Comprehensive
Psychiatry
(Official Journal of the American Psychopathological
Association)
JANUARY/FEBRUARY 1991
VOL. 32, NO. 1
EDITORIAL
Some Ideas for a New Year
I
N THE COURSE of the year, an editor sees multiple manuscripts, reviews, revisions, letters, other scientific journals, and time permitting, attempts to remain generally literate. It is a unique privilege to be at a crossroad of new ideas. Occasionally one gets a glimpse of the forest in which others are cultivating trees. Several topics, from fields other than psychiatry or clinical psychology, have been recurring in the literature over the past year which, at least to this editor, bear watching over the next year. Two technologies show promise for elaborating brain mechanisms underlying psychopathology, functional brain imaging, and molecular genetics. Positron emission tomography (PET) and single photon emission tomography (SPECT) can provide information about cerebral blood flow and metabolism.‘+’ Receptor ligands for PET and SPECT are now available that permit analysis of specific neurotransmitter systems in the living brain and the response to psychotropic agents. One recent report indicates that SPECT is accurate in the diagnosis of Alzheimer’s disease.3 PET and SPECT studies in schizophrenia and the affective disorders will be of interest. Molecular genetics and the human genome project4 have received a great deal of publicity in the scientific and lay press. There are reports of loci for the genes of Huntington’s disease, Alzheimer’s disease, schizophrenia, and bipolar disorder, although replication studies are required. A recent report on sources of human psychological differences in twins reared apart extends genetic findings from psychopathology to the heritability of psychological traits.5 This is not a new concept, but molecular biology may get us closer to the biological basis of pathological as well as normal behaviors. Another development is the explosion of scientific information, or more importantly, the technological advances that make the information so available. The National Library of Medicine receives over 20,000 serial titles. Abstracts are readily available by modem or on CD-ROM; reprints by FAX. Soon entire texts will be on-line. An emerging medical discipline has been christened “medical informatics.“6 This ready availability of information is equivalent in import to the introduction of the printing press in the 15th century. The challenge is to learn how to abstract, synthesize, and judge the valildity and application of the information. A clinician who bases practice on one case is thought to be naive; the same is true of one who forms an opinion on the basis of a single reference. In an excellent book on the computer and the sciences of complexity, the late Heinz Pagels presents some ideas relevant to psychopathology.’ He defines Comprehensive
Psychiatry,
Vol. 32, No. 1 (January/February),
1991: pp l-3
1
2
EDITORIAL
complexity as “a quantitative measure that can be assigned to a physical system or a computation that lies midway between the measure of simple order and complete chaos.” James Gleick, in Chaos: Making a New Science, translates for the nonscientist the emerging theory of deterministic chaos.’ These mathematical concepts are being applied to complex systems that tend to develop turbulence and manifest aperiodicity, systems such as the weather, economics, and population biology. Models of Neptune’s great dark spot imply deterministic chaos.’ Chaos theory, with its “strange attractors,” has been applied to cardiac arrhythmias, why not manic-depressive disorder? Simple linear deterministic models, the La Placian universe, are not adequate for the complex conditions we deal with. Philosophers are again interested in psychopathology. Manfred Spitzer writes in the introduction to Philosophy and Psychopathology: “For at least two and a half thousand years, philosophers have thought about the mind and its functions. If we are to say anything reasonable about disorders of the mind and its functions, we cannot disregard philosophy.“” But Jaspers told us this years ago: “Psychology and medicine are the scientific disciplines most closely linked with psychopathology but the latter, of course, like any other science, has remoter connections with all other branches of human enquiry, one of which should have a special mention here the discipline of philosophy with its accent on methodology.“” Marsden Blois put it this way in an essay on “Medicine and the Nature of Vertical Thinking”: “ The availability of quantitative data and the application of mathematics are regarded by many as the sine qua non of a science. But it is not clear that either has anything to do with the scientific method. This is especially so with respect to clinical observation and reasoning. Here, natural language remains the primary means of recording and communicating observations and of subsequently drawing inferences from them.“” As Thomas Kuhn pointed out, when there is a paradigm shift in science, observations are seen in a different perceptual gestalt.13 Uranus was observed in the heavens at least 17 times by astronomers between 1690 and 1781 before it was recognized as a planet by Sir William Herschel. This required an acceptance of the Copernican paradigm, as well as the availability of a better telescope. There may be a parallel here. We have powerful new technologies to study the brain and the gene, access to information and communication literally at the speed of light. Perhaps exploration of alternative conceptual models and philosophical reflection on the meaning of symptoms and categories is in order. Imre Lakatos, a Hungarian-born philosopher of science, spoke of progressive research programs.‘4 Great science is not an isolated hypothesis, but a research program, nor is science simply trial and error, a series of conjectures and refutations. A program has a “hard core,” which is protected by a vast “protective belt” of auxiliary hypotheses. “As opposed to Popper the methodology of scientific research programs does not offer instant rationality. One must treat budding programs leniently: programs may take decades before they get off the ground and become empirically progressive. Criticism is not a Popperian quick kill, by refutation. Important criticism is always constructive: there is no refutation without a better theory.” Anyway, some new thoughts for the new year! Ralph A. O’Connell, M.D.
