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In its fluent evocation of the interplay of philosophy, medicine, and the creative arts, The Intentional Brain echoes Michael Trimble's much acclaimed The Soul in the Brain published nine years previously. Because Trimble has in effect already provided a lengthy review of his own fourteen-chapter volume in the June 2016 issue of CNS Spectrums, what follows will avoid a general summary. Instead, we shall particularly focus upon three issues whose conceptual and methodological facets are explicitly foregrounded. First of all, what does he means by "neuropsychiatry"? Next, is his appeal to a holistic conception of neuropsychiatry based upon a holistic re-construal of brain and body sufficiently clarified? Finally (and more briefly), to what extent is there a tension in his narrative strategy of "interweaving past events and personalities" (282)?
For a generation currently given to affixing "neuro-" to so many of its areas of enquiry—ranging from neuropsychology and neuropathology to neurotheology and neuro-aesthetics—what is neuropsychiatry as espoused by Michael Trimble of London's Institute of Neurology? His preface to The Intentional Brain immediately informs readers that it is a medical discipline not only concerned with "descriptions of clinical abnormalities" (ix) demonstrating our understanding of the relationship between the human brain and human behaviour. Neuropsychiatry is also concerned with "the meaning of abnormal behaviour" (ix). What does this in turn imply? That neuropsychiatrists, when probing the "content," "form," and "contingencies" influencing symptoms and the gap between clinically formulated "disease" and personally experienced "illness" of patients, need to "tolerate uncertainty," an uncertainty arising as much from developmental as from interpersonal contingencies (ix-x). Ultimately, therefore, neuropsychiatric practice cannot "account for all mental disorder" (x).
The foregoing is further elaborated when Trimble's prefatory commentary turns to definitions of neuropsychiatry circulating since the 'eighties. At first, he dismisses the "flagship" definition that "mental disorders are disorders of the brain" (xiv) as being too narrow and tending to be identified with behavioural neurology and its pre-occupation with "correlating" cerebral "lesions with behavioural changes" (xv). Again, the International Neuropsychiatric Association's declaration that we are dealing with "a field of scientific medicine" focused upon "the complex relationship between human behaviour and brain function," where behavioural abnormalities and disorders are framed as "an interaction of neurobiological and psychological-social factors," is declared "a compromise" (xv; citing Periminder Sachdev's 2005 editorial in Neuropsychiatric Disease & Treatment). Trimble himself returns to his own earliest definition which includes the corollary that the "discipline" requires "multidisciplinary ideas for…full understanding" of "certain disorders" (xv; cf. 135 n.37) before bolstering it with the Jeffery Cumming & Angela Hegarty discussion of neuropsychiatry's relationship to neurology and psychiatry in the February 1994 issue of Neurology. There they argue that the neurological dimension construes "disorders of brain function" and "behavioural abnormalities from a neurobiological perspective" in the quest to uncover "the mechanisms of behaviour" whereas the psychiatric dimension "integrates… psychology, sociology and anthropology to grasp the motivation of behaviour" (xv).
Curiously, Trimble only makes passing mention of any counter-argument that neuropsychiatry lacks a "conceptual core or stable definition" (xiii). Hence, readers are not given the opportunity of entering the critical debate mounted by German Berrios and Ivana Markova in the August 2002 issue of Journal of Psychosomatic Research which, at the same time, presents contrasting interpretations of past intellectuals Trimble himself covers, such as Wilhelm Griesinger, Theodor Meynert, and Karl Wernicke amongst others in the nineteenth-century (e.g. 143ff.). For those unfamiliar with Berrios & Markova (2002), it is worth noting they trace a variant of the above-mentioned "flagship" definition, namely, "mental diseases are diseases of the brain," in order to expose the "absence of conceptual continuity between utterances of core claims," an absence further compounded by marked regional and temporal differences in cultural and linguistic, social and economic contexts (2002: 629). They then remind us that "flagship" contentions of the kind "cerebral lesions or changes cause mental disturbance or disorder" are logically independent of claims that the body, specifically the brain, "houses the human soul (mind)" (2002: 631). The problem facing past writers, once the brain began to represent for them some form of mental embodiment, was then to explain the nature of mind (a problem Trimble tersely notes as dualism—"the idea that body and soul were..differing substances"—which constitutes "the heart of the mind-brain problem" (7)). In fact, covering a period of ten generations up to the relatively neglected work of Constantin von Monakow and Raoul Mourgue in 1928, Berrios and Markova largely conduct their critique by assessing the extent to which putatively nascent neuropsychiatric explanations appealed to "dynamic qualities" within brain and body to accommodate mental characteristics (2002: 631-636).
Let us now turn to the persistent holistic approach figuring in The Intentional Brain, which, unlike the "romantic brain," is unindexed. The holistic and the romantic are rapidly aligned (e.g. 70). Thereafter, as Trimble surveys "neural Romanticism" from Erasmus Darwin's 1794 Zoonomia onwards, he alights, for example, upon Franz Gall whom he regards as
perhaps the most romantic of the neuroscientists of this era, seeking to understand a unity of structure and function within diversity, not only from an evolutionary standpoint but also within the individual brain (77)
and upon Jean Pierre Flourens who
considered the cortex of the brain possessed equipotentiality; the brain acted holistically, and each part had an action in common with others (80).
By the time, Trimble discusses Hughlings Jackson (116ff., 144f., 174f.), whom he identifies together with Jean-Martin Charcot as founders of modern neuropsychiatry (133), the holistic conception assumes a hierarchical gloss:
structures evolved from the undifferentiated, simple, and homogenous to the differentiated, complex, and heterogenous with integration of differentiated parts. …a universal law…that…could be applied to the evolution of the functions of the brain (119; cf. 121, 131).
