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The mind-brain gap and the neuroscience-psychiatry gap

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DOI: 10.1111/jep.12891

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Received: 17 December 2017 Revised: 21 January 2018 Accepted: 23 January 2018
DOI: 10.1111/jep.12891

PERSONAL VIEW

The mind‐brain gap and the neuroscience‐psychiatry gap

Diogo Telles‐Correia MD PhD, Professor

1
Psychiatry Department, Faculty of Medicine,
University of Lisbon, Lisboa, Portugal Abstract
Correspondence A problem underlying the mind brain gap is the complex integration among the disciplines
Diogo Telles‐Correia, Faculty of Medicine, involved in it: neurosciences, clinical psychiatry and psychology, and philosophy of science.
Psychiatry Department, University of Lisbon, Research in neurosciences and clinical psychiatry requires a positioning in relation to some
Av Egas Moniz, Lisboa, Portugal.
conceptual/philosophical aspects. These are related to the models of interrelationship of the
Email: tellesdiogo@gmail.com
brain and the mind, to explanatory approaches in psychiatry, and to conceptual issues such as
dimensionality versus categories, symptoms versus disorders, and neurobiological correlates
versus clinical determination of mental disorder. In this article, we try to address some of these
issues that, if taken into account, could reduce the gap between psychiatrists and neuroscientists
and turn the research in this area more profitable.

KEY W ORDS

causality in psychiatry, mind‐brain gap, mind‐brain models, neurosciences, philosophy of psychiatry,

psychiatry

1 | I N T RO D U CT I O N empirical research, such as translational psychiatry that seeks to find

the neurobiological correlates of mental symptoms. One of the weak-
The mind‐brain problem, which Shopenhauer referred to as the “world nesses of the research in translational psychiatry is that it sometimes
knot,”1 is 1 of the most complex enigmas in mankind. lack a conceptual analysis that can guide it ontological and epistemo-
A problem underlying the mind brain gap is the complex integra- logically. Before research in this area is initiated, a deep conceptual
tion among the disciplines involved in it: neurosciences (biological reflection is needed for the emergence of innovative objectives and
domain), clinical psychiatry and psychology (clinical domain), and phi- research topics, and for selecting the most appropriate research
losophy of science (domain of concepts). methods.4
The area of psychiatry in general escapes the ideal of science In this article, we try to address some (because it is an infinite area)
described by Kuhn because it obligatorily integrates different para- issues that, if taken into account, could reduce the gap between psy-
digms. Thus, unlike most sciences in which research deals with solving chiatrists and neuroscientists and turn the research in this area more
problems within a single paradigm, in psychiatry, any research requires profitable.
an integration of paradigms.2
Research in neurosciences and clinical psychiatry requires a posi- 1. Models of interrelationship of the brain and the mind
tioning in relation to some conceptual/philosophical aspects, although
this often goes unnoticed. These are related to the models of interre- There are different models that seek to establish a relationship
lationship of the brain and the mind and to explanatory approaches between the brain and the mind.
in psychiatry, for example. Among them are dualism, identity theory, and functionalism.
On the other hand, recent conceptual analysis carried out by psy- Dualism argues that the mind is constituted by something very
chiatrists and psychologists has drawn attention to some issues, such different from the physical and material components and that the
as the importance of dimensionality rather than categories and symp- mental events are governed by other than the laws that guide the
tom assessment rather than disorders, to obtain a more valid picture natural sciences.5-7
3
of what is going on in the minds of people with mental disorders. Two types of dualism can be considered: (1) substance dualism
These conclusions are mainly the result of conceptual analysis and that holds that mind and brain are composed of different substances
not empirical research. However, they can and should be used by and (2) property dualism, which holds that, although they are made

J Eval Clin Pract. 2018;1–6. wileyonlinelibrary.com/journal/jep © 2018 John Wiley & Sons, Ltd. 1
2 TELLES‐CORREIA

