We thank the correspondents for their interest in our article Reference Bullmore, Fletcher and Jones1 that, following Craddock's polemic, Reference Craddock, Antebi, Attenburrow, Bailey, Carson and Cowen2 we hoped would provoke some responses and debate. While we would dearly like to agree with the Editor's suggestion Reference Tyrer3 that a belief in the importance of the brain marks us out as Cavaliers, we fear that the neuroscientific enterprise, marked by slow, painstaking data collection, hypothesis testing and incremental advances does not quite suit his analogy. Nor do we, in championing neuroscience, dismiss the importance of other levels of explanation as some of our respondents suggest. Our original editorial was clear on this. As for the suggestion that neuroscience is a form of behaviourism and must thereby deny the mind, we do hope that a brief survey of the past decade's cognitive neuroscientific literature refutes that concern.
McQueen is right to take us to task for forgetting emotion: this is an oversight in our article but not, we are happy to say, in the field, where affective and social neurosciences thrive. Blewett is also correct when he points out that major impacts on the lives of patients have arisen and continue to flow from phenomena that are meaningless when conceived solely within a neuroscientific framework.
We certainly do not demur from a biopsychosocial formulation; these are the three primary colours in which we paint our discipline and which make it more vibrant than other medical specialties. Rather, we point out that the ‘bio-’ aspect of psychiatry is getting brighter, stronger and, in our opinion, more useful such that, as a profession, we cannot afford to ignore it lest we do a disservice to our patients. To argue, as does Datta, that if we embrace this change then we shall be taken over by neurology is surely, as Johansson indicates, unfalteringly absurd.
After all, patients need good doctors first and foremost, and we believe that Reil conceived psychiatry as a broad discipline reflecting his own polymathematical abilities.
When we manage someone's arachnophobia with an appropriately eclectic mix of graded exposure, a selective serotonin reuptake inhibitor for comorbid depression, psychoeducation and family support we do not aim for them to live in a world populated by tarantulas, let alone become one. So, too, for psychiatry: in pointing out its neurophobic tendencies we aim to restore good function and allow it to move on. To us, this doesn't appear to be rocket science, just neuroscience.
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