Descriptive Psychopathology: The Signs and Symptoms of ...

3The brain and psychopathologyThe reader will find no other definition of “Psychiatry” in this book but the one given on thetitle-page: “Clinical Treatise on Diseases of the Fore-Brain”. The historical term psychiatry,i.e. “treatment of the soul”, implies more than we can accomplish, and transcends the boundsof accurate scientific investigation. 1The understanding that behavioral disturbances reflect biological events hasgrowing acceptance. Theorists who place intervening constructs between thebiology and behavior also recognize that at some level the brain generatesbehavior. Trained as a neuropathologist, Freud assumed his framework for thepsyche had neurologic roots. 2 In discussing hysteria, he wrote: “A dynamic lesionis indeed a lesion [in the brain] but one of which no trace is found after deathsuch as an edema, an anemia or an active hyperemia.” 3The relationship between the brain and psychiatric illness, however, has beenclinically marginalized, as the summing of a few clinical features now substitutesfor diagnostic reasoning. This chapter provides an alternative framework to thatapproach, illustrating that the understanding of brain–behavior relationships isrelevant to patient care.The boundaries between normalcy and disease53Brain–behavior relationships define behavioral wellness as well as disease, and theboundary between behavioral wellness and disease is not always clear. Presentclassification deals with the ambiguities by arbitrarily separating behavioraldisease (e.g. the DSM Axis I) from behavioral deviation (e.g. Axis II). Theseparation is not successful. Schizotypal, schizoid, and paranoid personalitydisorders, for example, reflect low-grade illness, not personality deviations. 4Obsessive–compulsive personality disorder is also not trait behavior, but part ofthe obsessive–compulsive disorder spectrum.Some have also argued that the exclusive focus on brain–behavior relationshipsas the basis for understanding psychiatric syndromes is unwarranted. The analogy