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Mindlessness and Brainlessness in Psychiatry

Published online by Cambridge University Press:  29 January 2018

Leon Eisenberg
Leon Eisenberg*
Affiliation:
Department of Social Medicine and Health Policy, Harvard Medical School, Boston, Massachusetts 02115, USA
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Extract

The theme of this address—that brain and mind are as warp and woof in the fabric of psychiatry—may seem so much a truism as to be a banal choice. I think not. Despite the lip service paid to brain-mind integration, its implications are daily contravened in both theory and practice. At least, this is so in the country where I reside. If the problem is more extreme in the States, as most everything seems to be, recall the words Sir Aubrey Lewis (1953) wrote in commenting on Anglo-American contrasts, some 30 years ago: “the chief differences between your psychiatric scene and ours are differences only of quantity and tempo.” Think of me, then, as an anthropologist describing an exotic foreign culture and reporting on the strange customs of the natives, in hope of shedding light on your own.

Type
Lecture
Information
The British Journal of Psychiatry , Volume 148 , Issue 5 , May 1986 , pp. 497 - 508
Copyright
Copyright © 1986 The Royal College of Psychiatrists 

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References

Aghajanian, G. K. (1985) Modulation of a transient outward current in serotonergic neutrons by alpha1-adrenoreceptors. Nature. 315, 501–503.CrossRefGoogle Scholar
Almy, T. P. (1981) The role of the primary physician in the health care “industry”. New England Journal of Medicine. 304, 225–228.CrossRefGoogle ScholarPubMed
APA Newsletter, 14, No. 5 (1962) Washington, DC: American Psychiatric Association, January.Google Scholar
Appel, K. E. & Pearson, M. M. (1959) Facilities for psychiatric education: survey of psychiatric departments in medical schools. American Journal of Psychiatry, 115, 698–705.CrossRefGoogle ScholarPubMed
Arana, G. W., Baldessarini, R. J. & Ornsteen, M. (1985) The dexamethasone suppression test for diagnosis and prognosis in psychiatry: commentary and review. Archives of General Psychiatry. 42, 1193–1204.CrossRefGoogle ScholarPubMed
Ariel, R. N., Golden, C. J., Berg, R. A. et al (1983) Regional blood flow in schizophrenics. Archives of General Psychiatry, 40, 258–263.CrossRefGoogle ScholarPubMed
Avery, D. H., Osgood, T. B., Ishiki, D. M. et al (1985) The DST in psychiatric outpatients with generalized anxiety disorder, panic disorder or primary affective disorder. American Journal of Psychiatry. 142, 844–848.Google ScholarPubMed
Barrowclough, C. & Tarrier, N. (1984) Psychosocial interventions with families and their effects on the course of schizophrenia: a review. Psychological Medicine. 14, 629–642.CrossRefGoogle ScholarPubMed
Barton, W. E. & Malamud, W. (eds.) (1963) Training the Psychiatrist to Meet Changing Needs. Washington: American Psychiatric Association.Google Scholar
Beck, A. T., Shaw, A. J., Rush, B. F., et al (1979) Cognitive Therapy of Depression. New York: Wiley.Google Scholar
Beck, A. T. Hollon, S. D., Young, J. E., et al (1985) Treatment of depression with cognitive therapy and amitriptyline. Archives of General Psychiatry. 42, 142–148.CrossRefGoogle ScholarPubMed
Berretini, W. H., Goldin, L. R., Nurnberger, J. I. et al (1984) Genetic factors in affective illness. Journal of Psychiatric Research, 18, 329–350.CrossRefGoogle Scholar
Bloom, F. E. (1984) The functional significance of neurotransmitter diversity. Cell Physiology, 15, 184–194.CrossRefGoogle Scholar
Bohr, N. (1932) Life and life. In (1985) Neils Bohr. A Centenary Volume (eds. French, A. P. & Kennedy, P. J.). Cambridge, Massachusetts: Harvard University Press.Google Scholar
Bohr, N. (1949) Discussion with Einstein on epistemological problems in atomic physics. In Albert Einstein: Philosopher-Scientist (ed. Schlipp, P. A.). Evanston, Illinois: Library of Living Philosophers.Google Scholar
Bohr, N. (1962) Light and life revisited. In Neils Bohr: A Centenary Volume. Op cit. p. 319.Google Scholar
