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Integrating subjective and objective—spatiotemporal approach to psychiatric disorders

Molecular Psychiatry volume 28, pages 4022–4024 (2023)Cite this article

Subjects

The excellent perspective by Kyzar and Denfield [1] points out nicely the necessity for integrating subjective and objective approaches in the investigation of psychiatric disorders. They make especially the point of considering phenomenological approaches like the subjective experience of abnormal time speed in mania or major depressive disorder (MDD). Despite the excellent reflections on integrating phenomenology and modern neuroscience, we do believe their perspective is incomplete because two important questions of modern psychiatry remain unanswered: First, the question regarding an integrated brain-mind model that underlies and guides our methodological approaches like neurophenomenology. Second, how can we link the subjective experience to neuronal activity in mental disorders and can that yield the still lacking neuro-experiential markers for clinical differential-diagnosis? Based on earlier and most recent neuroscientific studies, we suggest that a number of conceptual, methodological and clinical pathways should be undertaken to answer the two above mentioned questions:

In order for brain and experience to be related with each other, they must share some features. Current models usually consider them as radically different like subjective vs objective, as pointed out by Kyzar and Denfield [1]. One may then either reduce the mind to cognitive function and its neural correlates [2] or consider it as an add-on [3]. Given that the former approach reduces the mind to the brain’s function, one can speak of “function-based approach” [4] while the latter associates the mind with cognition, e.g., “cognitive neuroscience approach” [5]. Both approaches are contrasted with the “phenomenological approach” [6], which poses the primacy of subjective experience (rather than function or cognition). However, none of the three models provides an answer to the question how brain and mind are connected in MDD, mania and schizophrenia (SZ). We are aware that this question is one of the most complex questions in psychiatry and one may speculate whether it will ever be resolved. The so-called Cartesian dualism was first described by René Descartes (1596–1650) in his book “Meditations on first Philosophy” [7] published in 1641. In his book, Descartes argued that there are two kinds of human foundation: physical (body) and mental (mind). For centuries, this strict separation between body and mind (e.g. problem of incommunicability) led the way for both clinical and scientific psychiatry [8,9,10]. Although this dualistic concept of psychiatric illness has been discussed and criticized by many [11,12,13], it was only about two decades ago that the first studies attempting to overcome this dualism were conducted (for history of the different concepts of mind and body see Berrios [10]).

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Fig. 1: The different psychopathological symptoms are shaped by both neural and mental activity providing their connection as “common currency”.

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Acknowledgements

This work was supported by the German Research Foundation (DFG, grant number DFG HI 1928/5-1 and HI 1928/6-1 to D.H.) G.N. is grateful for financial support from Physicans Incorporated Services (PSI) and Canada Institute of Health Research (CIHR) in Canada. The DFG, PSI and CIHR had no further role in the writing of this correspondence and in the decision to submit the paper for publication. Figure 1 was created by BioRender.com.

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  1. Mind, Brain Imaging and Neuroethics Research Unit, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Georg Northoff

  2. Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Dusan Hirjak

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GN and DH: initial idea, writing and manuscript revision.

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Northoff, G., Hirjak, D. Integrating subjective and objective—spatiotemporal approach to psychiatric disorders. Mol Psychiatry 28, 4022–4024 (2023). https://doi.org/10.1038/s41380-023-02100-4

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