As I stated in my previous post,
the second major content theme in The Atlas of Social Complexity is the Dynamics of Human Psychology. So far
for this theme, I’ve given a basic overview, found here. I then moved on to the first theme, Human psychology as dynamical system (Chapter 13).
The focus of this post is Chapter
14: Psychopathology of mental disorders.
OVERVIEW OF CHAPTER
Chapter 14 explores the question:
What is a mental disorder and how best should we assess it in terms of social
complexity?
The field of psychopathology (also sometimes referred to as
abnormal psychology) is the formal term for the study of mental disorders.
Subfields include developmental, child, adolescent, and adult psychopathology.
The general focus across all these sub-fields is on ‘abnormal’ states of
thinking, feeling and behaving, particularly within a clinical context – with
an awareness that our conceptualisation of what is ‘abnormal’ is deeply
connected to our interpersonal relationships, community, culture and sociohistorical
context.
There is general agreement that,
when it comes to psychopathology, what matters most is that a person is
legitimately troubled by their emotional, cognitive, behavioural or social
difficulties. In short, they are suffering.
There is less agreement, however,
on what constitutes a mental disorder. For example, are a person’s psychological
difficulties a brain disease or latent psychological construct? Or are they a
scientific classification that points to the clustering of sets of
psychological symptoms that have no fundamental underlying biological
existence? The former view has historically dominated. The latter – referred to
as the new science of mental disorders – is fast becoming the major
alternative, with the potential to override the former.
Mental Health Symptom Networks
The
network science of psychopathology got its start in the Psychology Department
at the University of Amsterdam with the publication of two key articles.
The first, in 2008, was Denny Borsboom’s Psychometric perspectives on
diagnostic system. While breaking new ground, the concept of networks
remained unarticulated in it. A more
complete statement arrived with the second publication, in 2010, led by
Angélique Cramer. It
is at this point that this approach really takes off.
It is fitting that the title of Cramer and colleagues’ article is Comorbidity:
A network perspective, as symptom overlap is one of the primary reasons the
network approach was created. As Robinaugh and colleagues state, “The network
approach to psychopathology began a decade ago with a simple hypothesis: symptoms
may cohere as syndromes because of causal relations among the symptoms
themselves”.
From this perspective, they explain, “symptoms are not passive indicators of a
latent ‘common cause’; they are agents in a causal system”. Despite the significant advance over the last 13 years, the idea
of mental disorders being a collection of symptoms, many of which are shared by
or part of the symptom networks of other mental disorders, remains central for
this approach. There is no underlying latent construct and no single-cause
explanation for any mental health diagnostic category. There are only symptoms.
During the next thirteen years, the network approach would quickly
become a major contender for the definition and diagnosis of psychopathology as
well as a counterpoint to conventional approaches in psychometrics, with
articles being published widely. Symptom network analysis has been applied to
depression, schizophrenia, post-traumatic stress disorder, anxiety, psychosis,
sleep disorders, autism, bipolar disorder, and a variety of comorbid mental
health conditions.
This widespread adoption is demonstrated
well by the fact that Cramer and colleagues published a second article in Behavioral
and Brain Sciences in 2019.
Controversies, Challenges and an Agenda for Moving
Forward
When the symptom
network approach to psychopathology first emerged, its novelty was its virtue.
Here, suddenly, was a way to use the latest advances in complex network
analysis to think about mental disorders that felt authentic to clinical
intuitions and experience. Research
collided with practice, a rare event.
Nevertheless,
there are a list of challenges that need to be addressed. Here is a list of the
topics addressed in Chapter 14.
1. Statistical equivalence.
2. The
limits of centrality measures.
3. Symptoms can be latent variables.
4. The problem of reductionism.
5. Where is the social?
6. Timing, dynamics and time scales.
7. Reproducibility and replicability.
8. Therapeutically targeting symptoms.
Why Embrace this Approach?
Within
the soft transdiagnostic camp, the symptom
network approach is, for us, the more viable route for those interested in the
study of social complexity. And we say this despite the fact that this approach
has some considerable challenges to address – which we just listed. Here is our
rationale:
First
and foremost, given its grounding in the complexity sciences, the network
approach to psychopathology fits with the theoretical synthesis we have so far
stitched together.
Second,
this approach avoids the trap that the hierarchical
latent variable approach falls into,
given that the latter is still, ironically enough, in search of a more
fundamental set of causal factors to explain mental disorders.
Third, while we appreciate the hard
transdiagnostic camp’s attempt to revolutionise diagnostic nomenclature, its
argument is doomed. It will never happen.
Finally,
despite the flaws of the network approach, we will show that its problems can
be fixed, oddly enough, by making better use of complex networks.
Our
approach in Chapter 14 is to sidestep the theoretical shallowness of symptom
networks by embracing a hierarchical network approach, which stiches together
not only the biological and neuropsychological levels of human psychology but
also, moving into the next major section of the Atlas, the social.
Still, despite the advances made by the symptom network
literature, the social is still deafeningly missing from everyone’s work.
Transdiagnostic approaches need to stop treating the social as a trigger for
psychopathology, and see it, instead, as core to its formation.
KEY WORDS: symptom networks,
psychopathology, network theory, psychometrics, transdiagnostic psychiatry and
psychology, network science of mental disorders.
Angélique O. J. Cramer et
al., ‘Comorbidity: A Network Perspective’, Behavioral and Brain Sciences
33, no. 2–3 (June 2010): 137–50.
Donald J. Robinaugh et al.,
‘The Network Approach to Psychopathology: A Review of the Literature 2008–2018
and an Agenda for Future Research’, Psychological Medicine 50, no. 3
(February 2020), .p.
353.
