In man’s brain the impressions from outside are not merely registered; they produce concepts and ideas. They are the imprint of the external world upon the human brain. Therefore, it is not surprising that, after a long period of searching and erring, some of the concepts and ideas in human thinking should have come gradually closer to the fundamental laws of this world, that some of our thinking should reveal the true nature of atoms and the true movements of the stars. Nature, in the form of man, begins to recognize itself.

Victor Frederick Weisskopf
Knowledge and Wonder

          It is no wonder that there is such widespread public bewilderment about psychiatric illness. Poor transfer of knowledge between scientific/research experts in psychiatry and the general population is a major contributing factor. When data about psychiatric illness is available, often it is unscientific or too technical for broad comprehension. Furthermore, the very concepts on which psychiatry is founded are an admixture of factual and mythic elements. Add the fact that there is no general model of psychiatry to unite competing paradigms into one intelligible perspective, and the environment is ripe for confusion.
          Whereas public awareness of fundamental scientific facts is fairly good, appreciation of definite psychiatric principles has been lost in the "knowledge gap" between neuropsychiatry and the rest of the world. Even among healthcare professionals, widely disparate opinions exist with regard to cause of psychiatric illness and efficacy of treatments. My original objective in writing this book was to help patients understand behavior. Since then, it has evolved into an offering for the public at large, designed to bridge the knowledge gap and dispel widely held misconceptions about psychiatry.
          The neuropsychiatric principles and definitions presented here, based on the general psychiatric model (the medical model), are beneficial for everyone’s understanding of human behavior and illness. Furthermore, it is essential for all of us to know that there is no perfect brain and that all of us will face one or more forms of brain failure at some point in our lives.
          It is my hope, for example, that the principles explained here will provide a common ground for both healthcare specialists and patients to bring about more rational and effective medical treatment of brain disorders. At the same time, attorneys can use the principles presented in Brain Basics to effect more equitable applications of the law to cases involving aspects of psychiatry. In the corporate world, Brain Basics principles can assist administrators with implementation of personnel policies that are more sensitive to the impact of mental health on work performance. In fact, Brain Basics can help individuals from all walks of life better understand the facts about diagnosis and treatments of brain disorders.
          The first step in closing the knowledge gap is recognizing psychiatry’s shift in focus from theories on maladaptive psychological processes to research on medical diseases. This approach, which began to gain momentum in the mid-1980s, emphasizes study and treatment of brain disorders as opposed to mind disorders.
          Mental health usually is assessed, nonprofessionally, according to specific types of behavior; that is, external acts that reflect brain activity. Few people realize that behavior is an active biological entity, not simply a collection of attitudes and physical or verbal responses. It is an outward manifestation of the health of an internal organ—the brain.
          Because of psychiatry’s former emphasis on dysfunctional psychological processes, it is not surprising that there is such general misunderstanding about behavior and its biological determinants, including such conditions as depression, panic disorder and schizophrenia. The public perception of a psychiatrist as a bearded, bespectacled physician/therapist who probes the dreams and emotional trauma of his patient, as the latter lies on the infamous analyst’s couch, is-at best-a limited view and reflective of a completely unscientific approach to psychiatric treatment.
          Many psychiatrists till base patient care on psychological determinants of behavior, such as stress, lack of parental love, childhood trauma, and gender jealousy. Gradually, however, others are approaching diagnosis and therapy guided by the medical model, which considers the impact of biological and psychological determinants. In order to determine the presence of brain abnormalities, today’s progressive psychiatrist stakes into account not only factors noted in patients’ psychological histories, but results of comprehensive physical examinations and scientific testing, as well.
          Founded on basic laws of science and precise research methods, the medical model provides a rational approach to psychiatry and eliminates a great deal of "mystique" surrounding the specialty. At the Biological Psychiatry Institute, clinical application of the medical model has enabled us to more accurately "engineer" diagnosis and therapy, while revealing new aspects of specific disorders and changing the way they are treated.
          Many psychiatric patients who receive care according to a psychological model are treated without benefit of systematic guidelines. The medical model, on the other hand, provides a precise way to monitor the presence or absence of active illness, a step-by-step method to determine whether behavior is illness-generated or personality-generated. Ultimately, when patients are taught to discern this difference, they can become empowered by greater understanding and are in a better position to take more responsibility for self-care.
          The purpose of Brain Basics is to educate readers about the basics of psychiatry, with particular emphasis on principles of behavior. The five primary educational phases include:

1. definition of foundational terminology and explanation of normal brain function
2. definition of brain dysfunction, its mechanisms and methods of identification
3. description of biological psychiatric or neuropsychiatric diagnosis, based on the medical model
4. explanation of the open model or the integrated approach to psychiatry
5. presentation of guidelines for selecting a biological psychiatrist and description of neuropsychiatric principles used with the brain model of illness

          It is my hope to close the psychiatric knowledge gap by arming readers from a range of backgrounds and professional experiences with an integrative approach to understanding human behavior that will help them recognize behavioral disorders and identify appropriate therapy. Those who acquire a heightened comprehension of the value of psychiatry based on the medical model may be in a position to make more timely, logical choices regarding behavioral healthcare and to retain the services of a reputable biological practitioner, if necessary.

(Author’s note: Readers of this text who have no formal education in or experience with psychiatry may wish to begin with the clinical material contained in Chapter 4.)

Robert A. Williams, MD
Director, Biological Psychiatry Institute
Phoenix, Arizona
March 1998