Bonn, J. A., Readhead, C. P. A. & Timmons, B. H. (1984) Enhanced behavioural response in agarophobic patients pretreated with breathing retraining. Lancet, ii. 655–669.Google Scholar
Boronow, J., Pickar, D., Ninan, P. T. et al (1985) Atrophy limited to the third ventricle on chronic schizophrenic patients. Archives of General Psychiatry. 42, 266–271.CrossRefGoogle ScholarPubMed
Brown, G. W., Monck, E. M., Carstairs, G. M. et al (1962) Influence of family life on the course of schizophrenic illness. British Journal of Preventive and Social Medicine. 1, 55–68.Google Scholar
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241–258.CrossRefGoogle ScholarPubMed
Brown, G. W. & Harris, T. (1978) Social Origins of Depression. London: Tavistock.Google Scholar
Brown, W. A., Keitner, G., Qualls, B. et al (1985) The dexamethasone suppression test and pituitary-adrenocortical function. Archives of General Psychiatry, 41, 121–123.CrossRefGoogle Scholar
Buchsbaum, M. S., Ingvar, D. H., Kessler, R. et al (1982) Cerebral glucography with positron tomography. Archives of General Psychiatry, 39, 251–260.CrossRefGoogle ScholarPubMed
Cade, J. F. J. (1949) Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia, 36, 349–352.Google Scholar
Changeux, J.-P. (1985) Neuronal Man: The Biology of Mind. New York: Pantheon.Google Scholar
Charney, D. S., Heninger, G. R. & Breier, A. (1984) Noradrenergic function in panic anxiety. Archives of General Psychiatry, 41, 751–763.CrossRefGoogle ScholarPubMed
Charney, D. S. & Jatlow, P. I. (1985) Increased anxiogenic effects of caffein in panic disorders. Archives of General Psychiatry. 42, 233–243.CrossRefGoogle Scholar
Clark, M. L. (1985) Upper intestinal endoscopy, Lancet. i, 629.CrossRefGoogle Scholar
Cunningham, B. A. (1985) Molecular biology of cell adhesion molecules. Presentation at the Annual Meeting of the Association for Research in Nervous and Mental Disease. New York City, 7 December.Google Scholar
Davis, J. M. & Maas, J. W. (eds.) (1983) Affective Disorders. Washington, DC: American Psychiatric Press.Google ScholarPubMed
Descartes, R. (1649) The passions of the soul. In Philosophical Works, Vol. 1. Translated by Haldane, E. S. & Ross, G. R. T. New York: Dover.Google Scholar
Deutsch, A. (1944) The history of mental hygiene. In One Hundred Years of American Psychiatry (eds. Hall, J. K., Zilboorg, G. & Bunker, H. A.). New York: Columbia University Press.Google Scholar
Easter, S. S., Purves, D., Rakic, P. et al (1985) The changing view of neural specificity. Science, 230, 507–511.CrossRefGoogle ScholarPubMed
Edelman, G. M. (1984) Cell adhesion molecules: a molecular basis for animial form. Scientific American, 250, 118–129.CrossRefGoogle Scholar
Eisenberg, L. (1962) If not now, when? American Journal of Orthopsychiatry, 32, 781–793.CrossRefGoogle ScholarPubMed
Eisenberg, L. (1970) Disease and illness: distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry, 1, 9–23.CrossRefGoogle ScholarPubMed
Eisenberg, L. (1973) Psychiatric intervention. Scientific American, 229, 116–127.CrossRefGoogle ScholarPubMed
Eisenberg, L. (1977a) The social imperatives of medical research. Science, 198, 1105–1110.CrossRefGoogle ScholarPubMed
Eisenberg, L. (1977b) Development as a unifying concept. British Journal of Psychiatry, 131, 225–237.CrossRefGoogle ScholarPubMed
Eisenberg, L. (1977c) The search for care. Daedalus, 106, 235–246.Google Scholar
Eisenberg, L. (1980) What makes persons “patients” and patients “well”? American Journal of Medicine, 69, 277–286.CrossRefGoogle ScholarPubMed
Ewald, D. A., Williams, A. & Levitan, I. B. (1985) Modulation of single Ca2+-dependent K+-channel activity by protein phosphorylation. Nature, 315, 503–506.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W. et al (1982) Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine. 306, 1437–1440.CrossRefGoogle ScholarPubMed
McGill, C. W. (1985) Family management in the prevention of morbidity of schizophrenia: clinical outcome of a two-year longitudinal study. Archives of General Psychiatry. 42, 887–896.Google Scholar