Trimble leaves the contemporaneous source for such thinking unreferenced. Nonetheless, readers may well recognise the words of Herbert Spencer on the law of organic development, indeed all development, which purports to demonstrate the "advance from the simple to the complex, through a process of successive differentiation….in which the progress essentially consists [in] the transformation of the homogeneous into the heterogeneous" ("Progress: Its Law and Cause," 1857: 28). Holistic "principles of brain function," by way of von Monakow and Mourgue mentioned above, provide an alternative to "narrow views of localization" that correlate cerebral regions with physiological functions (174-175). Each function emerges from a sequence of processes, implying that they also unfold temporally and become integrated developmentally, both phylo- and ontogenetically. As Trimble pithily expresses it, "Lesions are located in space; functions are revealed and move in time" (175).
Subsequently, as Trimble concludes, other "models" have "emphasized hierarchies within the brain and sympathy within and between parts of the body and the brain," both of which are "relevant for the romantic brain" (281). Amongst such models is Gestälttheorie, Kurt Goldstein being acclaimed a neuropsychiatrist much influenced by it who reacted against associationist theories "in which the mind was viewed as…independent sensory elements" (241). The holistic character of Gestältpsychologie is identified by Trimble as follows: (a) "mental processes" being conceptualised as "the activity of the brain as a whole"; (b) mental processes always being "aimed at performing some function, which implied an active and creative agency"; (c) mental acts always being "directed at or refer[ring] to something" (best known since Franz Brentano as "intentionality" (163)); and (d) brain injuries, especially of the prefrontal kind, affecting the patient's "personality as a whole" to the point of impairing his or her "capacity for 'abstraction'" because of the reversion to cognitive "concretization" and hence his or her "difficulties in grasping the essentials of a given whole" (241-242).
What Trimble has not pinpointed for readers, be they clinical practitioners, medical historians, or philosophical psychology researchers, are the various ways the holistic can be distinctively construed (even if the above shifts between brain and mind seem unproblematic). For example, are readers being told that the whole is more than the sum of its parts? Or that the whole determines the nature of its parts? Or that the parts cannot be actually comprehended if considered apart from the whole? Or that the parts are somehow co-ordinated or interactive, inter-related or interdependent? Again, are readers left to assess whether Trimble is hypothesizing that, firstly, if we have knowledge of the parts, then some properties of the whole cannot be predicted; or, secondly, if properties of the whole have been apprehended, then that prevents us from explaining it in terms of the properties of the parts; or, finally, if we have knowledge of the whole, then that alone licenses scientific clinical theories to refer to properties of the whole? Were the preceding questions deemed to be an ungenerous reading of Trimble, it still threatens us with the conundrum that more often than not we cannot know the parts without knowing the whole and, vice versa, we cannot know the whole without knowing the parts. Hence, are we deprived of securing an independent perspective from which to analyse the holistic per se? Has the fact that Trimble "is working from the past to the present" rather than "taking things are they are today and working backward" (283) helped identify the distinctive ways appeals to the holistic are used?
Trimble explicitly wants his readers to grapple with the western "intellectual legacy" (xi) of contemporary neuropsychiatry, particularly as it emerged in the romantic era of the nineteenth century:
Congruence not disharmony, connectivity not separation, uniting not splitting, wholeness not hollowness, the self in the world not alienated from it—all of these are embedded in the romantic view (ix; cf. xvi-xvii, 89-91).
Whilst Trimble gives us an historical perspective for viewing the development of neuropsychiatry, he does not see himself as providing an historical exegesis, let alone "a linear trajectory" (xiii). Nor does he wish to confuse the task of physical or natural sciences with the human or social sciences such as intellectual history. Whereas the former aims at explaining knowledge of causal relationships of entities or phenomena typically by way of evidence and proofs, the latter centres upon understanding the significance of lived experience. Citing Wilhelm Dilthey's 1894 essay on descriptive and analytic psychology, Trimble contends "We explain nature, but we understand mental life" (279). For those readers who would regard him as soiling neurology with "philosophical speculation (280)," each of Trimble's fourteen chapters shows us how deeply engrained in the neurosciences philosophical ideas have been, a major strength of his monograph.
Trimble's narrative strategy of "interweaving past events and personalities" (282) forms part of his laudable goal of accounting for "the development of neuroscientific discovery and the evolution of ideas, the latter influenced by cultural and social factors, themselves intertwined with developing and developed constructs" (283). Yet there are occasions when his vignettes fall short. For example, it may not be obvious to all readers what purpose is served by the inclusion of, say, the suicide of Hans Berger during the Nazi tyranny (202) or the poisoning of Vladimir Bekhterev during the Stalinist tyranny (237). Perhaps, these instances remind us of how easily intellectual history can slide between investigating how kinds of thinking become manifested or deflected, distorted or suppressed and emphasizing the socio-cultural history of individual intellectuals, be it part biographical and part institutional.
Despite doubts and questions raised by this critique of The Intentional Brain, they do not diminish the sheer potency and scope of the work. It behoves us to recall that, when paraphrasing Aristoteles' Peri aistheseos 436a19-21 (Sense and Sensibilia (B.C. 347±)), Trimble has no hesitation sharing his overarching ideal: "the philosopher should end with medicine and the physician commence with philosophy" (xi).
© 2017 R.A. Goodrich
R.A. Goodrich is affiliated with the A.R.C. Centre for the History of Emotions (University of Melbourne) and the A.D.I. European Philosophy & History of Ideas (Deakin University), co-edits the online refereed arts journal, Double Dialogues, and co-ordinates with Maryrose Hall a longitudinal project investigating linguistic, cognitive, and behavioural development of higher-functioning children within the autistic spectrum and related disorders.