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Letters to the Editor

1995; Johns Hopkins University Press; Volume: 39; Issue: 1 Linguagem: Inglês

10.1353/pbm.1995.0019

1529-8795

Steven Fleck, Richard E. Peschel, Lucien Karhausen,

Neurology and Historical Studies

LETTERS TO THE EDITOR Dear Sir: At the risk of being grouped with those who opposed or debunked Harvey's discovery of circulation and Semmelweis's advice regarding obstetrical hygiene, I need to object to and oppose the need for a new language, to wit "neuropathiatry " as proposed by Enid and Richard E. Peschel [I]. They proclaim that psychiatric illnesses (ill-defined as they are) are neurological or brain diseases. Despite the "neurobiological revolution," this proposal marks regression (not in the Freudian sense) to dualism, i.e., the separation of mind and body as expounded by Descartes. Psychiatric illnesses, as well as other diseases, are not solely physical or organic conditions, but are intertwined with thoughts, feelings, and interpersonal factors . The fact that there are neurophysiological or neurochemical and metabolic components in emotion has not only been advocated or speculated but demonstrated long since, for instance, by Walter B. Cannon's Bodily Changes in Pain, Hunger, Fear and Rage [2], as well as by Pavlov's experiments and the production of experimental neurosis by exposing animals to mixed and confusing signals [3]. Likewise, in our time, post-traumatic stress disorder patients show neurochemical transmitter changes which are part of the syndrome—but not the cause. The problem with the Peschels' thesis is that it reflects a linear causal chain of events, instead of heeding the revolution which concerns conceptualization in systems terms as first formulated by Ludwig V. Bertalanffy [4]. This means that neurochemical and even structural changes in the brain need not be inborn or result from some "physical cause" but occur in systems interactions, such as the sensitization to battle-like noise. This involves not only the external stimulus but also a readiness of the reacting systems to modify a routine which could constitute "organic" predisposition to so-called neurobiological disorder triggered by external stimuli. Besides, the "revolutionary" findings to which the Peschels' refer as if they were universal in all such patients is inaccurate—there are neuropathological findings in significant numbers of patients, but so far only in a minority of patients with schizophrenia or Tourette's syndrome or even in people without disease [5]. REFERENCES 1. Peschel, E., and Peschel, R. E. Neuropathiatry: New language necessitated by the neuroscience revolution. Persp. Biol. Med. 38:182-187, 1995. Permission to reprint letters printed in this section may be obtained only from the authors. 150 Letters to the Editor 2.Cannon, W. B. Bodily Changes in Pain, Hunger, Fear and Rage. New York: Appleton, 1934. 3.Gantt, W. H. Experimental Basisfor Neurotic Behavior. New York: Paul B. Hoeber, 1944. 4.Bertalanffy, L. von. General Systems Theory: Foundation, Development, Applications. New York: Braziller, 1968. 5.Andreasen, N. C, ed. Schizophrenia: From Mind to Molecule. Washington, DC: Am. Psychiatric Press, 1994. Steven Fleck Department of Psychiatry Yale University 25 Park Street New Haven, Connecticut 06519 Dear Sir: I have read Dr. Steven Fleck's critical letter of our article [1] with interest. Dr. Fleck's criticism that our proposal marks regression to dualism is not new. This argument has been used for years in an attempt to discount the neurobiological approach to human thought and behavior [2]. As Steven Rose has so eloquently stated, the dualism controversy "has clouded western scientific and philosophical thinking with its obsessive and misguided worries about the 'mindbrain problem' for centuries." Dr. Fleck cites several references published in 1934-1968 to support his conceptual framework for psychiatric illnesses [3-5]. Although I would not attempt to convince Dr. Fleck of the correctness of the neurobiological approach to psychiatric illness, I would suggest that the readers ?? Perspectives in Biology and Medicine consider three additional references by Steven Rose [2], Richard M. Restak [6], and Francis Crick [7]. After perusing Dr. Fleck's three references and the three I have listed, I would ask your readers to decide which conceptual framework—Dr. Fleck's or a neurobiological approach—is best suited to study psychiatric illness as we enter the 21st century. Finally, Dr. Fleck correctly states that "there are neuropathological findings in significant numbers of patients, but so far only in a minority of patients with schizophrenia or Tourette's syndrome . . . ." However, the true test of any...