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A history of metaphorical brain talk in psychiatry

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.

He began by noting that “the impossibility of a satisfactory solution [to the mind-body problem] … has led to numerous attempts to bridge the gap separating events of the body and mind by means of airy constructions of speculative fantasy ” p. 351. The impartial observer will barely be able to contain his astonishment when he sees how, in the very medical discipline most lacking in factual and scientifically useful empirical evidence, there exists a flourishing tendency to extend theory all the way back to the most primal state of the phenomena[ 21] p. 354. In the fifth edition of his short textbook Clinical Psychopathology[ 56], in his section on classification, he describes two groups of disorders – those termed “abnormal variations of psychic life” and the other “effects of Illness.” All the latter have clear somatic etiologies (e.g., general paresis of the insane, cerebral damage), except schizophrenia and what Schneider called “cyclothymia,” equivalent to Kraepelin’s manic-depressive illness.

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