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Psychiatric Diagnosis: Brain Function Changes our Perspectives

Posted Sep 16 2008 4:59am

When I began training in psychiatry, almost 40 years ago, much of the diagnostic psychiatric world evolved from affect thinking: depression and anxiety, euphoria, and misperceptions of reality. In a word, we began with a Freudian,  affect driven, trauma driven set of patterns. Freud Freudian thinking, and careful observations of behaviors were all we had until technology arrived.

In fact, one of the highlights of my early training in Philadelphia was meeting Freud's daughter, Anna Freud, [the founder of child psychoanalysis ] at the Philadelphia Association for Psychoanalysis after her interesting presentation on her book, Ego and the Mechanisms of Defense, hosted by the Association. [See her remarks on personal qualities of psychoanalysts, and you will understand more of my early interest.]

Now functional brain science, SPECT, fMRI, qEEG, is changing the way we make brain and psychiatric diagnosis. With the understanding of brain function we inevitably change the way we think about the patient in the room... the way we actually make the diagnosis.

These are interesting contemporary comments by Harvard Professor John Ratey from a User's Guide to the Brain:

"The transition from trauma to biology has unfortunately failed to wean clinicians from  affect-centered diagnosis. If you are unhappy and decide to seek help, the main thrust of the diagnostic process begins with an inquiry into how you feel. From this initial information, diagnosis and treatment proceed, as a rule, by either sifting through your psyche for sources of guilt, anger, or unfulfilled longing, or by attempting to modify the affective symptoms pharmacologically, or both."

And for an edgy bit more, read on:

"The entire approach here is, in my opinion, quite misguided. Many brain disorders, particularly those that produce deficits in perception and cognition, can turn the lives of patients into abject misery. Historically virtually all metal disorders were associated with character flaws.... leaving enough residual confusion to feel ashamed of psychological shortcomings."

The world has changed considerably in these last few years. Ratey does a great job of discussing the science in layman's terms so that anyone can begin to see the profound impact of the new science on diagnosis and treatment.

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