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Neurohawks fight back

Published online by Cambridge University Press:  02 January 2018

Daniel McQueen*
Affiliation:
The Cassel Hospital, Emerging and Severe Personality Disorder Service, 1 Ham Common, Richmond, Surrey TW10 7JF, UK. Email: daniel.mcqueen@wlmht.nhs.uk
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2009 

Psychiatry rests on the biopsychosocial model rather like a three-legged stool: remove any one of the legs and the stool, and psychiatry, fall over. Another three-legged stool might be that of emotion, cognition and behaviour, each is necessary, but insufficient, for understanding humans.

In ‘Why psychiatry can't afford to be neurophobic’, Reference Bullmore, Fletcher and Jones1 Bullmore et al give a compelling picture of the complexity and explanatory power of genotype and phenotype in modern psychiatry and neuroscience. They expand phenotype to include behaviour and cognition, and also refer to Reil's vision of psychiatrists as physicians of the mind. Reil (1759–1813) coined the term ‘psychiatry’ and was concerned with the soul and soul organ, which he considered to be a product of the nervous system. Reference Marneros2 Reil's conception of the soul would be considerably wider than cognitive function and behaviour. Living during the Romantic period, he was concerned with what today might be called emotions, character and self-regulation.

It is difficult to do justice to the full breadth of neuroscience in an editorial; however, neuroscience and psychiatry are far broader than genes, cognition and the intervening processes. Although the nod is given to psychoanalysis and the importance of ‘mental, interpersonal, developmental and therapeutic processes’, and ‘maternal deprivation and child abuse’, there is no reference to emotion and its mental representation, affect, and the rapidly growing fields of affective neuroscience, attachment theory, affect regulation, mentalisation and developmental psychopathology.

Biology, ethology and palaeoanthropolgy have shown that social living has been the most important recent evolutionary pressure for brain development. Reference Wills3 Subjectivity is intrinsic to, and an emergent property of, our social brain. Reference Solms and Turnbull4 Ethology and attachment theory have shown how emotions are the glue of social interactions; from the moment of birth we are instinctually driven to engage with others: attachment behaviours, smiling and crying are genetically programmed. The representation of affect states in self and other (mentalisation) is vital to affect regulation and effective social adaptation; affect regulation and mentalisation are acquired through secure attachment relationships; and secure attachment, mentalisation and self-regulation contribute significantly to emotional resilience, which helps us to weather the challenges that life presents. Reference Fonagy, Gergely, Jurist and Target5,Reference Sroufe, Egeland, Carlson and Collins6

The danger of seeming to neglect the importance of emotion and relating (while emphasising the importance of cognition, molecules and genes) in psychiatry is that we risk promoting the disengagement from neuroscience that Bullmore et al argue so passionately against.

References

1 Bullmore, E, Fletcher, P, Jones, PB. (2009). Why psychiatry can't afford to be neurophobic. Br J Psychiatry 2009; 194: 293–5.CrossRefGoogle ScholarPubMed
2 Marneros, A. Psychiatry's 200th birthday. Br J Psychiatry 2008; 193: 13.CrossRefGoogle ScholarPubMed
3 Wills, C. The Runaway Brain. Harper Collins, 1993.Google Scholar
4 Solms, M, Turnbull, O. The Brain and the Inner World. Other Books, 2002.Google Scholar
5 Fonagy, P, Gergely, G, Jurist, E, Target, M. Affect Regulation, Mentalization, and the Development of the Self. Karnac, 2004.Google Scholar
6 Sroufe, LA, Egeland, B, Carlson, EA, Collins, WA. The Development of the Person. The Minnesota Study of Risk and Adaptation from Birth to Adulthood. Guilford, 2005.Google Scholar
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