8/9/2019 Bakker_et_al_02

1/2

Letters

Academic Psychiatry 26:3, Fall 2002 219

The Social Brain: A UnifyingFoundation for Psychiatry

TO THE EDITOR: The ResearchCommittee of the Group for theAdvancement of Psychiatry (GAP),a specialty think tank, has ad-dressed psychiatrys need for a uni-fying scientic foundation. Such afoundation would consider the dis-orders commonly treated by psy-chiatrists in terms of the physiolog-ical baseline from which theydepart, much as heart disease is un-derstood as deviation from normalcardiac function. The relevantphysiological focus for psychiatryis the social brain.

The social brain is dened byits functionnamely, the brain is a body organ that mediates social in-teractions while also serving as therepository of those interactions.The concept focuses on the inter-face between brain physiology andthe individuals environment. The brain is the organ most inuenced

on the cellular level by social fac-tors across development; in turn,the expression of brain function de-termines and structures an individ-uals personal and social experi-ence. The social brain frameworkmay have greater direct impact onthe understanding of some psychi-atric disorders than others. How-ever, it helps organize and explainall psychopathology. A singlegene- based disorder like Huntingtons

disease is expressed to a large ex-tent as social dysfunction. Con-versely, traumatic stress has struc-tural impact on the brain, as doesthe socially interactive process of psychotherapy.

Brains, including human brains,derive from ancient adaptations to

diverse environments and are them-selves repositories of phylogeneticadaptations. In addition, individualexperiences shape the brain throughepigenesis; that is, the expression of genes is shaped by environmentalinuences. Thus, the social brain isalso a repository of individual de-velopment. On an ongoing basis,the brain is further rened throughsocial interactions; plastic changescontinue through life with bothphysiological and anatomical mod-ications.

In contrast to the conventional biopsychosocial model, the social brain formulation emphasizes thatall psychological and social factorsare biological. Nonbiological andnonsocial psychiatry cannot exist.Molecular and cellular sciences of-fer fresh and exciting contributionsto such a framework but providelimited explanations for the socialfacets of individual function.

The social brain formulation isconsistent with current research

and clinical data. Moreover, it ulti-mately must

Unify the biological, psycho-logical, and social factors inpsychiatric illness.

Dissect components of illnessinto meaningful functional sub-sets that deviate in denableways from normal physiology.

Improve diagnostic validity bygenerating testable clinical for-

mulations from brain-based so-cial processes.

Guide psychiatric research andtreatment.

Provide an improved languagefor treating patients as well aseducating trainees, patients,their families, and the public.

Account for the role of inter-personal relationships in brainfunction and health.

The concept of the brain as anorgan that manages social life pro-vides signicant power for psychi-atrys basic science. Burgeoning de-velopments in neural and geneticareas put added demands on theconceptual structures of psychiatry.Findings from such incoming workmust be juxtaposed and correlatedwith the behavioral and experien-tial facets of psychiatry to give it acomplete and rational basis. Psy-

chiatrys full and unied entry intothe realm of theory-driven anddata-based medical science has been overdue. The social brain con-cept allows psychiatry to utilizepathogenesis in a manner parallelto practice in other specialties.

This statement was composed by thelisted members of the Research Committeeof the Group for the Advancement of Psy-chiatry (GAP) during the periodic meetingsof this group. The opinions expressed arethose of the authors and do not represent anofcial opinion of GAP.