Frank, J. D. (1961) Persuasion and Healing: A Comparative Study of Psychotherapy. Baltimore: The Johns Hopkins Press.Google Scholar
Freud, S. (1914) On narcissism: an introduction. In Collected Papers, Vol. IV. London: Hogarth Press.Google Scholar
Funkenstein, D. (1976) Medical students, medical schools and the issues facing psychiatry. Working Papers of the 1975 Conference on the Education of the Psychiatrist. Washington: American Psychiatric Association.Google Scholar
Gelder, M. G., Marks, I. M. & Wolff, H. H. (1967) Desensitization and psychotherapy in the treatment of phobic states: a controlled inquiry. British Journal of Psychiatry, 113, 53–73.CrossRefGoogle ScholarPubMed
Gottesman, I. I. & Shields, J. (1982) Schizophrenia: The Epigenetic Puzzle. Cambridge: Cambridge University Press.Google Scholar
Gur, R. E., Skolnick, B. E., Gur, R. C. et al (1983) Brain function in psychiatric disorders, I: Regional cerebral mood flow in medicated schizophrenics. Psychiatry, 40, 1250–1254.Google Scholar
Gur, R. E., Gur, R. C., Skolnick, B. E. et al (1985) III Regional cerebral blood flow from unmedicated schizophrenics. Archives of General Psychiatry, 42, 329–334.CrossRefGoogle ScholarPubMed
Hahn, R. A. & Kleinman, A. (1983) Belief as pathogen, belief as medicine: “voodoo death” and “placebo phenomenon” in anthropological perspective. Medical Anthropology, 14, 6–19.Google Scholar
Hirschfeld, R. M. A., Koslow, S. H. & Kupfer, D. J. (1983) The clinical use of the dexamethasone suppression test in psychiatry. Journal of the Ameriocan Medical Association. 250, 2172–2174.CrossRefGoogle Scholar
Hogarty, G. E., Goldberg, S., Collaborative Study Group (1973) Drug and sociotherapy in the aftercare of schizophrenic patients. Archives of General Psychiatry. 28, 54–64.CrossRefGoogle ScholarPubMed
Hudson, J. I., Hudson, M. S., Rothschild, A. J. et al (1984) Abnormal results of dexamethasone suppression tests in non-depressed patients with diabetes mellitus. Archives of General Psychiatry. 41, 1086–1089.CrossRefGoogle Scholar
Kandel, E. R. (1985) Steps toward a biology of learning and of short- and long-term memory. The Thomas William Salmon Lectures, New York City, 5 and 6 December.Google Scholar
Hudson, J. I. & Schwartz, J. H. (eds.) (1985) Principles of Neural Science. New York: Elsevier.Google Scholar
Kanner, L. (1933) The significance of a pluralistic attitude in the study of human behaviour. Journal of Abnormal and Social Psychology, 28, 30–41.CrossRefGoogle Scholar
Kanner, L. (1955) The status of historical perspective in psychiatric instruction. Bulletin of the History of Medicine, 29, 329–336.Google ScholarPubMed
Kappers, J. A. (1979) Short history of pineal research. In The Pineal Gland of Mammals Including Man (eds. Kappers, J. A. & Pevet, P.). New York: Elsevier/North Holland Biomedical Press.Google Scholar
Kety, S. S. (1960) A biologist examines the mind and behavior. Science. 132, 1861–1870.CrossRefGoogle ScholarPubMed
Klein, D. F. & Rabkin, J. G. (eds.) (1981) Anxiety: New Research and Changing Concepts. New York: Raven Press.Google Scholar
Klein, D. F. Zitrin, C. M., Woerner, M. G. et al (1983) Treatment of phobias II: behavior therapy and supportive psychotherapy: are there any specific ingredients? Archives of General Psychiatry, 40, 139–148.CrossRefGoogle ScholarPubMed
Klerman, G. L. (1974) Pharmacotherapy of schizophrenia. Arnual Review of Medicine, 25, 199–217.CrossRefGoogle ScholarPubMed
Klerman, G. L. (1982) The psychiatric revolution of the past twenty-five years. In Deviance and Mental Illness. Vol. 6 (ed. Gove, W.). London: Sage Publications.Google Scholar
Leff, J. P., Kuipers, L., Berkowitz, R. et al (1982) A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.CrossRefGoogle ScholarPubMed
Leff, J. P., Kuipers, L., Berkowitz, R. (1983) Life events, relatives' expressed emotion and maintenance neuroleptics in schizophrenic relapse. Psychological Medicine, 13, 799–806.CrossRefGoogle ScholarPubMed
Leff, J. P., Kuipers, L., Berkowitz, R. (1985) A controlled trial of intervention in the families of schizophrenic patients: a two year follow-up. British Journal of Psychiatry, 146, 594–600.CrossRefGoogle ScholarPubMed