of the same substance, mind and brain have different properties. While between a whole organism and the environment, functioning as
substance dualism was advocated by Descartes, property dualism is a mediator and not a causal factor.13
6
that most defended nowadays.
The identity theory opposes the previous one. It defends that 2. Explanatory approaches to psychiatric disorders
“mind is brain” and nothing more than this. According to this line of
thought, it would be expected with the evolution of science that all The search for causality in psychiatry may also follow different
mental states could be “observed” in neuroimaging exams. An example paths. Reductionism is opposed to explanatory pluralism.
of this view would be to interpret that the sensation of pain was Biological reductionism argues that mental illness can be
equivalent to the physical and natural properties of the neurons completely defined and understood through neuroscience. There were
(not having to consider any other aspect as, for example, the personal 2 major moments in history when reductionism was most pronounced
meaning of pain), and the same would happen regarding all different in psychiatry: at the end of the 19th century (Griesinger and his
mental states.5,6 disciples) and at the end of the 20th century (following the onset of
Monism is a special doctrine of the identity theory that accepts psychotropic drugs). At the beginning of the 21st century, this reduc-
that the same substance may seem different kinds of things or acquire tionist model started to be criticized because its results (in discovering
different atributes.8,9 the neurobiological mechanisms of mental illnesses as well as in psy-
There are several kinds of monism such as neutral monism and chopharmacological advancement) fell short of expectations. Contrary
anomalous monism. to what is often claimed, reductionism is not a scientific attitude but a
According to neutral monism, nature consists of 1 kind of metaphysical one. There is no scientific method that proves that the
substance (itself neither mental or physical) but capable of mental or mind can be reduced to the brain and that the laws that govern the
physical attributes. Grouped 1 way, the neutral entities that constitute mind are the same that govern the nervous system.14 Reductionism
our brain are thoughts and feelings; grouped another way, they are can be openly assumed, but it can also manifest indirectly through
neurons. But the entities themselves are free of mental or physical the way the research methodology is planned as well as through how
properties (therefore, their neutrality).10-12 the results are interpreted.14
A theory very related to this one is the double aspect theory As an alternative to the reductionist explanatory model emerges
according to which a subject can be described equally in mental or the explanatory pluralism, which argues that psychiatric diseases are
physical terms, which then denote different aspects of the same influenced by different causal mechanisms that act at different levels
entity.11,13 of abstraction.4 There are several reasons why explanatory pluralism
Another kind of monism, the anomalous monism, described by (involving multiple causes at different levels of explanation) is a more
6,11
Donald Davidson, argues that all mental states are also physical realistic and fruitful attitude in scientific research:
and biological states but that the laws that regulate mental states are
different from the laws that regulate physics and natural sciences (i) The importance of environmental factors can manifest itself in
(therefore, the term anomalous). It can be defined as a metaphysical different ways. There is strong enough evidence that traumatic
6
reductionism but not an epistemological reductionism. According to events can have a causal influence on the onset of psychiatric ill-
Davidson, “anomalous monism resembles materialism in its claim that ness. For example, a traumatic event in childhood (eg, death of a
all events are physical, but rejects the thesis, usually considered relative) may have a causal influence on the onset of depression
essential to materialism, that mental phenomena can be given purely in adulthood. Although the traumatic event in childhood may have
11
physical explanations” (p. 214). Thus, this integrative line of thought a translation at the level of brain biology, it does not mean that it is
denies that there are psychophysical laws but defends that mental through neurosciences that these traumatic events can be best
characteristics are in some sense dependent, or supervenient, on described and explored. Here, we will need another level of
physical characteristics. abstraction other than neurosciences to assess causality in
Functionalism is an approach closely linked to cognitive science, psychiatry.4,15
computer science, and artificial intelligence, which argues that men-
tal states should be functionally characterized in relation to their On the other hand, sociocultural factors can also have a major
sensory inputs, behavioural outputs, and links with other mental influence on the emergence or resurgence of certain mental ill-
states.5,12 Functionalists consider the mind as software that runs in nesses,16 for example, not only in eating disorders17 but also in anxiety
the hardware of the brain. Thus, mental disorders can be due to and depression,18 among others.
problems in the software of the mind or in the hardware of the
brain, exactly as it occurs when the computer programmes stops (ii) Biological factors do not act directly predisposing to mental ill-
working (due to software or hardware problems). Functionalists ness but rather interact with environmental factors. For example,
do not care about knowing what the mind is made of, but only the impact of genetic risk factors on the onset of psychiatric dis-
how it works.5,12 eases can be modified by the surrounding environment,19,20 by
In recent years, several proposals for new mind‐brain models stressful life experiences,21,22 and by sociocultural factors.23 On
have emerged. Among them stands Thomas Fuchs model, which sees the other hand, it is important to know not only the biological
the mind as a complex process (activity) where brain, body, and components (genetic, molecular, and neuronal) that may predis-
environment participate. The brain serves to mediate this interaction pose to the emergence of psychiatric symptoms but also those
TELLES‐CORREIA 3