Cornelis Bakker,Russell Gardner, Jr.,

Vassilis Koliatsos, Jacob Kerbeshian, John Guy Looney, Beverly Sutton,

Alan Swann, Johan Verhulst,Karen DineenWagner, Frederick

S.Wamboldt, Daniel R.Wilson

Psychiatry and Major Literature

TO THE EDITOR: The letters aboutpsychiatrists as major authors (1,2),reacting to an excellent article onpoetry by Robert Pinsky (3), seemto be misguided in several aspects.To begin with, psychiatry is a fairly

8/9/2019 Bakker_et_al_02

2/2

LETTERS

220 Academic Psychiatry 26:3, Fall 2002

young specialty compared with therest of medicine. How many psy-chiatrists were around at the timeAnton Chekhov wrote his playsand short stories? Not many. Over-all, the number of physicians whoauthored major literature (what-ever it meansnot everybodywould consider work by practicingand nonpracticing physicians Ar-chibald J. Cronin, Michael Crich-ton, or Walker Percy major litera-ture) has not been large, andpsychiatry is not the largest medi-cal specialty. Reliable numbers forphysician-authors and psychiatrist-authors do not exist, so we do notknow how comparable the numberof psychiatrists who authored mi-nor or major literature is to thenumber for the rest of medicine.Authorship also takes many forms.How many of us know that a well-known present-day political col-umnist (not a major author,though), Charles Krauthammer,authored a classic article on sec-ondary mania (4) in his previouscareer? Or how many consider the

work of psychiatristminister M.Scott Peck (The Road Less Traveled)major literature?

This debate is also a bit cultur-ally skewed. It focuses on so-calledmajor literary works and majornational literatures. I am not sosure whether in the non-German-speaking lands in the West,Schnitzler does not approach theacclaim enjoyed by Williams or

Chekhov, who were mentioned asexamples. I agree that he does notreach the acclaim of Chekhov; onlya few authors do, and Chekhovhas never attracted anything butadmiration (5). But how manypeople (and how many psychia-trists) still know the work of Wil-liam Carlos Williams? Schnitzler,on the other hand, has enjoyedfairly high acclaim among Germanand non-German-speaking readersand psychiatrists in Europe.

In literatures other than En-glish, there are many examples of well-known authors who are psy-chiatrists. One of the foremost Por-tuguese novelists, Antonio LoboAntunes, is (or at least was at thetime of his major literary writings)a practicing psychiatrist. The NewYork Times Book Review describedhim once as A mad amalgam of Dos Passos and Celine. TheCzechs have Josef Nesvadba, awell-known psychiatristsciencection writer. The Bosnian Serbshave the infamous psychiatrist-poet-nationalist-war criminal Ra-

dovan Karadzic. The Egyptianshave Nawal El Saadawi, a well-known feminist. The Finns haveVeronica Pimenoff. The Swedeshave Axel Munthe, author of TheStory of San Michele. And the Swisshave Walter Vogt (who switched topsychiatry from radiology), whose book Der Wiesbadener Kongressmakes poignant fun of research andacademia.

Finally, I feel that the assump-tion of a special role for psychiatryamong medical specialties in re-gard to major literary writing isspecialty-biased. Why do we as-sume that by confronting daily thestuff of human narrative, drama,and fantasy, they [psychiatrists]would seem to be uniquely posi-tioned to produce compelling c-tion and poetry? Why do we as-sume that the tragedy and sufferingobserved by psychiatrists is uniquecompared with the observations of other physicians?

Nevertheless, I agree that liter-ary work by psychiatrists is edu-cationally interesting (3) and enjoy-able, and that it could and should be used as a teaching tool.

Richard Balon, M.D.Department of Psychiatry and Behavioral

Neurosciences, Wayne State UniversitySchool of Medicine, Detroit, MI

References

1. Schwartz M: Psychiatrists as major au-thors? Academic Psychiatry 2001; 25:239

2. Scheurich N: Psychiatrists and the liter-ary canon. Academic Psychiatry 2001;25:239

3. Scheurich N: Robert Pinsky and the po-etry of psychiatry. Academic Psychiatry2001; 25:173180

4. Krauthammer C, Klerman GL: Second-ary mania: manic syndromes associatedwith antecedent physical illness ordrugs. Arch Gen Psychiatry 1978; 35:13331339

5. Hensher P: Incomparable naturalism.The Atlantic Monthly, January 2002, pp126131