Frisch Stefan
Department of Neurology, University Hospital Frankfurt/Goethe University, Frankfurt am Main, Germany.
Psychopathology. 2016;49(3):135-42. doi: 10.1159/000447359. Epub 2016 Jul 19.
Neuroscientific research has substantially increased our knowledge about mental disorders in recent years. Along with these benefits, radical postulates have been articulated according to which understanding and treatment of mental disorders should generally be based on biological terms, such as neurons/brain areas, transmitters, genes etc. Proponents of such a 'biological psychiatry' claim that mental disorders are analogous to neurological disorders and refer to neurology and neuropsychology to corroborate their claims. The present article argues that, from a clinical-neuropsychological perspective, 'biological psychiatry' is based on a mechanistic, 'cerebrocentric' framework of brain (dys-)function which has its roots in experimental neuroscience but runs up against narrow limits in clinical neurology and neuropsychology. In fact, understanding and treating neurological disorders generally demands a systems perspective including brain, organism and environment as intrinsically entangled. In this way, 'biological' characterizes a 'holistic', nonreductionist level of explanation, according to which the significance of particular mechanisms can only be estimated in the context of the organism (or person). This is evident in the common observation that local brain damage does not just lead to an isolated loss of function, but to multiple attempts of reorganization and readaptation; it initiates new developments. Furthermore, treating brain disorders necessarily includes aspects of individuality and subjectivity, a conclusion that contradicts the purely 'objectivist', third-person stance put forward by some proponents of biological psychiatry. In sum, understanding and treating brain damage sequelae in the clinical neurosciences demands a biopsychosocial perspective, for both conceptual and historical reasons. The same may hold for psychiatry when adopting a brain-based view on mental disorders. In such a perspective, biological psychiatry seems an interesting project but falls short of its original claims.
近年来，神经科学研究极大地增进了我们对精神障碍的了解。伴随着这些成果，一些激进的假设也被提了出来，即对精神障碍的理解和治疗通常应基于生物学概念，如神经元/脑区、递质、基因等。这种“生物精神病学”的支持者声称，精神障碍与神经疾病类似，并援引神经学和神经心理学来佐证他们的观点。本文认为，从临床神经心理学的角度来看，“生物精神病学”基于一种机械的、“以脑为中心”的脑（功能失调）功能框架，该框架源于实验神经科学，但在临床神经学和神经心理学中存在狭隘的局限性。事实上，对神经疾病的理解和治疗通常需要一个系统的视角，将脑、机体和环境视为内在相互纠缠的整体。这样一来，“生物学”表征了一种“整体的”、非还原论的解释层面，据此特定机制的意义只能在机体（或人）的背景下进行评估。这在常见的观察中很明显，即局部脑损伤不仅会导致功能的孤立丧失，还会引发多次重组和重新适应的尝试；它会引发新的发展。此外，治疗脑部疾病必然涉及个体性和主观性方面，这一结论与一些生物精神病学支持者提出的纯粹“客观主义”的第三人称立场相矛盾。总之，出于概念和历史原因，临床神经科学中对脑损伤后遗症的理解和治疗需要生物心理社会视角。当对精神障碍采用基于脑的观点时，精神病学可能也是如此。从这样的角度来看，生物精神病学似乎是一个有趣的课题，但未能实现其最初的主张。
