Tacit knowledge and clinical reasoning in psychiatry

Clinicians constantly shift the focus of their attention when seeing a patient with a putative mental disorder. Arguably, it is not possible to tell in advance (that is, before quite a while in the diagnostic assessment process) where the problem lies, whether it is necessary to zoom in and look into the patient’s brain, or if we have to zoom out and pay special attention to his/her relational world, or even if we should stop anywhere in between these two endpoints. After all, we are dealing with embodied subjects and their actions within context, not merely bodily dysfunctions. However, if we reject reductionism, that is, the very idea that there is a single fundamental level of explanation for all mental disorders, and adopt instead a multilevel model within a pluralist explanatory stance, we must be able to account for the changes of level operated in clinical practice in order to avoid potential charges of subjectivism and eclecticism. In this paper, we examine whether or not such changes of explanatory levels can be fully codified or, in other words, to which extent they inevitably rely on tacit knowledge.