Notes
Notes ONE: The Status Quo 1. Emil Kraepelin is not anywhere nearly as famous as Freud among nonpsychiatrists. Even in psychiatry, at least in the United States, he was, until the 1970s, considered a dusty old German ideologue whose views were hopelessly old-fashioned. Kraepelin was largely ignored because Freud was so popular, and because Freud’s methods and theories were so different. In American psychiatry, the influence of Adolf Meyer also led to a downgrading of Kraepelin’s ideas, since Meyer was more interested in psychosocial factors related to behavioral problems than in a strictly medical approach to psychiatric diagnosis as exemplified by Kraepelin. The 1970s saw a rebirth of a consciously neoKraepelinian school in psychiatry, which led to DSM-III and the radical restructuring of psychiatric nosology. Today, references to Kraepelin are quite frequent in psychiatric articles in the standard nonpsychoanalytic journals, whereas those to Freud are few and far between. This does not mean that history has passed its judgment on these two fathers of psychiatry; the seesaw between the two men seems to go on indefinitely. 2. One might include Thomas Szasz (1970) and some other scholars in this school of thought. One of the limitations of individuals such as Szasz and Laing is that they appear to take a dogmatic approach to psychiatry. The existential approach is but one approach to psychiatry, with many limitations as well as some strengths. (According to one of my themes in this book, the same is true of any single approach.) Because in many persons, life situations can be misinterpreted as mental illness, Szasz and Laing conclude that in no instance is any psychological symptom reflective of a mental illness. This is simply a type of extremism that differs in no way, in terms of form, from the strictest psychoanalytic orthodoxy or from blind biological reductionism. Reality is much more complex, the wishes of true believers to the contrary notwithstanding. 3. Obviously the content of the works of these individuals differs, but they all share the method of applying interpersonal and social methods to psychiatry. Havens focuses most on the contributions of Sullivan. 4. My colleague David Brendel has emphasized this point to me. 5. Kandel was co-awarded the prize along with Arvid Carlsson and Paul Greengard, but of the three, Kandel was the only one with an M.D. who had trained in a clinical psychiatry residency program. 6. Paul Roazen has pointed out to me that this retrospective criticism of WagnerJaurregg may not do justice to his skills and dedication. He apparently was a careful, dedicated clinician and researcher of high caliber. 7. I am indebted here to the work of Jillian Craigie and Ian Gold (2002), presented at a recent conference. They describe the concept of fractionation, the attempt to break down cognitive properties to simple terms and then to link these simple cognitive terms to complex neural terms. Their idea is that each level of description explains the level above it, owing to shared properties. There is an isomorphism, in that one thing is explained in two different languages. Although, in the presentation I attended, Craigie did not make the direct link to the type of integrationism espoused by Kandel, I think a link could indeed be made. Another well-known effort along similar lines, more indebted to evolutionary theory, is that of Gerald Edelman (1988). TWO: What There Is 1. Jackson’s example of Mary the color scientist is the classic thought experiment used to illustrate the problem of qualia. 2. The pain thought experiment is an old one, well described by Flanagan. This text is, in my opinion, the most comprehensive and comprehensible summary of modern philosophy of mind. 3. Dennett’s views are best laid out in Consciousness Explained. His recent work (1995) has expanded into attempting to find a basis in evolutionary theory for his views. 4. Aviel Goodman (1991) has tried to bring some of the philosophical concepts of emergence into psychiatry, while linking them to the Erklaren-Verstehen distinction. Goodman links the emergence concept to mind-body dualism and to the biopsychosocial theory of Engel. Although this is not illogical, emergence does not need to be linked only with the biopsychosocial theory. 5. Cobb was a unique figure in modern psychiatry. He was fully trained in neurology and neuropathology, and he also completed his psychiatry residency with Adolf Meyer at Johns Hopkins during World War I. He ran the neurology service at Harvard’s...
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