Language of the Brain

I am writing in response to Dr. Paul Appelbaum’s cry of distress over the “Crumbling MH System” in the November 15 issue. I have practiced in the military, in private practice, for an HMO, and for two community mental health systems (in Virginia and in Maryland during its demise). I conclude that for APA to have maximum influence in any area of our specialty, it is imperative to claim and proclaim the brain as our organ of expertise. We need to learn to talk the language of the brain to one another, our patients, and the public, including our legislators. This is not to give preference to either biological or psychotherapeutic treatments, as long as we proceed to integrate them rather than haggle over hegemony.

Like it or not, the mind remains an elusive concept in the marketplace and legislatures, and the “ment” of mental health is still almost meaningless to many. We need to extol the brain’s magnificence, the wonder of its workings, and the agonies of its dysfunctions. We need not apologize because we do not understand the totality of the relationships between brain, mind, and behavior—and perhaps we never will. We need to focus on how much is known right now and where it can lead. I have read many papers urging the formulation of a psychiatry of integration with the brain as the center point. What I have yet to see is APA’s taking such a position on the brain.

Try to imagine cardiology without heart, dermatology without skin, proctology without. . . .You know what I mean.

With the pharmaceutical companies skewing treatment to the biological and, so I’m told, residencies teaching mainly an organic orientation, APA needs to take the lead in advocating integration based on the brain, a brain that cannot be separated from its manifestations. I predict we would then be in a position to demand parity and to find funding and researchers to study the effects of psychotherapy on brain function, as researchers in psychopharmacology and genetics now are doing to a much greater degree. It will be a great and challenging undertaking.

Brain—use it or lose it.