EDITORIAL
3
REFERENCES 1. Council on Scientific Affairs. Report of the Positron Emission Tomography Panel: Positron emission tomography: A new approach to brain chemistry. JAMA 260:2704-2710,1988 2. Holman BL, Tumeh SS: Single-photon emission computed tomography (SPECT): Applications and potential. JAMA 263:561-564,199O 3. Johnson KA, Holman BL, Rosen TJ, et al: Iofetamine I’? Single photon emission computed tomography is accurate in the diagnosis of Alzheimer’s disease. Arch Intern Med 150:752-756,199O 4. Watson JD: The human genome project: Past, present and future. Science 248:44-49,199O 5. Bouchard TJ, Lykken DT, McGue M, et al: Sources of human psychological differences: The Minnesota study of twins reared apart. Science 2.50:223-250,199O 6. Greenes RA, Shortliffe, EH: Medical infonnatics: An emerging academic discipline and institutional priority. JAMA 263: 1114-1120,199O 7. Pagels HR: The Dreams of Reason: The Computer and the Sciences of Complexity. New York, NY, Simon & Schuster, 1988 8. Gleick J: Chaos: Making of a New Science. New York, NY, Viking, 1987 9. Polvani LM, Wisdom J, DeJong E, et al: Simple dynamical models of Neptune’s great dark spot. Science 249:1393-1398,199O 10. Spitzer M, Maher BA (eds): Philosophy and Psychopathology. New York, NY, Springer-Verlag, 1990 11. Jaspers K: General Psychopathology. Chicago, IL, University of Chicago Press, 1963 12. Blois M: Medicine and the nature of vertical reasoning. N Engl J Med 318:847-851, 1988 13. Kuhn TS: The Structure of Scientific Revolutions. Chicago, IL, University of Chicago Press, 1970 14. Lakatos I: The Methodology of Scientific Research Programmes. New York, NY, Cambridge University Press, 1978
Psychiatry
(Official Journal of the American Psychopathological
Association)
JANUARY/FEBRUARY 1991
VOL. 32, NO. 1
EDITORIAL
Some Ideas for a New Year
I
N THE COURSE of the year, an editor sees multiple manuscripts, reviews, revisions, letters, other scientific journals, and time permitting, attempts to remain generally literate. It is a unique privilege to be at a crossroad of new ideas. Occasionally one gets a glimpse of the forest in which others are cultivating trees. Several topics, from fields other than psychiatry or clinical psychology, have been recurring in the literature over the past year which, at least to this editor, bear watching over the next year. Two technologies show promise for elaborating brain mechanisms underlying psychopathology, functional brain imaging, and molecular genetics. Positron emission tomography (PET) and single photon emission tomography (SPECT) can provide information about cerebral blood flow and metabolism.‘+’ Receptor ligands for PET and SPECT are now available that permit analysis of specific neurotransmitter systems in the living brain and the response to psychotropic agents. One recent report indicates that SPECT is accurate in the diagnosis of Alzheimer’s disease.3 PET and SPECT studies in schizophrenia and the affective disorders will be of interest. Molecular genetics and the human genome project4 have received a great deal of publicity in the scientific and lay press. There are reports of loci for the genes of Huntington’s disease, Alzheimer’s disease, schizophrenia, and bipolar disorder, although replication studies are required. A recent report on sources of human psychological differences in twins reared apart extends genetic findings from psychopathology to the heritability of psychological traits.5 This is not a new concept, but molecular biology may get us closer to the biological basis of pathological as well as normal behaviors. Another development is the explosion of scientific information, or more importantly, the technological advances that make the information so available. The National Library of Medicine receives over 20,000 serial titles. Abstracts are readily available by modem or on CD-ROM; reprints by FAX. Soon entire texts will be on-line. An emerging medical discipline has been christened “medical informatics.“6 This ready availability of information is equivalent in import to the introduction of the printing press in the 15th century. The challenge is to learn how to abstract, synthesize, and judge the valildity and application of the information. A clinician who bases practice on one case is thought to be naive; the same is true of one who forms an opinion on the basis of a single reference. In an excellent book on the computer and the sciences of complexity, the late Heinz Pagels presents some ideas relevant to psychopathology.’ He defines Comprehensive
Psychiatry,
Vol. 32, No. 1 (January/February),
1991: pp l-3
1
2
EDITORIAL
