This is not the first attempt to integrate biology with human behavior and mental illness. The Bible attributes emotional and cognitive functions to heart, bowels, and kidneys. The ancients favored a humoral view of temperament (sanguine, phlegmatic, choleric, and melancholic). Over the ages the many attempts to treat mental illness have included physical and medicinal measures: purging, hydrotherapy, galvanic stimulation, and many other strange interventions, in the belief that doing something to the body would exorcise mental illness.
With the discovery of hormones, their effects on body, mind, and behavior—both normal and abnormal—were studied in the hope that they would be therapeutically useful. Early electroencephalographs investigation was expected to give us easy access to the functions of the brain and mind, but instead revealed disappointingly little information about mental illness and, in fact, about mental function in general. Only in the mid-20th century did Adolf Meyer promote a biological psychiatry that brought everything that was known to be relevant to mental health and illness to bear upon psychiatric diagnosis and treatment.
Sigmund Freud, who was best known for his original and perceptive insights into the psychology of mental illness, in fact maintained a consistent interest in biology. From the outset he argued that the same neural systems and functions that, in illness, give rise to the signs and symptoms of neurological disease, also bring about the signs and symptoms of mental illness. In 1891, Waldeyer gave final form to the neuron theory. Freud enthusiastically embraced it as a possible basis for what he called a "scientific psychology," resulting in an uncompleted work, later known as the Project for a Scientific Psychology. He abandoned that effort when he realized that it was a will o' the wisp, an illusory scheme, based on verbal constructs rather than neural mechanisms. Biological psychiatry, as it became fully biologized, has also abandoned many ambiguous mental constructs. Now a key challenge is how to bring those subtle attributes of the brain-mind, such as affects, into the neurobiological arena. One credible way is to try to link the visually observable instinctual apparatus of animals to affective processes.
Freud's concept of drive was closely aligned with the ethologic concept of instinct; he attributed qualities to the drive that resemble closely those commonly associated with instinct. He saw instinct as "a concept on the frontier between the mental and xv the somatic, ... the psychical representative of the stimuli originating from within the organism and reaching the mind." (Instinct and Their Vicissitudes, 1915, p. 121-122, Standard Edition) Running like a red thread throughout his work was the concept of energy, which always remained poorly defined. That too was a border concept: On the one hand, it was psychic energy; on the other hand it anticipated that medications still to be discovered in 1939, the year of his final statement, would exert their therapeutic effect by influencing this psychic energy.
Early intimations of a direct relation between the brain and hallucinated images and emotions were disclosed by the studies of the effects of direct stimulation of the exposed human brain by Wilder Penfield and his disciples in the middle of the 20th century. Soon thereafter, psychedelic and other psychoactive drugs revealed a chemically based mental apparatus with which neither scientific psychiatry nor psychology has come to terms.
It was soon after World War II that modern neuroscientific studies were initiated and rapidly developed momentum. Applied neuroscience (i.e., psychopharmacology) exerted its initial impact on a clinical psychiatry that had yet to become fully biologized. Though they had been preceded by the barbiturates that, in their day, had proved very useful, the newer agents now exhibited antipsychotic and mood-correcting powers. When the possibility of affecting mental illness chemically became clear, the drug companies addressed the problem with their formidable resources and in rapid succession introduced new variants of the basic therapeutic agents. Although the psychiatric profession accepted and employed these medications enthusiastically, the early literature exhibited little interest in using psychopharmacologic experience as a point of entry for a neuroscience of mental illness. The amazing development of molecular neuropharmacology recently has catalyzed that coordination.
The present volume represents a landmark in this developing trend. Trained as a behavioral neuroscientist and psychologist, editor Jaak Panksepp is knowledgeable in the field of psychoanalysis and experienced in practical psychotherapy. He has actively pursued reliable knowledge about brain function in its relation to behavior through careful animal experiments. He proceeds from the assumption that affect is the central variable in human behavior, to which other features are secondary. His 1998 work, Affective Neuroscience, is becoming one of the scriptures of the third revolution in 21st-century psychiatry. I consider psychoanalytic psychiatry the first, psychopharmacologic psychiatry the second, and a functional neuroscientific psychiatry the third.
In Affective Neuroscience, Panksepp examined the several instinctual systems, their affective correlates, and the autonomic and physiologic systems that subserve them. The neurochemistries involved also provided points of correlation with established and potentially new pharmacologic strategies. His was a novel and original approach to human behavior that permitted clinicians like myself a view of the opportunities and the promise of the neuroscientific approach to psychiatry.
In this Textbook of Biological Psychiatry, Panksepp fulfills this promise. I draw the reader's attention especially to his introductory chapter in which he points the way to the elusive synthesis of studies of mind and brain, focusing on affect as the essential and functional link. This emphasis is both timely and ironic since affect had been remote from the central interest of both psychoanalysts and neuroscientists.
For this endeavor, he has assembled a group of scientists and clinicians and invited them to apply contemporary neuroscience to psychiatric issues. This coordination of Panksepp's persistence and brilliance along with the insights of his carefully selected collaborators will afford a new, practical understanding of biological psychiatry, at once imaginative and realistic.
President, Psychoanalytic Research and Development Fund
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