Core Psychiatric Challenges

Conceptual categories reflect one of the crowning capacities of the human mind—the ability to see, and to create, finer and finer distinctions among the things we perceive. Indeed, one could argue that this is the main function of our cortico-cognitive apparatus. This function allows us to see deeply into the nature of things and also to make distinctions that serve no function other than endlessly detailing minor differences, both real and imaginary.

Modern psychiatric diagnostic categories have long been open to such criticisms. From a pragmatic, utilitarian perspective, the critical issue is at what point do our distinctions provide useful new understanding as opposed to weighing us down with irrelevant details. This has always been the diagnostic dilemma, and even though we have yet to create diagnostics that tell us much about the etiologies of the major psychiatric disorders, there is substantial agreement that distinctions of lasting importance have been envisioned.

There are characteristic disturbances of the mental apparatus that have sufficiently robust class similarities, to offer substantial confidence that we have now recognized, with considerable agreement, some of the major emotional difficulties of mental life. The schizophrenias, the depressions, manias, and varieties of anxiety disorders will remain with us as fundamental concepts for as long as humanity will survive. We know that various symptom clusters often go together, and we can utilize such diagnostics as heuristics for prescription practices. The major adult psychiatric problems will be the focus of discussion in this section (Chapters 7-13). Chapter 14 will be devoted to the many childhood

Textbook of Biological Psychiatry. Edited by Jaak Panksepp Copyright © 2004 by Wiley-Liss, Inc. ISBN: 0-471-43478-7

syndromes that are now provisionally understood at the genetic level, and Chapter 15 is devoted to aging problems that have to be discussed in terms of the gradual dissolution of the nervous system.

There were many other topics that deserved to be covered, from addictions, to various sexual and other appetite problems, to disturbances of body image. Unfortunately, space did not permit any comprehensive coverage of such issues. Some of those topics are touched upon in various nooks and crannies of this text. However, our larger goal for this middle section of the text was to cover most of the main-line topics of biological psychiatry. In carefully crafted chapters, we cover the major syndromes from basic science and therapeutic perspectives. We must also hope that as the neuroscience revolution continues, and our understanding of the mental apparatus matures, that our capacity to use biological interventions in supportive humanistic frameworks, whereby patients can help create new and positive meanings for their lives, will increase rather than diminish.

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