Am J Psychiatry 1992; 149:991-998
Copyright © 1992 by American Psychiatric Association
Psychodynamic psychiatry in the "decade of the brain"
GO Gabbard
C.F. Menninger Memorial Hospital, Topeka, KS 66601-0829.
OBJECTIVE AND METHOD: To illustrate the continued relevance of
psychodynamic thinking in the practice of contemporary psychiatry, the
author reviews a number of studies that demonstrate the intimate connection
between psychosocial and neurophysiological factors in the etiology and
pathogenesis of psychiatric disorders. A survey of three specific anxiety
disorders illustrates the complex interaction between mind and brain in
these disorders. RESULTS: Research on both primates and humans suggests
that psychological influences result in permanent alterations of a
neurobiological nature. Similarly, psychological interventions in a
treatment context may have a profound impact on neurophysiology. Clinical
case examples demonstrate that "biologically based" disorders may be rich
in unconscious meaning. Clinical understanding of the meaning of symptoms
may be instrumental in ensuring patients' compliance with pharmacotherapy
regimens and in the removal of other resistances to treatment. CONCLUSIONS:
In contemporary psychiatry, a psychodynamic perspective must be preserved.
Without it, meaning will be lost, and both diagnostic understanding and
informed treatment planning will suffer as a result.
