The Brain, The Mind and Mental Illness

SEPT. 20, 2007

To the Editor:

Sally Satel (“Mind Over Manual,” Op-Ed, Sept. 13) suggests that the diagnostic confusion within psychiatry is due to a lack of “a clear picture of the brain mechanisms underlying ... mental illnesses.” She says psychiatry “lacks a firm grasp of the causal underpinnings of mental illness,” suggesting the “staggering complexity of the brain” as one reason.

Her article suffers in its being biased by the current zeitgeist that overemphasizes brain-based mechanisms as causes. While this may, in fact, have explanatory power for some conditions, it is more likely that causal explanations will often include frames of reference that are psychological (including psychodynamic) as well as biological.

Ken Kendler, a prominent psychiatric researcher, has pointed out that straightforward causal mechanisms (like the spirochete bacterium causing syphilis) are unlikely to apply to any of the major mental disorders because of their complex nature.

If we only look at “brain” causes and neglect the mind and the social world our patients live in, we lose a balanced perspective that our patients deserve and need.

Larry S. Sandberg, M.D.
New York, Sept. 14, 2007

The writer is clinical associate professor of psychiatry at Weill Cornell Medical College and co-author of “Psychotherapy and Medication: The Challenge of Integration.”