Diseases of the Mind and Brain: Overview

Psychiatry is about to have the tissue mechanisms of its major illnesses delineated. The genes, the proteins, the neural systems, the neurotransmitters, the inheritance, and the history of individual life experience all will be woven together to explain the disease manifestations that we see daily in our patients. To accommodate this, our mental terms depicting concepts like mind, consciousness, feelings, and the unconscious will be augmented to include neural concepts like neuronal binding, activation/inhibition patterns of regional cerebral blood flow, and intracellular signaling pathways. We will learn the mechanisms whereby human behavior affects brain biology and how CNS pathology alters behavior. This will happen even though the mechanisms that join these two realms are, arguably, highly complex. As the biological correlates of psychological phenomena are better understood, our treatments—both psychological and biological—are likely to be more efficiently constructed. Medications will be able to be directed toward specific cellular processes, even though the link between the cellular processes and behavioral/symptomatic targets will remain an empirical process for the foreseeable future.

It will remain a task for all of us to keep up with the biological facts about psychiatric illnesses and watch as they fit themselves together. In psychiatry, we will see in future decades the “biological” joining with the “mental.” Then it will be up to each one of us to fit these new discoveries into our own clinical understanding of the diseases we treat and into our everyday practice. This issue marks the beginning of a new Images in Neuroscience series, “Diseases of the Mind and Brain.” In this series, we will attempt to guide practitioner attention to current formulations of the presentation, genetics, pathology, molecular manifestations, and treatment targets of mental illnesses. New information will develop over decades and will demand sustained attention. The payoff, of course, will come with the discovery and understanding of mechanisms of human mental, motor, cognitive, and affective phenomena and our use of this knowledge to improve patient treatment.