Alberto Monterde-Fuertes

La depresión es una epidemia silenciosa y los Millennials y la Generación Z son generaciones deprimidas. Tras estas afirmaciones realizadas en medios de comunicación se encuentra la idea de que la depresión es una epidemia. Esta percepción ha generado tanto un rechazo social como una crítica académica a la psiquiatría. Sin embargo, argumentaré que la depresión no es una epidemia y que la siguiente hipótesis explica el fenómeno actual: las implicaciones prácticas de los problemas epistémicos presentes desde la medicalización de la depresión no han sido revisados. Para ello me apoyo en artículos epidemiológicos sobre la epidemia de depresión y la percepción del aumento de casos de depresión. Estos estudios impiden afirmar la condición epidémica de la depresión y buscan hipótesis explicativas alternativas. Estas hipótesis están relacionadas con los problemas epistémicos de la psiquiatría. Dicha relación se conformó a través de valores no epistémicos en el proceso de medicalización de la depresión. Los problemas epistémicos que implicaban los valores no epistémicos no se han corregido. Esta revisión permite proponer que el proceso de medicalización de la depresión comparte características con un proceso de farmaceuticalización y disease mongering. Estos procesos de medicalización se caracterizan por la falta de rigor epistémico.

This dissertation addresses the problems related to the persistent conflation of pain and nociception in pain science and medicine. Despite decades of explicit attempts to distinguish them, scientific explanations and research practices continue to identify pain with nociceptive mechanisms, and no satisfactory account exists of why this issue persists. I argue that the source of this persistence lies in the reductive simplifications on which pain research depends. These simplifications are methodologically necessary, but when their results are extended beyond the domain that justified them, they generate onto-epistemic conclusions about the nature of pain that the original simplifications do not support. To develop this diagnosis, I first address a prior methodological question: how to carry out Engaged Philosophy of Science in a field with no established philosophical tradition. From a systematic analysis of existing work in the field, I derive a set of methodological heuristics that structure the analysis developed throughout the dissertation. Following these heuristics, I reconstruct the twentieth-century controversy over pain specificity and show that standard reconstructions overlook clusters of dissent in which the pain-nociception conflation persistently surfaces, whether explicitly addressed or implicitly at stake, which means the dominant narrative of the field cannot explain why that conflation persists. I then develop the framework of pragmatic reduction to account for how reductive simplifications can be simultaneously necessary and problematic, and apply it to pain research to identify a recurrent pattern of a posteriori reductionism in which simplifications originally adopted for bounded methodological purposes are gradually extended until they become claims about the nature or sufficient explanation of pain. Existing conceptual proposals have not interrupted this pattern because they operate at the discursive level without reconfiguring the practices that generate it. To resolve the conflation, I propose moving the distinction between pain and nociception from a basis in subjective experience to a functional one. After critically examining existing functional ascriptions in pain science and philosophy of mind and finding them inadequate, I develop an alternative grounded in the framework of biological autonomy, on which nociception has the organizational function of detecting physicochemical perturbations that threaten tissue integrity and producing immediate protective responses that preserve organizational closure, while pain has the qualitatively distinct organizational function of reorganizing the organism's priorities when nociceptive input acquires sufficient organizational weight in its integration with the system's other demands, extending protection to prolonged temporal scales.

Philosophers of science are increasingly pursuing engaged work that addresses scientific and societal challenges. Previous scholarship has mapped forms of engagement and proposed reforms to enhance its impact. This paper examines the methodological decisions structuring engaged inquiry through qualitative content analysis of 40 peer-reviewed publications from Socially Relevant/Socially Engaged Philosophy of Science (SRPoS/SEPoS), Field Philosophy, and Philosophy in Science. I identify five recurring heuristics: problem-oriented framing, audience-tailored framing, context-sensitive integration, methodological modulation, and normative structuring. These capture higher-order methodological decisions with implications for how engaged philosophy of science is understood, evaluated, and taught.

Desde mediados del siglo XX ha aumentado progresivamente la incidencia y prevalencia de la depresión y se ha llegado a considerar que existe una epidemia de depresión. Los autores que han analizado esta idea consideran que la evidencia no avala tales extremos, pero señalan diferentes factores explicativos propios del desarrollo histórico de la psiquiatría, de su situación interna y de su relación con la sociedad. Tales explicaciones guardan similitud con las características propias de un proceso de disease mongering que se define por ampliar las fronteras de la enfermedad para expandir los mercados. Mostraré como una revisión del desarrollo histórico de la psiquiatría, en relación con estas posibles hipótesis explicativas, permite afirmar que ciertas actitudes o situaciones han podido fomentar un proceso de disease mongering asociado a intereses privados y valores de los agentes relevantes en el desarrollo de la psiquiatría en cuestiones como: creación de un método diagnóstico, innovación farmacológica y regulación de nuevos fármacos. Sin embargo, debido a limitaciones conceptuales o epistémicas, no se puede realizar una afirmación más fuerte.

Pain science and management have long grappled with significant conceptual challenges, particularly the differentiation of pain from nociception. This chapter addresses this challenge by adopting the framework of biological autonomy, which conceptualizes living systems as self-regulating entities dynamically interacting with their environments. From this perspective, pain emerges as a context-sensitive phenomenon that protects autonomy by guiding adaptive behavior and anticipating future threats. In contrast, nociception is a mechanistic process that transduces and transmits noxious stimuli to elicit protective reflexes. By integrating insights from pain research, medicine, and philosophy, the chapter advances a relational and functional understanding of pain while outlining its practical implications.

This paper proposes a philosophical interpretation of scientific controversies in pain research and management by examining underlying philosophical notions. Pain scholars typically frame these disagreements within the dichotomy of Aristotelian versus Cartesian perspectives on pain. However, I contend that such a dichotomous interpretation overlooks crucial elements of twentieth-century discussions. I posit that the limits of reductionism is a central philosophical theme persisting across both past and present scientific controversies in pain research and medicine. Through analyzing the scientific disagreements between groups of scientists within the scholarship of pain, the paper aims to demonstrate that underlying philosophical notions play a significant role in shaping these controversies. This approach highlights the relevance of philosophical ideas for understanding scientific debates, ultimately aiming to foster communication and collaboration between philosophy and science.