Psychodynamic psychiatry in the "decade of the brain"

OBJECTIVE AND METHOD: To illustrate the continued relevance of psychodynamic thinking in the practice of contemporary psychiatry, the author reviews a number of studies that demonstrate the intimate connection between psychosocial and neurophysiological factors in the etiology and pathogenesis of psychiatric disorders. A survey of three specific anxiety disorders illustrates the complex interaction between mind and brain in these disorders. RESULTS: Research on both primates and humans suggests that psychological influences result in permanent alterations of a neurobiological nature. Similarly, psychological interventions in a treatment context may have a profound impact on neurophysiology. Clinical case examples demonstrate that "biologically based" disorders may be rich in unconscious meaning. Clinical understanding of the meaning of symptoms may be instrumental in ensuring patients' compliance with pharmacotherapy regimens and in the removal of other resistances to treatment. CONCLUSIONS: In contemporary psychiatry, a psychodynamic perspective must be preserved. Without it, meaning will be lost, and both diagnostic understanding and informed treatment planning will suffer as a result.