Lewis, A. (1953) Letter from Britain. American Journal of Psychiatry, 110, 401–405.CrossRefGoogle ScholarPubMed
Mai, F. M. (1983) New diagnostic instrument brings psyche into view. Ontario Medical Review, 50, 515–517.Google Scholar
Mann, J. J., Brown, R. P., Halper, J. P. et al (1985) Reduced sensitivity of lymphocyte beta-adrenergic receptors in patients with endogenous depression and psychomotor agitation. New England Journal of Medicine, 313, 715–720.CrossRefGoogle ScholarPubMed
McGuffin, P., Farmer, H. E., Gottesman, I. I., et al (1984) Twin concordance for operationally defined schizophrenia. Archives of General Psychiatry, 41, 541–545.CrossRefGoogle ScholarPubMed
Meyer, A. (1912) Conditions for a home of psychology in the medical curriculum. Presidential Address to the American Psychological Association. Journal of Abnormal Psychology, 7, 313–325.CrossRefGoogle Scholar
Meyer, A. (1956) Psychobiology: A Science of Man. Springfield, Illinois: C. C. Thomas.Google Scholar
Mishina, M., Kurosaki, T., Tobimatsu, T. et al (1984) Expression of functional acetylcholine receptor from cloned cDNAs. Nature, 307, 604–608.CrossRefGoogle ScholarPubMed
Mishina, M., Tobimatsu, T., Imoto, K. et al (1985a) Location of functional regions of acetylcholine receptor alpha-subunit by site-directed mutagenesis. Nature, 307, 364–369.CrossRefGoogle Scholar
Mishina, M., Takahashi, T., Takai, T. et al (1985b) Role of acetylcholine receptor subunits in the gating of the channel. Nature, 318, 538–543.Google Scholar
Mitchell, S. W. (1894) Address before the 50th Annual Meeting of the American Medico-Psychological Association. Journal of Nervous and Mental Disorders, 21, 413–438.CrossRefGoogle Scholar
Murphy, G. E., Simons, A. D., Wetzel, R. D. et al (1984) Cognitive therapy and pharmacotherapy. Archives of General Psychiatry, 41, 33–41.CrossRefGoogle ScholarPubMed
National Institutes of Health (1984) Consensus Development Conference on Mood Disorders: Pharmacologic Prevention of Recurrences, 5, No. 4, April 24–26.Google ScholarPubMed
National Institutes of Health (1985) Consensus Development Conference on Electroconvulsive Therapy, 5, No. II, June 10–12.Google ScholarPubMed
Owens, D. G. C., Johnstone, E. C., Crow, T. J. et al (1985) Lateral ventricular size in schizophrenia. Psychological Medicine, 15, 27–31.CrossRefGoogle Scholar
Phelps, M. E. & Mazziotta, J. C. (1985) Positron emission tomography and human brain function and biochemistry. Science, 228, 799–809.CrossRefGoogle ScholarPubMed
Pitts, F. N. & McClure, J. N. (1967) Lactate metabolism in anxiety neurosis. New England Journal of Medicine, 277, 1328–1336.CrossRefGoogle ScholarPubMed
Reiman, E. M., Raichle, M. E., Butler, F. K. et al (1984) A focal brain abnormality in panic disorder, a severe form of anxiety. Nature, 310, 683–685.CrossRefGoogle ScholarPubMed
Relman, A. S. (1980) The new medical industrial complex. New England Journal of Medicine, 303, 963–970.CrossRefGoogle ScholarPubMed
Reveley, M. A. (1985) CT scans in schizophrenia. British Journal of Psychiatry, 146, 367–371.CrossRefGoogle Scholar
Richardson, B. P., Engel, G., Donatsch, P. et al (1985) Identification of serotinin M-receptor subtypes and their specific blockade by a new class of drugs. Nature, 316, 126–131.CrossRefGoogle Scholar
Rifkin, A., Klein, D. F., Dillon, D. et al (1981) Blockade by Imipramine or desipramine of panic induced by sodium lactate. American Journal of Psychiatry, 138, 767–777.Google ScholarPubMed
Rogers, D. (1985) The motor disorders of severe psychiatric illness: a conflict of paradigms. British Journal of Psychiatry, 147, 221–232.CrossRefGoogle ScholarPubMed
Rosenberg, C. E. (1968) The Trial of the Assassin Guiteau. Chicago: University of Chicago Press.Google Scholar
Rosenfeld, A. H. (ed.) (1976) Psychiatric Education: Prologue to the 1980s. Washington: American Psychiatric Association.Google Scholar
Rubin, R. T. (1985) The prospects for clinical psychoneuroendocrinology. Psychological Medicine, 15, 451–454.CrossRefGoogle ScholarPubMed
Rutter, M. (1981) Psychological sequellae of brain damage in children. American Journal of Psychiatry, 138, 1533–1544.Google Scholar
