Foundational Concepts

The background topics relevant to psychiatric disorders in biological terms is vast and typically includes neuroanatomy, neurophysiology, and neurochemistry. Since such approaches are remarkably well represented in various recent handbooks, and typically all substantive neuroscience courses, one more redundant effort in that direction would not be all that useful. Accordingly, we have used the limited space available to focus on topics that are more intimately related to psychological issues—the nature of emotionality, consciousness, stress, personality, and the brain imaging technologies that have changed the face of psychiatry in the past decade.

This decision was also fostered by the recognition that we have finally reached an era where the mind-brain barrier is beginning to dissolve. Although there are many ambiguities about what we may mean when we talk about "the mind," most generous scholars accept that the dynamics of mind ride upon the dynamics of the brain, and we now know that for any psychotherapy to work, it must influence brain functions (Cozolino, 2002). Empirical demonstrations of this concept are growing rapidly, ever since Baxter and colleagues (1989) demonstrated that cognitive behavioral therapy could reduce the frontal cortical overactivity in obsessive-compulsive disorders. A few years ago the Archives of General Psychiatry published two back-to-back lead articles on how interpersonal therapy modified brain activities of depressed individuals in ways resembling those of modern serotonin-specific antidepressants (Brody et al., 2001; Martin, 2001).

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

Daniel J. Stern said it well in the foreword to Cozolino's (2002) treatise on the Neuroscience of Psychotherapy, as he indicated that clinicians immerse themselves

"in the stories of individuals who come for help in feeling better____Whatever the approach, lasting change in therapy occurs as a result of changes in the human mind... which involve changes in the functions of the brain. Exactly how the mind changes during the therapeutic process is the fundamental puzzle that the synthesis of neuroscience and psychotherapy seeks to solve" (p. ix). Stern emphasized the difficult but productive marriage between clinical and neuroscientific disciplines, highlighting how "psychotherapy emphasizes the importance of subjective experience and the power of relationships to transform the growing mind" while "neuroscience focuses on quantifiable, objective data and the scientific method to create models of mind and brain" (p. x). The interpenetration of neuroscientific knowledge and psychiatric practice is becoming much more than the impressive recitation of the great victories of the neuroscience revolution of the past half century. We are finally seeing, in many experimental domains, how subjective psychological processes are related to a demonstrable impact on the objective dynamics of the brain.

The first half dozen chapters of this text attempt to bridge between the clinical and scientific issues. To do this, we have to blend the fine and abundant evidence that is being derived from rather indirect studies of the human brain/mind and the detailed knowledge about brain functions we can cull from our fellow creatures, who also live emotional lives that deserve our close attention and sympathy. These subtle issues, such as the fundamental neural nature of affective experiences, need to be discussed not only in neural terms, but also in terms of the evolved substrates and qualities of consciousness. The logo of this book reflects this philosophy of recognizing that the multiple layers of brain/mind evolution are reflected in the evolutionary passages which serve as a foundation for the human mind.

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