Am J Psychiatry 1995; 152:1563-1575
Copyright © 1995 by American Psychiatric Association
The social construction of the human brain
L Eisenberg
Department of Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
OBJECTIVE: The purpose of this article is to review the development of
concepts about the contribution of nature and nurture to brain structure
and mental function, and to derive the implications of these changing
concepts for clinical practice. METHOD: The literature of the past five
decades, as refracted by the author's personal experience in academic
psychiatry during that interval, is reviewed. RESULTS: Psychiatric theory
has swung through mighty arcs in recent years but has begun to
re-equilibrate. Fifty years ago, psychoanalysis dominated the academic
scene; for the past two decades, reductionist biological determinism has
held the fort. Neither position is tenable. To subscribe to either is
possible only by ignoring conflicting evidence. Worse, it means
short-changing patients, whose disorders do not come neatly packaged into
"organic" and "functional" compartments. Development is neither predestined
in the genome nor completely malleable to shaping by the environment.
Children inherit, along with their parents' genes, their parents, their
peers, and the communities they inhabit. CONCLUSIONS: Contemporary
psychiatric research conclusively demonstrates that mind/brain responds to
biological and social vectors and is jointly constructed by both. Major
brain pathways are specified in the genome; detailed connections are
fashioned by, and consequently reflect, socially mediated experience in the
world. Just at the time when integration at the level of theory is coming
into sight, comprehensive patient care is endangered by for-profit
corporate managed care, which is transforming medical visits into
commodities on a production line. Physicians and patients must join in a
coalition to protect quality, ensure access, and build continuity into all
of medical care.
