Psychiatric Models: Reconciling Neurobiology, Metaphor, and Uncertainty

Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neuroessentialist models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. Despite calls for explanatory pluralism as a philosophical structure for psychiatry, neurobiology continues to hold an elevated status among psychiatrists and the public alike. New approaches are needed to reconcile neurobiological models with the uncertainty of science, clinical practice, and the knottiness of finding language to describe (let alone explain) the experience of mental illness. To address this conceptual gap, we draw upon interdisciplinary sources to examine the meta-cognitive process of explanatory reasoning that clinicians and their patients use to develop models of the mind. We propose a clinical approach to explanatory reasoning based on logical inference, the considered use of metaphor, and the tolerance of uncertainty. Our goal is to bring attention to the possibility that uncertainty, metaphor, and neurobiological models share a common logical framework, and that their reconciliation has the potential to enrich our understanding of mental life and clinical practice.