臺灣博碩士論文加值系統

這篇論文主要意圖為提出一個憂鬱症之初步模型（Model），相較於其他模型，此初步模型能更好地處理憂鬱症之異質性（heterogeneity）的問題。首先我將檢視憂鬱症之異質性問題，這個問題同時也是對於《精神疾病診斷與統計手冊》第五版（The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition）的一個批評；我會先在概念上分析憂鬱症之異質性，然後分別討論並且評價兩種現有的研究進路如何處理此問題，此兩種研究進路分別為現象學進路（phenomenological approach）以及精神醫學進路（psychiatric approach）。現象學進路最初的意圖在於補充DSM-5的不足，但該進路在最終卻形塑了自身對於憂鬱症之解釋；我將試圖論證現象學進路沒有成功補充DSM-5，原因在於兩者的問題意識並不一樣，現象學進路將異質性理解為同一性問題，然而DSM-5所引起的異質性實際上是一個分類系統的問題。另一方面，精神醫學進路或許能提供一些解決方案，其中一個方案是建構精神疾病的因果機制模型（causal mechanistic model），但是究竟如何建構因果機制模型仍處於爭論中。本文將援引William Bechtel所倡導的「動態機制解釋論」（dynamic mechanistic explanation），並將該理論視作一個新的科學解釋框架，以之重新看待憂鬱症。在這個框架中，我將試圖提出個人對於憂鬱症的觀點：憂鬱症是一種心理機制（mental mechanism）的缺陷。我將透過兩個步驟來論證我的觀點：首先，我將在動態機制解釋論的規範下建構一個憂鬱症的初步模型，並且闡述所謂的心理機制缺陷實際上關涉到的情況是憂鬱症患者無法形構新的經驗，但是正常人可以。其次，我將展示我所提出的初步模型如何能夠相容於普遍被觀察到的憂鬱現象，並且額外討論一些特殊情況。

This thesis aims to propose a model of depression that can address the concern about the heterogeneity of depression better than the other models. I first examine the heterogeneity of depression, which is one of the critiques to DSM-IV-TR/DSM-5. I will start with analyzing the concept of heterogeneity of depression. I will then turn my focus to two available accounts, and evaluate how they handle the heterogeneity. The two accounts are: the phenomenological approach and the psychiatric approach. The phenomenological approach originally attempts to supplement DSM-5, but forms its own explanation of depression at the end. I argue that the phenomenological approach fails to supplement DSM-5 successfully because it understands heterogeneity as a problem of identity, but heterogeneity in DSM-5 is actually a problem of classification system. On the other hand, the psychiatric approach may have solutions to the heterogeneity. One solution is to build a causal mechanistic model of mental disorder. But it is still under debate regarding how to build this kind of model. In this thesis, I will apply what William Bechtel called “dynamic mechanistic explanation” as a new explanatory framework for depression. I will use this framework to elaborate my own thesis: Depression is a defected mental mechanism. I will defend my thesis by completing the following two tasks. First, I will build a preliminary model for depression under the framework of dynamic mechanistic explanation, and suggest that this defect involves the condition in which depressed subjects cannot produce new experience, as non-depressed subjects can. Second, I will employ this proposed model to show how it can accommodate the commonly observed depressive phenomena, including some difficult cases.

目 錄
摘要………………………………………………………………………i
Abstract……………………………………………………………………ii
目錄………………………………………………………………………iii
圖目錄……………………………………………………………………v
前言………………………………………………………………………1
第一章 憂鬱症現有之問題：異質性……………………………………3
第一節 什麼是異質性？……………………………………………4
第二節 臨床診斷上的異質性………………………………………10
第三節 異質性是個問題嗎？………………………………………12
第四節 異質性重要嗎………………………………………………15
第二章 如何處理異質性：精神醫學現象學進路………………………21
第一節 Ratcliffe對於憂鬱症的研究………………………………22
第二節 Ratcliffe對於DSM-5的質疑……………………………26
第三節 DSM-5之中的同一性議題………………………………31
第四節 Ratcliffe能解決異質性嗎…………………………………37
第五節 Ratcliffe的憂鬱症問卷研究………………………………41
第三章 如何處理異質性：精神醫學因果機制論進路………………45
第一節 精神醫學中的因果機制論………………………………46
第二節 因果機制論的爭論………………………………………53
第三節 Bechtel的動態機制論…………………………………55
第四節 動態機制論與憂鬱症……………………………………60
第四章 憂鬱症機制……………………………………………………63
第一節 Bechtel的Mental Mechanisms……………………64
第二節 發展一個憂鬱症的動態機制論解釋……………………70
第三節 重要現象…………………………………………………75
第四節 我的論點和模型的優點和缺點………………………79
第五節 可能的質疑與整體回顧討論…………………………81
結語………………………………………………………………………84
參考文獻…………………………………………………………………85

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