Kendler Kenneth S
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.
Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
Mol Psychiatry. 2025 May 13. doi: 10.1038/s41380-025-03053-6.
From the very beginnings of our field in the late 18th century, psychiatrists have engaged, often extensively, in "metaphorical brain talk" - rephrasing descriptions of mental processes in unconfirmed brain metaphors (e.g., "diseased working of the brain convolutions"). In the late 19th century, Kraepelin criticized the later developments of such approaches, termed "brain mythology" by the philosopher/psychiatrist Jaspers in 1913. In this essay, I review the history, meaning, and significance of this phenomenon and reach four conclusions. First, this trend has continued to the present day in metaphors such as the "broken brain" and the use of simplistic and empirically poorly supported explanations of psychiatric illness, such as depression being "due to an imbalance of serotonin in the brain." Second, our language stems from the tension in our profession that seeks to be a part of medicine yet declares our main focus as treatment of the mental. We feel more comfortable with the reductionist approach of brain metaphors, which, even though at times self-deceptive, reinforce our commitment to and membership in a brain-based medical specialty. Third, metaphorical brain talk can also be seen as the "promissory note" of our profession, a pledge that the day will come when we can indeed explain accurately to ourselves and to our patients the brain basis of the psychiatric disorders from which they suffer. Finally, moving away from metaphorical brain talk would reflect an increasing maturity of both the research and clinical aspects of our profession.
从18世纪末我们这个领域诞生之初起，精神科医生就常常广泛地参与“隐喻性脑话语”——用未经证实的大脑隐喻来重新表述心理过程的描述（例如，“脑回的病变运作”）。19世纪末，克雷佩林批评了这种方法的后续发展，1913年哲学家兼精神科医生雅斯贝尔斯将其称为“脑神话”。在本文中，我回顾了这一现象的历史、意义和重要性，并得出四个结论。第一，这种趋势一直持续到今天，如“受损大脑”这样的隐喻以及对精神疾病使用简单且缺乏实证支持的解释，比如抑郁症“归因于大脑中血清素失衡”。第二，我们的语言源于我们这个行业的一种矛盾状态，既试图成为医学的一部分，又宣称我们的主要关注点是心理治疗。我们对大脑隐喻的还原论方法感觉更自在，这种方法尽管有时具有自我欺骗性，但强化了我们对基于大脑的医学专业的投入和归属感。第三，隐喻性脑话语也可被视为我们这个行业的“期票”，是一种承诺，即终有一天我们能够确实向自己和患者准确解释他们所患精神疾病的大脑基础。最后，摒弃隐喻性脑话语将反映出我们这个行业在研究和临床方面日益成熟。