Shepherd, M. (1957) An English view of American psychiatry. American Journal of Psychiatry, 114, 417–420.CrossRefGoogle ScholarPubMed
Simons, A. D., Garfield, S. L. & Murphy, G. E. (1984) The process of change in cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry, 41, 45–51.CrossRefGoogle Scholar
Snyder, S. H. (1982) Schizophrenia. Lancet, ii, 970–974.CrossRefGoogle Scholar
Snyder, S. H. (1984) Drug and neurotransmitter receptors in the brain. Science, 224, 22–31.CrossRefGoogle Scholar
Snyder, S. H. & Reynolds, I. J. (1985) Cakium-antagonist drugs: receptor interactions that clarify therapeutic effects. New England Journal of Medicine, 313, 995–1002.Google ScholarPubMed
Southard, E. E. (1912) Psychopathology and neuropathology: the problems of teaching and research contrasted. American Journal of Psychology, 23, 230–235.CrossRefGoogle Scholar
Spiro, H. M. (1974) My kingdom for a camera—some comments on medical technology. New England Journal of Medicine, 291, 1070–1072.CrossRefGoogle ScholarPubMed
Stanfield, P. R., Nakajima, Y. & Yamaguchi, K. (1985) Substance P raises neuronal membrane excitability by reducing internal rectification. Nature, 315, 498–501.CrossRefGoogle Scholar
Stevens, C. F. (1985) Modulations of some deadly sins. Nature, 315, 454.CrossRefGoogle Scholar
Stokes, P. E., Stoll, P. M., Koslow, S. H. et al (1984) Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: a multicenter study. Archives of General Psychiatry, 41, 257–267.CrossRefGoogle ScholarPubMed
Szasz, T. S. (1960) The myth of mental illness. American Psychologist, 15, 113–118.CrossRefGoogle Scholar
Szasz, T. S. (1985) Psychiatry: rhetoric and reality. Lancet, ii, 711–712.CrossRefGoogle Scholar
Taube, C. A. & Barrett, S. A. (1983) Mental Health, United States 1983. DHHS Publication ADM 83–1275. Rockville, Maryland: National Institute of Mental Health.Google Scholar
Vaughn, C. & Leff, J. P. (1976a) The measurement of expressed emotion in the fami Ues of psychiatric patients. British Journal of Social and Clinical Psychology. 15, 157–165.CrossRefGoogle Scholar
Vaughn, C. & Leff, J. P. (1976b) The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry. 129, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, C. E., Snyder, K. S., Jones, S. et al (1984) Family factors in schizophrenic relapse. Archives of General Psychiatry. 41, 1169–1177.CrossRefGoogle ScholarPubMed
Watt, D. C. Katz, K. & Shepherd, M. (1983) The natural history of schizophrenia: a five-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment. Psychological Medicine. 13, 663–670.CrossRefGoogle Scholar
Webster, T. G. (1969) Psychiatry and behavioral science curriculum hours in U.S. schools of medicine and osteopathy. In Teaching Psychiatry in Medical School (ed. Early, L. W.). Washington: American Psychiatric Association.Google Scholar
Wenberger, D. R. (1984) Brain disease and psychiatric illness: when should a psychiatrist order a CAT scan? American Journal of Psychiatry. 141, 1521–1527.Google Scholar
Wenberger, D. R., Wagner, R. J. & Wyatt, R. J. (1983) Neuropathological studies of schizophrenia: a selective review. Schizophrenia Bulletin, 9, 193–212.CrossRefGoogle Scholar
Weissman, M. M., Klerman, G. L., Pruoff, B. A. et al (1981) Depressed outpatients: results one year after treatment with drugs and/or interpersonal psychotherapy. Archives of General Psychiatry. 38, 51–55.CrossRefGoogle ScholarPubMed
Whitehorn, J. C. (1944) A century of psychiatric research in America. In One Hundred Years of American Psychiatry. New York: Columbia University Press.Google Scholar
Whitehorn, J. C. (ed.) (1953) The Psychiatrist. His Training and Development. Washington: American Psychiatric Association.Google Scholar
Wolkin, A., Jaeger, J., Brodie, J. D. et al (1985) Presence of cerebral metabolic abnormalities in chronic schizophrenia as determined by positron emission tomography. American Journal of Psychiatry. 142, 564–571.Google Scholar
World Health Organization (1979) Schizophrenia; An International Follow-up Study. New York: Wiley.Google ScholarPubMed
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