Psychodynamic psychiatry in the "decade of the brain".
OBJECTIVE
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.
C.F. Menninger Memorial Hospital, Topeka, KS 66601-0829.
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Gabbard
D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D001689:Biological Psychiatry; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D011570:Psychiatry; D011582:Psychological Theory; D011613:Psychotherapy
D014151:Anti-Anxiety Agents