The Lesion and the Function: Setting Up the Reductionist Problem

THE LESIONAND THE FUNCTION: SETTING UP THE REDUCTIONIST PROBLEM COLLEEN D. CLEMENTS* Introduction: Framing the Right Question Familiar key words, reductionism and holism, appear with predictable regularity in the life sciences. With an emphasis on Darwin's centenary, reports underline the "reductionism-holism axis" in evolutionary biology [1-3] and also underline the exclusionary framework of the problem, reduction or holism. While this problem is more acute in the life sciences , it is a more general conceptual problem for all science, has practical implications fer medical science, and results from a persistent (but hardly heuristic) way of asking the basic question: Is there a difference of kind among levels of organization, or which is the superior level of scientific explanation? As long as the question is asked in this way, no worthwhile answer can be made. The same nonproductive dichotomy is present in medicine. Choose between the biochemical and the behavioral, between the physiological and the psychological, between "hard" science and art or practice. General systems theory, as Engel understands [4], can eliminate this forced choice, but only if it succeeds in avoiding the same mutually exclusive conceptual frame, choosing between reductionism or holism. Otherwise, it becomes the same poor question, expressed with new vocabulary, and one more obstacle to asking the right questions. In this paper, I will briefly try to illustrate a new way oflooking at the problem, with specific psychiatric examples. However, the same approach can be used for genetics cases, and our Genetics Clinic also functions best when the problem is not seen as a forced choice between reduction or holism [5]. The author expresses her appreciation to Drs. Roger Sider and Norman Pointer for discussion on the conceptual and medical aspects of systems theory, to Dr. John Romano for his comments on systems theory as applied to schizophrenia, and to Dr. George Engel for his suggestions. Work is supported by NSF (EVIST) grant OSS-8018092. ?Assistant professor of psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, New York 14642.© 1983 by The University of Chicago. All rights reserved. 003 1-5982/83/2603-0341$01 .00 Perspectives in Biology andMediane, 26, 3 · Spring 1983 | 433 How we set up a problem, then, will finally determine the possibilities of solving it. As long as Kraepelin thought in terms of finding the lesion [6], he had already determined that a significant number of data (or a large slice ofexperience) would be outside his explanatory scheme. Any experience not capable of being "reduced" to a pathological lesion (or a genetic lesion) remained excluded as of no scientific interest. He was stating, in psychiatric terms, the structuring ofthe reductionist problem, still handed down in the sciences. We are presented with a forced option: lesion or function. The classificatory system for psychiatric illnesses edged toward a function choice [7], as had Janet [6] and Freud [8], with Freud reluctant to abandon the vision at least of physical reduction. The classificatory system [7], as the pendulum swings, has moved toward the lesion choice (but with the uneasy knowledge that the neurosciences are describing development and process rather than the static lesion of pathology [9] or the automatic copy of DNA [10]). It is clear no one wants this exclusive choice, but the way out of the choice is overgrown with cognitive debris. Even the new scientific way of looking at things and therefore restating the problem, systems theory, often falls into the same dichotomy trap. Polarity is a hard habit to break. Various systems theorists seem determined to set the problem up in the same traditional way, with different words: reduction level versus holism (organismic) level; biochemical explanation versus emergent properties explanation; part versus whole relationships; or finally, as expressed in the summary of a conference on the problem, "reductionism versus organicism" [1 1]. Ifwe persist in forcing this choice, seeing levels oforganization/complexity as different kinds of things to choose between, we are only repeating Descartes 's mind/body dilemma without a hope ofsolution. Asked to give up our knowledge of bioamines or our knowledge of repression, how can we profit from either choice? We could refuse to choose and adopt a practical eclecticism. There are good things...