that are associated with the influence that environmental factors (comprehensibility, adaptability, and harm criteria). Mental illness
have on the whole process that leads to these symptoms.24 Also, (and symptom) only assumes itself as such at the time of its clinical
the association between genes and the clinical manifestation of manifestation and the determination of what is considered inade-
a mental disorder may not be linear and direct. For example, cer- quate, disadapted, or cause of harm (taking into account the socio-
tain genes may influence the onset of depression because they cultural context of the patient), regardless of its neurobiological
predispose to certain behaviours that favour instability basis. In neurosciences, what we can find are the neurobiological
in interpersonal relationships, which, in turn, can lead to correlates of these clinical situations (which cause distress/disability
depression.25 to the patients). This does not mean that the distinction between
normal and pathological in psychiatry is made through neurobiolog-
Further, it is known that the influence of genes on the onset of ical markers. So, in this context, the clinical concepts precede the
mental illness does not follow a one‐to‐one pattern. But a gene may biological ones.16
predispose to different mental illnesses, depending on environmental
circumstances, so there are many different ways to get to the same (ii) Dimensionality of the mental symptom
syndrome.24
On the other hand, it has not been possible to demonstrate the
(iii) First‐person mental phenomena also have causal effects over the presence of natural borders between mental illness and normality nor
brain, in the outside the world, and also on other mental states.4 points of rarity between the different syndromes. Thus, the latest evi-
This fact complicates the causal relations at this level because dence demonstrates that the symptoms and mental disorders must
mental states themselves can alter the functioning of the brain, have a dimensional structure.3,30-32 Thus, we should not look in neuro-
influence the environment (these, also causally related to mental sciences for models of cleavage between normal and pathological, but
states), and directly induce other mental states. rather correlations between neurobiology and psychiatric symptoms
(iv) In psychology and psychiatry, we have to talk about different that are believed to be dimensional without a rigid boundary between
types of causality that coexist. One is the causality related to normal and pathological.
the world of meanings and intentionality, which explains that
certain experiences associated with a certain symbolism may be (iii) Symptoms versus disorders
the basis of some mental states. This intentional or meaningful
causality, with its own rules, can only exist through the brain Much of the research that has been done both neurobiologically

but cannot be reduced to the brain (which contradicts the mind and clinically has been based on syndromes or disorders rather than
brain reductionism). The other unintentional causality is free of symptoms.3 At the moment, it is advocated that it is based on the
meaning and follows the universal physical laws.26 observation and description of the psychiatric symptoms that maybe
one day will reach the mental axioms that correspond to the biological
3. Other epistemological issues correlates we are looking for.3 Most of the current psychiatric
disorders are constructs (probabilistic groups) grouped in certain previ-
There are several other conceptual factors that can hinder the ous historical periods and therefore carry with them contemporary
epistemology of clinical and translational research in psychiatry. presuppositions and bias.33
The current diagnostic categories have been shown to have many
(i) Neurobiological correlates versus clinical determination of mental limitations, and for new possibly more valid perspectives to emerge,

disorder we have to look at the purest manifestation of mental illness, ie, the
symptom. Unfortunately, in the post‐third generation of Diagnostic
A factor of great confusion, especially in the field of transla- and Statistical Manual of Mental Disorders (DSM‐III) era, descriptive
tional psychiatry, has been the idea that psychiatric disorders are psychopathology was abandoned and replaced by diagnostic catego-
natural kinds and can be directly visualized and discriminated by ries.3 This situation has not only impoverished clinical practice but also
neuroimaging tests. Psychiatric disorders are “social constructs”; blocked advances in research.34
they are not natural kinds that exist independently of any human According to several authors, the pursuit of the biological corre-
16,27
effort. The evaluation of what is or is not pathological in lates of psychiatric diseases can only be based on symptoms and not
psychiatry is related to (1) comprehensibility (whether or not the in disorders.34,35
mental state/behaviour is comprehensible given the sociocultural
context of the patient), (2) adaptability (adaptive or nonadaptive (iv) Terminological issues
in the context of the patient), and (3) connection to distress and
disability (whether or not they cause distress or disability). The The problem of terminological issues has long been a problem in
latter is the most universal criteria.28,29 These clinical criteria are psychiatry. Since 1980 with DSM‐III, the designations of the disorders
those that determine whether a symptom or a mental disorder is were generalized by all countries, as well as their diagnostic criteria
present, which is primary or even secondary to a physical illness. (increasing reliability). However, the terms used to define the various
For example, if there is a brain tumour that secondarily determines symptoms in psychopathological semiology (and that according to
a depression, clinical depression is evaluated by the clinical criteria the new models must guide research by neurobiological correlates)
4 TELLES‐CORREIA

