of general systems theories. A surprisingly small number of key publications sparked the ongoing fusion between ABM and IBM research. Beside reviews raising awareness of broad-spectrum issues, generic protocols for model formulation and boundary-transcending inference strategies were critical means of science integration. Accessible broad-spectrum software similarly contributed to this change. From the modelling viewpoint, the discovery of the unification of ABM and IBM demonstrates that a wide variety of systems substantiate the premise of ACS research that microscale behaviours of agents and system-level dynamics are inseparably bound.

Completely top-down hierarchical structure in quantum mechanics

Can a large system be fully characterized using its subsystems via inductive reasoning? Is it possible to completely reduce the behavior of a complex system to the behavior of its simplest "atoms"? In this paper we answer these questions in the negative for a specific class of systems and measurements. After a general introduction of the topic, we present the main idea with a simple two-particle example, where strong correlations arise between two apparently empty boxes. This leads to surprising effects within atomic and electromagnetic systems. A general construction based on pre- and postselected ensembles is then suggested, wherein the N-body correlation can be genuinely perceived as a global property, as long as one is limited to performing measurements which we term "strictly local." We conclude that under certain boundary conditions, higher-order correlations within quantum mechanical systems can determine lower-order ones, but not vice versa. Surprisingly, the lower-order correlations provide no information whatsoever regarding the higher-order correlations. This supports a top-down structure in many-body quantum mechanics.

Perspective: Reductionist Nutrition Research Has Meaning Only within the Framework of Holistic and Ethical Thinking

Today, it seems that nutrition is in a state of great confusion, especially for the general public. For decades, some nutrients (e.g., cholesterol, saturated fats, sugars, gluten, salt) and food groups (e.g., dairy, cereals, meats) have been regularly denigrated. In this position paper, we hypothesize that such a state of confusion is mainly the result of the reductionist paradigm applied to nutrition research for more than a century, and by being pushed to its extreme, this perspective has led to accusations about some nutrients and foods. However, the real issue is about foods taken as a whole and therefore about their degree of processing, which affects both the food matrix and composition. Indeed, we eat whole foods, not nutrients. Therefore, the objectives of this article are to emphasize the need for more holistic approaches in nutrition to preserve our health, animal welfare, and planet. We propose to first redefine the food health potential on a holistic basis and then to show that reductionism and holism are interconnected approaches that should coexist. Then, we try to explain how extreme reductionism has been disconnected from reality and ethical considerations and has ultimately led to environmental degradation and loss of biodiversity, notably through very specific crops, and to an increased prevalence of chronic diseases. Furthermore, to address the confusion of the general public and to simplify nutritional messages, we propose 3 holistic golden rules based on scientific evidence to protect human health, animal welfare, and the environment (climate and biodiversity). Finally, we try to show how these 3 rules can be easily applied worldwide while respecting the environment, cultural traditions, and heritage.

Can psychoanalysis contribute to the understanding of fundamentalism? An introduction to a vast question

During the past 20 years, religious and political fundamentalism has produced a number of barbaric terrorist attacks which have strongly shaken public opinion in the Western world. Can psychoanalysis contribute to the understanding of the unconscious functioning of these fundamentalist groups? The different presentations of fundamentalism and the various hypotheses concerning its origins and aims are discussed. Should fundamentalism be understood mainly as a means for strengthening the sense of identity, as a search for power, or as a refuge in certainty? When trying to understand these phenomena, are there any pitfalls a psychoanalyst should beware of? The slippery ground of applied analysis is discussed, as well as some dangers specific to this issue, such as reductionism, theoretical hyper-saturation, wild speculative over-interpretation, and emotional/ethnocentric biases. Whereas there is general inter-field agreement concerning the absence of obvious psychopathology or of a typical sort of personality in the members of fundamentalist groups, the major contribution of psychoanalysis might be to the understanding of the particular ways in which an individual appropriates a given ideology and the weight of group dynamics. On less slippery ground, detailed clinical material is used in order to illustrate both the defensive value of a fundamentalist position taken by an adolescent and the intervention of fundamentalism in everyday psychoanalytical societies. Particularly relevant issues are suggested to be narcissism and the structuring role of relationships with the others.

