Causal reasoning and the diagnostic process

Background: Causal reasoning as a way to make a diagnosis seems convincing. Modern medicine depends on the search for causes of disease and it seems fair to assert that such knowledge is employed in diagnosis. Causal reasoning as it has been presented neglects to some extent the conception of multifactorial disease causes. Goal: The purpose of this paper is to analyze aspects of causation relevant for discussing causal reasoning in a diagnostic context. Procedures: The analysis will discuss different conceptions of causal reasoning in medical diagnosis, discriminating primarily between narrow causal diagnosis and more thorough causal explanation. The theory of causes as non-redundant factors in effective causal complexes is used as an analytical background. Causal explanations are performed according to different causal models. Such models of diagnosis are assumptions concerning structure and mechanisms, which cannot be directly or immediately observed. Conceptions and results of causal search strategies differ, according to the focus of the searcher. Causal reasoning is also seen in diagnosis in a more extensive meaning: the pin-pointing of factors responsible for the condition of the patient at any time during the course of disease. Conclusion: Causal reasoning and diagnosis go well in hand, especially if both concepts are widened. The theory of causes as non-redundant components in effective causal complexes, modulated by what is referred to as the stop problem and causal fields, is valuable for explaining the many aspects of causal reasoning in medical diagnosis.     

Choice,the Invisible Element in Our Work

Unless they use a highly structured approach, psychotherapists make choices all the time in their work, but the role of choice is neglected in the professional literature. Because choices tend to issue under the radar, sometimes as personal enactments, our profession could benefit from examining them. This is especially true for leaders of therapy groups where there are pressures to align with conventional perspectives of pathology, of popular “goodness” and “badness.” Two important influences on our decisions here are milieu—the historical period in which we work—and our clinical identity (training, personality, identifications and practical experience). It is to reinforce these that we often make our choices.     

Causality in medicine: Towards a theory and terminology

One of the cornerstones of modern medicine is the search for what causes diseases to develop. A conception of multifactorial disease causes has emerged over the years. Theories of disease causation, however, have not quite been developed in accordance with this view. It is the purpose of this paper to provide a fundamental explication of aspects of causation relevant for discussing causes of disease. The first part of the analysis will discuss discrimination between singular and general causality. Singular causality, as in the specific patient, is a relation between a concrete sequence of causally linked events. General causation, e.g. as in disease etiology, means various categories of causal relations between event types. The paper introduces the concept of a reference case serving as a source for causal inference, reaching beyond the concept of general causality. The second part of the analysis provides exemplification of a theory of causation suitable for discussing singular causation. The chain of events that induce a disease state can be identified as effective causal complexes, each complex composed of nonredundant components, which separately contribute to the effect of the complex, without the individual component being necessary or sufficient in itself to produce the effect. In the third part of the analysis the theory is elaborated further. Causes, defined as nonredundant components, can furthermore be differentiated according to their avoidability, according to theories about human error or by the potential of eradication. Multifactorial models of disease creates a need for systematic approaches to causal factors. The paper proposes a taxonomical terminology that serves this purpose.     

What is a writing group? Dilemmas of the leader

A writing group can serve to reinforce literary and therapeutic goals. The model outlined here assumes a leader with literary and clinical training, including expertise in group dynamics. The group format is adapted to support exploration of the writer's main problem, the absence of the reader at the moment of writing. The group modifies the writer's "mythical" reader through member interactions with writer and writing. Giving and receiving feedback are central to the group process. The leader's dilemma in a bifocal form like this is to know when and how far to interpret group members' psychological issues. The best rule is to interpret "toward" the group (i.e., to bring up material that can be safely and readily processed there), but to be cautious about interpretation of patterns of early character formation.