Philosophical and Empirical studies towards a new thinking- and working model on psychopathology

During my work as a clinician, I was confronted with the limitations of our current thinking model. Supported by my background in philosophy, I began to question the fundamentals of psychopathology. Through my work with patients, I experienced that nosological categories provide support, but do not seem to correspond with the everyday reality of mental disorders. The current classification systems, like the DSM-5, reason from a medical model. In this model, the root cause of a disorder is thought to be a latent disease-entity, like a tumour or virus. However, after decades of research, a similar single latent disease-entity has not been found for mental disorders. My reflection on the fundamentals of psychopathology has resulted in the publication of two articles and from this, the idea originated to further elaborate on the subject through a PhD thesis. This has resulted in an honorary position at Maastricht University together with a part-time position as a GZ-Psychologist at GGZ Momentum. My research master in philosophy of science combined with my education and experience as a GZ-psychologist generate a unique profile that could offer an innovative angle and approach. The primary aim of this research project is to improve the mental health care system by the development of an alternative thinking and working model on psychopathology. This model will be more precise, personalised, and aligned with the unique biological, social and personal factors of the patient. The second aim is to improve treatment through increased participation of patients. Thirdly, this research project aims to bridge the gap between clinical practice and scientific research in order to continuously transfer, develop and implement knowledge. Within the current thinking and working model, patients are diagnosed and treated according to a psychiatric label. Meanwhile, patients within the same disorder category can differ more from each other than patients in another disorder category in terms of biological, personal and social factors. The current diagnostic process is not tailored towards these individual features of the patient, while the effectiveness of a treatment rests on the accuracy of its diagnostics. Treatments based on a more precise and personalised model might be more effective and can in effect prevent escalation of complaints, recidivism, chronicity and long treatments. The increased participation of patients will increase self-control and resilience, reducing the demand on the mental health care system. In general, this might lead to a substantial reduction in health care costs and improved work participation and well being of patients. The research design proposed below will consist of two parts. The first part is a theoretical reflection in order to develop a new thinking model, while the second part is empirical research in order to develop a new working model. The two published articles that will form the first two chapters of my doctoral thesis are theoretical reflections on the foundations of psychopathology. The first article focuses on a set of crucial psychological concepts: intelligence and related terms such as mental deficiency. The second article pertains to the way psychiatric classifications are constructed through the analysis of a case study. This theoretical approach will be extended in the third chapter by analysing the concept of personality disorders and co- and multimorbidity. Alternative perspectives will be considered and the theoretical part will be concluded with the introduction of a new thinking model. The empirical part of this thesis begins in chapter four with research on comorbidity (depression and borderline personality disorder) as seen through the lens of a network approach. This research will be conducted together with methodological experts from the University of Amsterdam. Chapter five will address patient participation through N=1 studies by measuring daily fluctuations in symptomatology in collaboration with the University of Groningen. During this research, patients will make use of an app to report their daily mood and behaviour. This chapter will be concluded with the introduction of a new working model. The sixth chapter will consist of qualitative research on the notions of patients and clinicians on psychopathology and their views on the most effective paths towards recovery. In the meantime, the Momentum Academy will be launched to bridge the gap between clinical practice and scientific research. The Academy offers the possibility to further develop and test the working model (scientific implementation). Meanwhile the scientific insights that evolve from this project can be put into practice (practical implementation). The knowledge that will evolve from this project will become a part of the Momentum Academy and developed into educational modules that will be offered to professionals, universities and other institutions of higher education (educational implementation).