Overture

It is a difficult task to capture the history of biological psychiatry in a brief essay. Let me frame this modest effort in a timeless humanistic perspective.

Psychiatry is the study and treatment of troubled mental lives. Its ultimate goal is to heal broken spirits. At its core, it is an attempt to better understand human thoughts and emotions and to allow this understanding to inform the healing arts. Despite our modern scientific hubris, we know rather little about how brains truly construct our minds and passions. Partly, this is because few scholars have come to terms with the need to understand the evolutionary neural dynamics that affective experiences are ultimately made of. It is all too easy to accept emotions as primitive "givens" and proceed toward a superficial understanding based on words, arbitrary definitions, and the quiddities of logic rather than biology. But the greater and more significant

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

depths of this mystery have to be plumbed by an integrative neuroscience that has barely emerged.

It is surely not off the mark to claim that the single most important scientific question for biological psychiatry is the accurate decoding of the basic neural nature of affective values and related cognitive experiences. Emotions and moods guide most of our thinking processes and behavioral choices, whether well-arranged or deranged. Many psychopathologies arise from imbalances in these feeling systems that motivate us to think and act in certain ways. At a deep psychological level, that often goes unspoken, emotionally disturbed people have some insight into the weaknesses of their minds. They simply don't know how to manage their persistent psychic disequilibrium. They are certainly no more accustomed to thinking about these psychic forces in neural terms than are the counselors and psychotherapists from whom they seek assistance.

Taxonomic schemes that do not directly acknowledge the underlying emotional faculties of the human mind and brain must be deemed provisional approximations of the goals to which we should aspire. Brain sciences that do not acknowledge or attempt to explore how such processes motivate and guide thinking do no great service to psychiatric thought. Mind sciences that do not dwell on the complexity of the internal world, replete with all manner of feelings and cognitions, do not serve our understanding well. The cognitive, behavioral, and affective sciences must devote equal effort to understanding the embeddedness of mind in brain, body, environment, and culture; otherwise essential components will be overlooked. Only by blending these perspectives judiciously, without inflaming simple-minded polarities such as nurture versus nature, is psychiatric practice well served.

By the end of the 20th century neuroscience had advanced to a point where we now understand the brain rather well. Unfortunately, the discussion of equally important, but more slippery, mind matters continues to lag far behind. Credibly linking facts about the brain to mental functions is maddeningly difficult. There are few incentives in our current system for integrating the abundant peppercorns of brain data into an integrated psychobiological understanding. A prevailing positivistic hope has been that knowledge will emerge automatically from the raw facts like cream rising from freshly expelled milk. To an undesirable degree, theoretical views have been demoted to second-class citizenship. Accordingly, rich discussions of many key functional issues almost disappeared in neuroscience as it mastered how to milk our neural nature during the last third of the 20th century. Indeed, the very concept of productive hypothesizing came to be termed, scornfully, as "mere speculation," perhaps because too many students of the mind (and certainly too many science popularizers) forgot the difference between a "working hypothesis" and a "provisional conclusion." Major textbooks of biological psychiatry and neuropsychiatry no longer discuss emotions prominently. Some consider them needless frills that intervene between reliable diagnostic categories and descriptions of related brain changes. Often, there is little tolerance for such "middle-level" theorizing that seeks to meaningfully link brain functions with mind. One aim of this text is to reverse this trend.

Thus, I proceeded to this historical sketch with several common but oft-neglected preoccupations that continue to trouble modern psychiatric thought. How are the passions of the mind truly created? How do they become overwhelming? How can mere words help heal minds? What is the healing touch? Why are character traits so important in healers as well as patients? What is the proper role of placebos in the therapeutic enterprise? Are our diagnostic categories as sound as they could be? Such concerns led me to encourage all contributors to this book to consider the central role of thought and emotions in psychiatrically significant disturbances of the psyche. My own bias is that the next great frontier in biological psychiatry is the topic that has been most neglected by modern neuroscience—the deep neurobiological nature of affective experiences. Even though our understanding of such key issues remains woefully incomplete, we must continue to share the harvest of knowledge we already have, and thereby fertilize the field, once more, so that those who come after us are better prepared to contend with the perennial joys and difficulties of mental existence.

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