The Monoamine Hypothesis, Placebos and Problems of Theory Construction in Psychology, Medicine, and Psychiatry :: Psychological Medical Psychiatric Essays

The Monoamine Hypothesis, Placebos and Problems of Theory Construction in Psychology, Medicine, and Psychiatry ABSTRACT: Can there be scientific theories in psychology, medicine or psychiatry? I approach this question through an in-depth analysis of a typical experiment for clinical depression involving the monoamine hypothesis, drug action, and placebos. I begin my discussion with a reconstruction of Adolph Grà ¼nbaum's conceptual analysis of 'placebo,' and then use his notion of "intentional placebo" to discuss a typical experiment using the monoamine hypothesis, two drugs and a placebo. I focus on the theoretical aspects of the experiment, especially on the notion of causal explanation. I then raise five conceptual and methodological problems for theory construction. These problems focus on questions of the causal efficacy of placebos and drugs; ad hoc versus ceteris paribus explanations in biomedicine and psychology; and the falsifiability of the monoamine hypothesis. I conclude by pointing out the need for further, rigorous philosophical analysis concerning the possibility of theory con struction in psychology, medicine, or psychiatry. I. Introduction Can there ever be scientific theories in psychology, medicine, or psychiatry? I argue that one approach to answering this question consists of investigating the nature of such purported theories and I focus on the monoamine hypothesis of clinical depression. (1) By a careful examination of a typical experiment involving the action of drugs and placebos for the cure of clinical depression-an experiment founded upon the monoamine hypothesis-I raise a number of methodological and conceptual problems that may lead one to conclude that rigorous scientific theories in these three disciplines may never be forthcoming, or at least that the state of scientific research in these areas is still in very rudimentary shape and in need of much logical and philosophical analysis. In addition, because no such biomedical theories may be forthcoming, I also undercut Adolf Grà ¼nbaum's analysis of the concept of a placebo, an analysis that makes the definition of "placebo" relative to a biomedical theo ry in the first place. I begin in section 2 by discussing Grà ¼nbaum's detailed analysis of what a placebo is. I then use his idea of a generic intentional Placebo and discuss one of many similar experiments concerning the phenomenon of clinical depression, experiments that use the monoamine hypothesis and the notion of a generic intentional placebo. This experiment is described in section 3. In section 4 I analyze the results of this study and in section 5 I offer concluding remarks.