Letters

The Social Brain: A Unifying

Foundation for Psychiatry
TO THE EDITOR: The Research
Committee of the Group for the
Advancement of Psychiatry (GAP),
a specialty think tank, has addressed psychiatrys need for a unifying scientic foundation. Such a
foundation would consider the disorders commonly treated by psychiatrists in terms of the physiological baseline from which they
depart, much as heart disease is understood as deviation from normal
cardiac function. The relevant
physiological focus for psychiatry
is the social brain.
The social brain is dened by
its functionnamely, the brain is a
body organ that mediates social interactions while also serving as the
repository of those interactions.
The concept focuses on the interface between brain physiology and
the individuals environment. The
brain is the organ most inuenced
on the cellular level by social factors across development; in turn,
the expression of brain function determines and structures an individuals personal and social experience. The social brain framework
may have greater direct impact on
the understanding of some psychiatric disorders than others. However, it helps organize and explain
all psychopathology. A single genebased disorder like Huntingtons
disease is expressed to a large extent as social dysfunction. Conversely, traumatic stress has structural impact on the brain, as does
the socially interactive process of
psychotherapy.
Brains, including human brains,
derive from ancient adaptations to
Academic Psychiatry 26:3, Fall 2002

diverse environments and are themselves repositories of phylogenetic

adaptations. In addition, individual
experiences shape the brain through
epigenesis; that is, the expression of
genes is shaped by environmental
inuences. Thus, the social brain is
also a repository of individual development. On an ongoing basis,
the brain is further rened through
social interactions; plastic changes
continue through life with both
physiological and anatomical modications.
In contrast to the conventional
biopsychosocial model, the social
brain formulation emphasizes that
all psychological and social factors
are biological. Nonbiological and
nonsocial psychiatry cannot exist.
Molecular and cellular sciences offer fresh and exciting contributions
to such a framework but provide
limited explanations for the social
facets of individual function.
The social brain formulation is
consistent with current research
and clinical data. Moreover, it ultimately must
Unify the biological, psychological, and social factors in
psychiatric illness.
Dissect components of illness
into meaningful functional subsets that deviate in denable
ways from normal physiology.
Improve diagnostic validity by
generating testable clinical formulations from brain-based social processes.
Guide psychiatric research and
treatment.
Provide an improved language
for treating patients as well as
educating trainees, patients,
their families, and the public.

Account for the role of interpersonal relationships in brain

function and health.
The concept of the brain as an
organ that manages social life provides signicant power for psychiatrys basic science. Burgeoning developments in neural and genetic
areas put added demands on the
conceptual structures of psychiatry.
Findings from such incoming work
must be juxtaposed and correlated
with the behavioral and experiential facets of psychiatry to give it a
complete and rational basis. Psychiatrys full and unied entry into
the realm of theory-driven and
data-based medical science has
been overdue. The social brain concept allows psychiatry to utilize
pathogenesis in a manner parallel
to practice in other specialties.
This statement was composed by the
listed members of the Research Committee
of the Group for the Advancement of Psychiatry (GAP) during the periodic meetings
of this group. The opinions expressed are
those of the authors and do not represent an
ofcial opinion of GAP.
Cornelis Bakker,
Russell Gardner, Jr.,
Vassilis Koliatsos, Jacob Kerbeshian,
John Guy Looney, Beverly Sutton,
Alan Swann, Johan Verhulst,
Karen DineenWagner, Frederick
S.Wamboldt, Daniel R.Wilson

Psychiatry and Major Literature

TO THE EDITOR: The letters about
psychiatrists as major authors (1,2),
reacting to an excellent article on
poetry by Robert Pinsky (3), seem
to be misguided in several aspects.
To begin with, psychiatry is a fairly
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LETTERS

young specialty compared with the

rest of medicine. How many psychiatrists were around at the time
Anton Chekhov wrote his plays
and short stories? Not many. Overall, the number of physicians who
authored major literature (whatever it meansnot everybody
would consider work by practicing
and nonpracticing physicians Archibald J. Cronin, Michael Crichton, or Walker Percy major literature) has not been large, and
psychiatry is not the largest medical specialty. Reliable numbers for
physician-authors and psychiatristauthors do not exist, so we do not
know how comparable the number
of psychiatrists who authored minor or major literature is to the
number for the rest of medicine.
Authorship also takes many forms.
How many of us know that a wellknown present-day political columnist (not a major author,
though), Charles Krauthammer,
authored a classic article on secondary mania (4) in his previous
career? Or how many consider the
work of psychiatristminister M.
Scott Peck (The Road Less Traveled)
major literature?
This debate is also a bit culturally skewed. It focuses on so-called
major literary works and major
national literatures. I am not so
sure whether in the non-Germanspeaking lands in the West,
Schnitzler does not approach the
acclaim enjoyed by Williams or

220

Chekhov, who were mentioned as

examples. I agree that he does not
reach the acclaim of Chekhov; only
a few authors do, and Chekhov
has never attracted anything but
admiration (5). But how many
people (and how many psychiatrists) still know the work of William Carlos Williams? Schnitzler,
on the other hand, has enjoyed
fairly high acclaim among German
and non-German-speaking readers
and psychiatrists in Europe.
In literatures other than English, there are many examples of
well-known authors who are psychiatrists. One of the foremost Portuguese novelists, Antonio Lobo
Antunes, is (or at least was at the
time of his major literary writings)
a practicing psychiatrist. The New
York Times Book Review described
him once as A mad amalgam of
Dos Passos and Celine. The
Czechs have Josef Nesvadba, a
well-known
psychiatristscience
ction writer. The Bosnian Serbs
have the infamous psychiatristpoet-nationalist-war criminal Radovan Karadzic. The Egyptians
have Nawal El Saadawi, a wellknown feminist. The Finns have
Veronica Pimenoff. The Swedes
have Axel Munthe, author of The
Story of San Michele. And the Swiss
have Walter Vogt (who switched to
psychiatry from radiology), whose
book Der Wiesbadener Kongress
makes poignant fun of research and
academia.

Finally, I feel that the assumption of a special role for psychiatry

among medical specialties in regard to major literary writing is
specialty-biased. Why do we assume that by confronting daily the
stuff of human narrative, drama,
and fantasy, they [psychiatrists]
would seem to be uniquely positioned to produce compelling ction and poetry? Why do we assume that the tragedy and suffering
observed by psychiatrists is unique
compared with the observations of
other physicians?
Nevertheless, I agree that literary work by psychiatrists is educationally interesting (3) and enjoyable, and that it could and should
be used as a teaching tool.
Richard Balon, M.D.
Department of Psychiatry and Behavioral
Neurosciences, Wayne State University
School of Medicine, Detroit, MI

References
1. Schwartz M: Psychiatrists as major authors? Academic Psychiatry 2001; 25:239
2. Scheurich N: Psychiatrists and the literary canon. Academic Psychiatry 2001;
25:239
3. Scheurich N: Robert Pinsky and the poetry of psychiatry. Academic Psychiatry
2001; 25:173180
4. Krauthammer C, Klerman GL: Secondary mania: manic syndromes associated
with antecedent physical illness or
drugs. Arch Gen Psychiatry 1978; 35:
13331339
5. Hensher P: Incomparable naturalism.
The Atlantic Monthly, January 2002, pp
126131

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