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Psychiatry as Cognitive NeuroscienceReview - Psychiatry as Cognitive Neuroscience
Philosophical Perspectives
by Matthew R. Broome and Lisa Bortolotti (Editors)
Oxford University Press, 2009
Review by Drozdstoj St. Stoyanov
Nov 17th 2009 (Volume 13, Issue 47)

This book covers most significant arena of the debate for the disciplinary status of psychiatry. Besides the ethical, phenomenological and folk-psychology considerations the main emphasis is put on the epistemological legitimacy of psychiatry as a scientific discipline. As it has been stressed in other recent studies of this issue (Stoyanov, 2009, Machamer and Stoyanov, 2009) the cognitive situation of psychiatry as inter- (or trans-) discipline is problematic because of many interconnected reasons. In prima facie psychiatry occupies a controversial area on the cross-section between medicine and humanities. This is why it counts on the contributions of both domains for the improvement and further development of knowledge about human mental health and disease. There were many publications in the last few decades addressing different facets of philosophy and psychiatry, including the international perspectives of philosophy and psychiatry (IPPP) of Oxford University Press. Unfortunately very few of them were focused on the vital topic of epistemology of mental illness and philosophy of science implicated in mental health. This topical mainstream was outlined by Bill Fulford, Tim Thornton and George Graham (the relevant chapters in the Oxford Textbook of Philosophy and Psychiatry); Dominic Murphy's "Psychiatry in a Scientific Image"; Bolton and Hill's "Mind, Meaning and Mental Disorder" and of course the papers of Kenneth F. Schaffner from the University of Pittsburgh, German E. Berrios and the Cambridge School as well as the recent contributions of Massimiliano Aragona, Drozdstoj Stoyanov, Peter Machamer.

I will try in the next few lines to elicit what I take as most valuable in Broome and Bortolotti's discourse as editors of this book.

The whole collection of articles demonstrates that neuroscience beyond any doubt has made a considerable impact on psychopathology. At the same time it remains fragmented from the other fields of human knowledge.  It is hinted by Broome and Bortolotti that psychiatry's existence as a profession is endangered by what we imply as "identity crisis" (Stoyanov, 2005, 2008). This is to say that modern psychiatry has no sufficient grasp of its location and connections with the other human (and life) sciences. On one hand psychiatry captures the mental disorder in separate perspectives (including neuroscience), dependent on the dominant theoretical frameworks and other socio-cultural influences. On the other, as it is deduced in R.Cooper's chapter, psychiatry is not a "unitary science" but in a rather promiscuous manner is adopting data form various methodological backgrounds in order to sustain  (or explain) the available clinical phenomena.

Therefore Broome and Bortolotti believe that biological markers can never serve a priori as sole diagnostic criteria. They suggest that a radical frame shift and redefinition of the currently employed descriptive notions of mental disorder is necessary in order to implement biological investigations:

"...for biological psychiatry to have any validity, and to be anything more than applied neuroscience, the main object of study needs to be the person. The normal and the abnormal themselves are normatively defined and are not properties of the brain".

The further challenge is envisaged in the role of externalism in the 'neuroscientific' psychopathology. By all evidence external to the brain factors, both architectural and content related are involved in the genesis of psychosis. It is referred in this sense the salience theory of Kapur (2003, 2005) which brings together dopamine deregulation and the aberrant salience of both external and internal representations of psychosis. Another methodological issue is raised in respect to the externalist challenge:

"Do certain environments yield particular information if the individual is in a given 'internal' (neurochemical, affective, neuropsychological) state?"

Our answer to this concrete question is positive (Stoyanov, Machamer, Schaffner, forthcoming). Psychological and psychopathological properties have definite neuro-biological correlates which need further exploration and clarification. The discourse of reconciliation we propose is synergistic with Broome and Bortolotti's: the behavioral and experiential processes must be assessed under a pattern of "cross-validation" with neuroscience, where both domains of knowledge are mutually informed. In order to achieve this kind of integrative cooperation however we depend on the critical role of philosophy. Put in the words of Broome and Bortolotti:

"...philosophy has a crucial role in bringing disparate discourses together and variables into relation with one another into a whole which aims at coherence".

From my perspective this is the decisive contribution of Matthew and Lisa to the debate in philosophy of science and psychiatry. Namely it is the utmost necessity of conformable dialogue at the intersection of the disciplines focusing on mental health and disorder.

  1. Murphy, D (2006), Psychiatry in a scientific image, MIT Press
  2. Bolton, D and Johnatan Hill, Mind, Meaning and Mental Disorder (2004), OUP
  3. Fulford, KWM, T.Thornton and G.Graham (2006), Oxford Textbook of Philosophy and Psychiatry, OUP
  4. Schaffner, KF (2005), Behavioral and Psychiatric Genomics: Current State and Future Forecasts" in VISION 2033: LINKING SCIENCE AND POLICY IN TOMORROW'S WORLD, Proceedings Celebrating the 30th Anniversary of the AAAS Science and Technology Policy Fellowship Programs. Washington, DC: American Association for the Advancement of Science. Pp. 64-71 (discussion by Bruce Sterling et al. pp. 72-73).
  5. Stoyanov, D (2009), The cross-validation in the dialogue of mental and neurosciences, Dial Phil Ment Neuro Sci, Vol. 2, Issue 1
  6. Stoyanov, D, P.Machamer and KF Schaffner (forthcoming 2010) In quest for scientific status of psychiatry: towards bridging the explanatory gap, to appear in special issue of History of Psychiatry

© 2009 Drozdstoj Stoyanov



Assoc. Prof. Dr. Drozdstoj Stoyanov, University of Medicine, Plovdiv, Bulgaria & University of Pittsburgh, USA



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