Development of a Preventive HIV Vaccine Requires Solving Inverse Problems Which Is Unattainable by Rational Vaccine Design

Hypotheses and theories are essential constituents of the scientific method. Many vaccinologists are unaware that the problems they try to solve are mostly inverse problems that consist in imagining what could bring about a desired outcome. An inverse problem starts with the result and tries to guess what are the multiple causes that could have produced it. Compared to the usual direct scientific problems that start with the causes and derive or calculate the results using deductive reasoning and known mechanisms, solving an inverse problem uses a less reliable inductive approach and requires the development of a theoretical model that may have different solutions or none at all. Unsuccessful attempts to solve inverse problems in HIV vaccinology by reductionist methods, systems biology and structure-based reverse vaccinology are described. The popular strategy known as rational vaccine design is unable to solve the multiple inverse problems faced by HIV vaccine developers. The term “rational” is derived from “rational drug design” which uses the 3D structure of a biological target for designing molecules that will selectively bind to it and inhibit its biological activity. In vaccine design, however, the word “rational” simply means that the investigator is concentrating on parts of the system for which molecular information is available. The economist and Nobel laureate Herbert Simon introduced the concept of “bounded rationality” to explain why the complexity of the world economic system makes it impossible, for instance, to predict an event like the financial crash of 2007–2008. Humans always operate under unavoidable constraints such as insufficient information, a limited capacity to process huge amounts of data and a limited amount of time available to reach a decision. Such limitations always prevent us from achieving the complete understanding and optimization of a complex system that would be needed to achieve a truly rational design process. This is why the complexity of the human immune system prevents us from rationally designing an HIV vaccine by solving inverse problems.

Misunderstanding RDoC

Mental illness is fundamentally mental, by definition about psychological rather than biological phenomena, but biological phenomena play key roles in understanding, preventing, and treating mental illness. The Research Domain Criteria initiative (RDoC) of the US National Institute of Mental Health is an unusually ambitious effort to foster integration of psychological and biological science in the service of psychopathology research. Some key features and common misunderstandings of RDoC are discussed here.

Nature and Consequences of Biological Reductionism for the Immunological Study of Infectious Diseases

Evolution has conserved "economic" systems that perform many functions, faster or better, with less. For example, three to five leukocyte types protect from thousands of pathogens. To achieve so much with so little, biological systems combine their limited elements, creating complex structures. Yet, the prevalent research paradigm is reductionist. Focusing on infectious diseases, reductionist and non-reductionist views are here described. The literature indicates that reductionism is associated with information loss and errors, while non-reductionist operations can extract more information from the same data. When designed to capture one-to-many/many-to-one interactions-including the use of arrows that connect pairs of consecutive observations-non-reductionist (spatial-temporal) constructs eliminate data variability from all dimensions, except along one line, while arrows describe the directionality of temporal changes that occur along the line. To validate the patterns detected by non-reductionist operations, reductionist procedures are needed. Integrated (non-reductionist and reductionist) methods can (i) distinguish data subsets that differ immunologically and statistically; (ii) differentiate false-negative from -positive errors; (iii) discriminate disease stages; (iv) capture in vivo, multilevel interactions that consider the patient, the microbe, and antibiotic-mediated responses; and (v) assess dynamics. Integrated methods provide repeatable and biologically interpretable information.

Would We Even Know Moral Bioenhancement If We Saw It?

The term "moral bioenhancement" conceals a diverse plurality encompassing much potential, some elements of which are desirable, some of which are disturbing, and some of which are simply bland. This article invites readers to take a better differentiated approach to discriminating between elements of the debate rather than talking of moral bioenhancement "per se," or coming to any global value judgments about the idea as an abstract whole (no such whole exists). Readers are then invited to consider the benefits and distortions that come from the usual dichotomies framing the various debates, concluding with an additional distinction for further clarifying this discourse qua explicit/implicit moral bioenhancement.

Primum non nocere. The case for a critical approach to global mental health

The Movement for Global Mental Health (MGMH) argues that there is a moral imperative that psychiatric treatments should be made available to all communities across the world. But psychiatric theories, categories and interventions emerged in the Western world are based on a set of assumptions about the nature of the self and society, nature and the supernatural, health and healing that are not universally accepted. In this paper we argue that there is a stronger moral case for caution with regard to the export of psychiatric thinking. Without a critical interrogation of such thinking the MGMH is at risk of doing a great deal of harm to the diverse, and sometimes fragile, systems of care that already exist across the world.

The Road to Certainty and Back

The author relates his intellectual journey from eye-testing clinician to experimental vision scientist. Starting with the quest for underpinning in physics and physiology of vague clinical propositions and of psychology's acceptance of thresholds as "fuzzy-edged," and a long career pursuing a reductionist agenda in empirical vision science, his journey led to the realization that the full understanding of human vision cannot proceed without factoring in an observer's awareness, with its attendant uncertainty and open-endedness. He finds support in the loss of completeness, finality, and certainty revealed in fundamental twentieth-century formulations of mathematics and physics. Just as biology prospered with the introduction of the emergent, nonreductionist concepts of evolution, vision science has to become comfortable accepting data and receiving guidance from human observers' conscious visual experience.