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A history of metaphorical brain talk in psychiatry

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We first turn to Adolf Meyer, the most influential psychiatrist in the US over the first 3rd of the 20th century [27]. It should be recalled that until World War II, American psychiatry was a rather small profession, largely composed of superintendents of mental hospitals who largely had a biologically orientation to their work. In 1907, while the director of the New York Psychiatric Institute, Meyer wrote about his concerns of the narrow views that US physicians would typically take in their approach to psychiatric illness that likely reflected his views about the excesses of earlier authors like Meynert:

Instead of analyzing the facts in an unbiased way and using the great extension of our experience with mental efforts to get square with things … they pass at once to a one-sided consideration of the extra-psychological components of the situation, abandon the ground of controllable observation, translate what they see into a jargon of wholly uncontrollable brain-mythology, and all that with the conviction that this is the only admissible and scientific way [28] p. 172.

Next, we examine a text on a similar theme from a quite different source - the psychiatrist-philosopher Karl Jaspers. In his the introduction to the first (1913) edition of General Psychopathology [29], he writes:

The still widespread “somatic prejudice” is: everything mental cannot be examined as such, it is merely subjective. If it is to be discussed scientifically, it must be presented anatomically, physically, as a physical function; for this it is better to have a preliminary anatomical construction, which is considered heuristic, than a direct psychological investigation. Such anatomical constructions are quite fantastic (Meynert…) and are rightly called “brain mythologies.” Things that have no connection to one another, such as cortical cells and memory images, brain fibers and psychological associations, are brought together. There is also no basis for these mythologies insofar as not a single specific brain process is known that could be assigned to a specific mental process as a direct parallel phenomenon [29] p. 8 (KSK translation).

We might think that recent scientific developments over the rest of the 20th century eliminated the need for metaphorical brain talk. We provide three examples suggesting that this is not the case.

First, in a series of articles published over several decades, the distinguished psychologist Paul Meehl proposed a cognitively and psychometrically sophisticated genetic single-locus model for schizophrenia spectrum disorders. A core part of this theory was equating cognitive and neurobiological parts of his theory, as expressed here in 1962:

The cognitive slippage is here conceived as a direct molar consequence of synaptic slippage, potentiated by the disruptive effects of aversive control and inadequate development of interpersonal communication sets [30] p. 834.

His phrase, “synaptic slippage,” has commonly been repeated in the subsequent literature [31, 32].

Second, in 1985, a leading biological psychiatrist, Nancy Andreasen, published a widely-cited book whose title was a paradigmatic example of metaphorical brain talk: The Broken Brain [33]. She writes, for example, that recent advances in research have “taught us that many forms of mental illness are due to abnormalities in brain structure or chemistry. Psychiatry is moving from the study of the “troubled mind” to the “broken brain” [33] p. VIII. In a later section, she describes, using broad metaphors, the kinds of brain abnormalities that occur in psychiatric disorders.

The various forms of mental illness are due to many different types of brain abnormalities … sometimes the fault maybe in the pattern of the wiring or circuitry, sometimes in the command centers, and sometimes in the way messages move along the wires” [33] p. 221.

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