Descriptive Psychopathology: The Signs and Symptoms of ...

54 Section 1: Present, past, and futureis the computer and the fact that all software must run on hardware, andthat glitches in software occur without hardware malfunction. 5 The analogy fails,however, because brain “programs” are as much neurological as are brain structures.Procedural memory (i.e. memory for motor, often skilled behaviors) isbrain-based and understanding this is clinically relevant. There are many moresequences of movement than there are motor neuron pyramidal cells. Patient 1.1,who suffered carbon monoxide poisoning and lost his ability to knit, experienceda biological event to his brain that affected his skilled motor programming.Anesthetic agents produce temporary malfunction of brain programmingwithout affecting the “hardware”.But while all behavior reflects the brain at work, behavioral disorders are moredifficult to define. The DSM conceptualizes a “disorder” as a condition that isclinically significant and that causes distress or disability. 6 This definition failsbecause it is over-inclusive, incorporating as disorders non-illness such as demoralization,jealousy and revenge, and criminality. By the definition, normal pregnancymight be considered a disorder. Others have argued that a more precisedefinition of illness is: a condition that causes harm and that derives fromdysfunction. Harmful dysfunction involves “something going wrong with thefunctioning of some internal mechanism, so that the mechanism is not performingone of the functions for which it was ‘designed’ by natural selection.” 7 Thisconceptualization works for most presently recognized psychiatric disorders, butmay fall short for some of the personality disorders. 8Confusion also arises from the fact that persons who appropriately receiveclassification labels are by definition deviant, but deviance has several fathers. Brainstructural and physiological lesions (genetic and acquired), maturational variation,and indoctrination at odds with the cultural context cause deviation. Furtherroiling the conceptual waters is the fact that some deviation is advantageous(e.g. high intelligence, talent).The social, political and health implications of these concerns have beendiscussed in depth elsewhere, and they impact patient care daily. 9 Descriptivepsychopathology, however, focuses mostly on deviant behaviors assumed theresult of brain dysfunction. It also addresses deviation of personality as a functionof maturational variation. 10The brain behind the mental statusAll behavior, no matter how complex, is an expression of the brain working.“The mind” cannot be separated from the body. Within a modern cognitiveneuroscience framework, the mind becomes representative short-hand for brainprocesses within our awareness. Brain activity outside of subjective experience