Re: "Not Diseases, but Categories of Suffering"

To the editor:

Gary Greenberg (1/30/12, Not diseases, but categories of suffering) notes that the DSM-III was introduced in 1980 having adopted a strategy 'mostly by leaving out meaning of our suffering' in favor of a descriptive approach of syndromes. This was in part an important corrective to the over reliance on psychodynamic explanations of mental illness at a time when biological psychiatry was in its infancy. But he perpetuates a myth that psychoanalysis has been largely discredited. 

The brain is a social construction where the environment interacts with one's genes to create the person we become. Insofar as biochemical markers advance our ability to heal, it will likely be due to studying them in relation to environmental factors. Contemporary psychoanalysis explores meaning as a critical vehicle to healing.  For some patients, this may include the meaning of having a 'biological' illness requiring medication or the way in which an apparent genetic vulnerability has been unmasked by certain life experiences.  While few patients pursue intensive psychoanalytic treatment, psychodynamic approaches  (which adopt basic psychoanalytic principles) have a growing evidence base for treating depression, anxiety and personality disorders. 

Respectfully submitted,

Larry Sandberg MD