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Book Review   |    
Jeffrey S. Barkin
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.3.336
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by Dominic Murphy; Cambridge, Massachusetts, MIT Press, 2006, 422 pages, $35

Dr. Barkin is in private practice in Portland, Maine.

Dominic Murphy is assistant professor of psychiatry in the Department of Philosophy, California Institute of Technology. His Psychiatry in the Scientific Image is a scholarly and rigorous volume that straddles clinical psychiatry and the boundaries of scientific theory. What emerges is a thorough discussion of psychiatric disorders at a deep theoretic level.

Murphy attempts, largely successfully, to understand and classify mental disorders. He tackles theoretic underpinnings in the cognitive neurosciences to foster a deeper philosophic description of what constitutes a mental illness. He takes us on a rigorous journey suggesting that categorical descriptions detract from allowing a deep understanding of mental phenomena. He posits that understanding psychiatric diagnosis must instead be rigorously defined by the scientific method and incorporate explanation from the cognitive neurosciences. We are shortchanged by atheoretic systems, such as the DSM, he argues, as we fail to adequately describe and understand what a mental disorder even is.

Murphy starts the book by defining what constitutes a mental disorder. At what point are certain unusual behaviors considered to be psychiatric disorders? Though persons with Tourette's syndrome demonstrate behavioral symptoms they are not psychotic. Motoric behaviors are not a departure from the reality that defines a psychotic state. Indeed, the categorical taxonomic description detracts from permitting an understanding of etiologic causality.

Murphy then draws upon the work of Guze and Kandel to define the medical model of explanation in psychiatry. Indeed, his description of Kandel's framework of biologic psychiatry is one of the excellent sections in this volume, and he chooses the work of Kandel as a model of scientific reductionism. Murphy then describes the work of Nancy Andreasen to define cognitive neuroscience as a series of convergences from numerous disparate models. He then makes a transition to define the very boundaries of mechanistic explanation of psychosis, addiction, and psychopathy. This section of the book is derived more from philosophy than psychiatry and is more difficult to grasp.

Murphy then segues into a theory of explanatory power that is more intellectually rigorous than simple construct validity. Indeed, in this section his central idea is realized: we must strive to understand psychiatric conditions based upon a group of symptoms that derive from understanding the causal features of normal mental functioning. Rather than a simple categorical description, we will be on firmer ground if we instead view mental disorders based upon underlying etiologies.

This volume is provocative in its intellectual indictment of conventional methods of classifying mental disorders. Murphy strives to understand psychiatric illness from the lens of normal mind- and brain-based behavior. This volume is not readily accessible to the clinically focused reader but will instead be of interest to students of cognitive neuroscience and hypothesis testing related to diagnostic classification.




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