vary between countries and even between researchers with different 2 | CO NC LUSIO NS
backgrounds.
The concern with the reliability ensured by the nosological catego- Some of the models of interrelationship of the brain and the mind
ries of the DSM came to bring a gradual disregard for the terms and were explained, such as dualism, identity theory, and functionalism.
34
concepts associated to descriptive psychopathology. Today, there It has not been demonstrated through any kind of research that either
has been an attempt to recover these concepts and ways of evaluating of these models is true or false. For example, the fact that neurosci-
them so that they can also be used in all kinds of psychiatry research. ences have found biological correlates of some mental phenomena
Moreover, according to some authors, often, neuroscientists mis- does not prove that the identity theory is true or that the dualistic
use psychological/psychiatric terms, without knowing exactly to which theory is false.6
36
concepts they correspond. Sometimes, there is no concern to clarify In relation to explanatory approaches, there are a number of evi-
the expressions, words, and concepts that are used, and this can dences that demonstrate that these should be pluralistic. Thus, it is
jeopardize all the steps of the investigation from the definition of not profitable in this area to defend “causal monologues,” by obses-
objectives to the implementation of appropriate methodology and sively seeking the relation between a particular factor and a psychiatric
the interpretation of results.36 Terms corresponding to complex illness, but it will be more useful to accept multiple causality. On the
concepts such as depression, for example, are often used in ways that other hand, one should not only think of the type of causes but of
do not correspond to their original meaning. For instance, some the interaction between them (interaction models). This can be a key
concepts are sometimes used as synonyms of depression but element in the discovery of the explanation of many of the psychiatric
correspond only to phenomena often associated with states of depres- diseases.37 The interaction of environmental and biological causal fac-
sion (such as lack of energy, cognitive distortions, and hopelessness). tors occurs at all levels. Most of the causal relations that psychiatry will
need to understand will be these organism‐environment interactions
4. An example of a translational research on depression that cross levels.37
Methodological reductionism may emerge as a possible practice‐
Transposing some of these considerations to a particular case such oriented solution but with no ambitions of explanatory theory. Accord-
as the translational research on depression, we could mention some ing to this view, given that mental phenomena result from multifacto-
suggestions. rial causality (biological, social, etc), the attempts to reduce them will
In research projects where we seek to investigate the cause of always be partial (considering some of their possible causes), but they
depression, it is essential that we accept an explanatory pluralism: (a) may be useful, in particular, for designing interventions that could alle-
symbolic meaningful‐traumatic events in childhood and adulthood viate the suffering caused by these situations.6 Kendler introduces the
(which follow a meaningful causality that obeys to its own rules and concept “patchy reductions,” which corresponds to the possibility of
cannot be reduced to neurobiology) and (b) genes and neurobiological clarifying the causal complexity of some phenomena through partial
characteristics (which also interact with the environment and meaning- explanations that arise from interlevel causal models. In other words,
ful‐traumatic events). instead of immediately pursuing a “grand theory,” it could be possible
It is also important to accept that the neurobiological dimension to phase out some partial evidence at different levels of causality that
can influence the onset of depression through different ways that may later be integrated.4
may each be studied by translational neuroscience: (a) neurobiological In the last decades, many attempts have been carried out to find
dysfunctions that are directly associated with the emergence of the the neurobiological correlates of mental states. In this area, a dualistic
symptoms of depression, (b)other neurobiological characteristics that view is not profitable.38 To find the brain‐mind correlations, it is neces-
can predispose to certain forms of personality that in turn can trigger sary to establish “bridge laws bettween psychiatry and neuroscience”
the emergence of traumatic events that cause depression, and (c) neu- that should be “underpinned with factual connections based on real
robiological characteristics that may interfere with the way an individ- findings of clinical sciences and neurobiology in health and disorder”
ual responds to traumatic events and can determine whether or not (p. 74).38 It is essential to develop in this area specific methodologies
depression emerges. that can lead to the establishment of correlations between different
On the other hand, it is essential to study the manifestations of subject matters (from different paradigms, eg, neuroscience and clinical
depression as dimensional symptoms, without a rigid boundary psychiatry). This interdisciplinary science, with its epistemological
between normal and pathological. And so a research on the neurobio- specificities, must include researchers that are not limited to an area
logical correlates of some of the depression symptoms (such as depres- of knowledge but integrate different disciplines (clinical psychiatry,
sive mood) could include persons with and without a nosological neurosciences, and philosophy of science).
disorder, respecting the natural continuity of symptoms. However, regardless of the research models we choose, we can
According to our considerations, it will also be determinant to never fail to believe that psychiatry's fundamental goal as a medical
search for the neurobiological correlates of symptoms rather than for discipline is to alleviate the suffering/disability of patients, associated
those of nosological disorders (which follow the criteria of nosological to psychiatric symptoms that are accessed in a clinical context (through
classifications). In the case of depression, depressive mood, anhedonia, the first‐person reports of patients).4 To reduce the symptomatology,
etc could be the target of a translational research and not the nosolog- we can use the knowledge born from neuroscience research, in partic-
ical types of depression (eg, bipolar depression, unipolar depression, ular the biological correlates of psychiatric symptoms, and we can even
and dysthymia). try methdological reductions in some research. But we cannot mistake
TELLES‐CORREIA 5

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