Tuesday, March 16, 2010

Why Psychiatry Is Not Neurology

I need to work on briefer posts, so that I can be more consistent here. The blogger as aphorist. Nothing so pithy today, but on Arts & Letters Daily today I found a book review by Sally Satel that pretty much summarizes what psychiatry is about. Read the article yourself--isn't that what makes web links so wonderful, that they obviate the need for dull summaries?

Mental disorders are disorders of agency and intentionality, which is not to say that they are simply chosen or merely willed. That is why psychiatry cannot and should not merge with neurology, which deals primarily with the nervous system as machine. As Satel notes, the crucial difference is the response of mental disorders to contingencies, which gives them a social and semantic distinction from purely physical disease states.

This is not to say that there is a clear and absolute dividing line between mental and non-mental disorders, but the distinction is there nonetheless. Inasmuch as they pertain to ailments of identity and free will, mental disorders are disorders of the self, which may sound grim and slanderous until one remembers that "ailments" range from the blemishes that we all have to, well, the cancers of the soul (which is the brain--how complicated!).


Dr X said...

I was thinking about this question just last week and was wrestling with how I might best draw the distinction. This was very helpful. I hadn't considered intentionality and agency. Makes a lot of sense.

Retriever said...

Good reflections. Particularly given the nonsensical triumph of the chemical imbalance theory, or the idea that a disorder absolves one of responsibility for one's actions. Of course, I am in a battle of wills with that far-off relative again, tho, so grouchy!

Novalis said...

The objection here is that agency and intentionality are themselves generated by the machinery (the "neurology") of the brain. However, to achieve what freedom of the will we do possess, consciousness must at least feign ignorance of its own origins. The dancer who performs his moves while gazing in the mirror and contemplating the activity of his own motor cortex will fall flat on his face. Psychiatry reflects our need to pretend--successfully--that we are more than determined biological systems. Know thyself, but only to a point. Know your limits, but not too stingily, lest this knowledge draw the limits tighter than they need be.