complexity as “a quantitative measure that can be assigned to a physical system or a computation that lies midway between the measure of simple order and complete chaos.” James Gleick, in Chaos: Making a New Science, translates for the nonscientist the emerging theory of deterministic chaos.’ These mathematical concepts are being applied to complex systems that tend to develop turbulence and manifest aperiodicity, systems such as the weather, economics, and population biology. Models of Neptune’s great dark spot imply deterministic chaos.’ Chaos theory, with its “strange attractors,” has been applied to cardiac arrhythmias, why not manic-depressive disorder? Simple linear deterministic models, the La Placian universe, are not adequate for the complex conditions we deal with. Philosophers are again interested in psychopathology. Manfred Spitzer writes in the introduction to Philosophy and Psychopathology: “For at least two and a half thousand years, philosophers have thought about the mind and its functions. If we are to say anything reasonable about disorders of the mind and its functions, we cannot disregard philosophy.“” But Jaspers told us this years ago: “Psychology and medicine are the scientific disciplines most closely linked with psychopathology but the latter, of course, like any other science, has remoter connections with all other branches of human enquiry, one of which should have a special mention here the discipline of philosophy with its accent on methodology.“” Marsden Blois put it this way in an essay on “Medicine and the Nature of Vertical Thinking”: “ The availability of quantitative data and the application of mathematics are regarded by many as the sine qua non of a science. But it is not clear that either has anything to do with the scientific method. This is especially so with respect to clinical observation and reasoning. Here, natural language remains the primary means of recording and communicating observations and of subsequently drawing inferences from them.“” As Thomas Kuhn pointed out, when there is a paradigm shift in science, observations are seen in a different perceptual gestalt.13 Uranus was observed in the heavens at least 17 times by astronomers between 1690 and 1781 before it was recognized as a planet by Sir William Herschel. This required an acceptance of the Copernican paradigm, as well as the availability of a better telescope. There may be a parallel here. We have powerful new technologies to study the brain and the gene, access to information and communication literally at the speed of light. Perhaps exploration of alternative conceptual models and philosophical reflection on the meaning of symptoms and categories is in order. Imre Lakatos, a Hungarian-born philosopher of science, spoke of progressive research programs.‘4 Great science is not an isolated hypothesis, but a research program, nor is science simply trial and error, a series of conjectures and refutations. A program has a “hard core,” which is protected by a vast “protective belt” of auxiliary hypotheses. “As opposed to Popper the methodology of scientific research programs does not offer instant rationality. One must treat budding programs leniently: programs may take decades before they get off the ground and become empirically progressive. Criticism is not a Popperian quick kill, by refutation. Important criticism is always constructive: there is no refutation without a better theory.” Anyway, some new thoughts for the new year! Ralph A. O’Connell, M.D.
EDITORIAL
3
REFERENCES 1. Council on Scientific Affairs. Report of the Positron Emission Tomography Panel: Positron emission tomography: A new approach to brain chemistry. JAMA 260:2704-2710,1988 2. Holman BL, Tumeh SS: Single-photon emission computed tomography (SPECT): Applications and potential. JAMA 263:561-564,199O 3. Johnson KA, Holman BL, Rosen TJ, et al: Iofetamine I’? Single photon emission computed tomography is accurate in the diagnosis of Alzheimer’s disease. Arch Intern Med 150:752-756,199O 4. Watson JD: The human genome project: Past, present and future. Science 248:44-49,199O 5. Bouchard TJ, Lykken DT, McGue M, et al: Sources of human psychological differences: The Minnesota study of twins reared apart. Science 2.50:223-250,199O 6. Greenes RA, Shortliffe, EH: Medical infonnatics: An emerging academic discipline and institutional priority. JAMA 263: 1114-1120,199O 7. Pagels HR: The Dreams of Reason: The Computer and the Sciences of Complexity. New York, NY, Simon & Schuster, 1988 8. Gleick J: Chaos: Making of a New Science. New York, NY, Viking, 1987 9. Polvani LM, Wisdom J, DeJong E, et al: Simple dynamical models of Neptune’s great dark spot. Science 249:1393-1398,199O 10. Spitzer M, Maher BA (eds): Philosophy and Psychopathology. New York, NY, Springer-Verlag, 1990 11. Jaspers K: General Psychopathology. Chicago, IL, University of Chicago Press, 1963 12. Blois M: Medicine and the nature of vertical reasoning. N Engl J Med 318:847-851, 1988 13. Kuhn TS: The Structure of Scientific Revolutions. Chicago, IL, University of Chicago Press, 1970 14. Lakatos I: The Methodology of Scientific Research Programmes. New York, NY, Cambridge University Press, 1978
