Reductionism by default: how implicit metaphysical assumptions influence psychiatric practice

Context and relevance. Modern psychiatry exists in permanent conceptual crisis rooted in the "hard problem of consciousness". This crisis manifests clinically through a progressive decline in phenomenological analysis and the dominance of unreflected reductionism, often masked by pragmatism and clinical consensus. Purpose: To conduct preliminary mapping of worldview positions among practicing psychiatrists regarding key philosophical issues in psychiatry and to develop a methodological framework for their further study. Methods: A cross-sectional anonymous online survey of 120 practicing psychiatrists (including residents and early-career specialists) was conducted using an original questionnaire designed to identify both explicit and implicit attitudes. Analysis included descriptive statistics, hierarchical cluster analysis (Ward's method), and link analysis using Pearson's χ² with Bonferroni correction. Results: The study revealed internal contradictions and eclecticism in worldview positions. While biological reductionist positions dominated (69.1%), a significant proportion of respondents demonstrated contradictory attitudes, particularly widespread implicit functionalism and views incompatible with physicalism (40% of total sample. The research also shows a weak link between philosophical views and clinical attitudes, indicating that clinical decisions are determined not by philosophical reflection but rather by systemic constraints, educational standards, and pragmatic simplified choices. Conclusions: The documented dominance of unreflected reductionism reflects psychiatry's systemic crisis and necessitates intentional integration of philosophical reflection into psychiatric education and clinical practice.

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