To the Editor: Lieberman's enthusiasm in the search for the neuropathology of schizophrenia is remarkable (1). The three articles he commends in his editorial do no more than add to the multitude of studies which report abnormalities in shape, size and functions in multiple anatomical regions of the brain and yet he recommends more neuroimaging studies. He concedes that the rate of research progress has been limited by the development of theoretical models from which to derive testable hypotheses.

Although models of the brain are no longer restricted by notions of anatomical fixity (2), partly because of neuroimaging studies, the philosophical basis of Lieberman's strategy needs to be challenged. He states that it has long been known that schizophrenia is a brain disease. True, it has been some time ago since Spinosa maintained that mind and body are the same substance, and statements that schizophrenia is a brain disease have been made since the concept of schizophrenia was established. Lieberman seems less aware that Spinosa also contended that mind and body are conceptualised under incommensurable systems and that mental states cannot be explained in terms of physical causes. If so, Lieberman is insufficiently critical about his assumptions. It may actually be theoretically correct to distinguish organic and functional mental disorders, and this conception may not just be an artefact of methodological incapacity.

Adolf Meyer was fond of seeing his philosophical approach to psychiatry, with its emphasis on the person, as an advance over the mechanistic philosophy of the 19th century (3). Psychiatry seems to have regressed when Lieberman now praises nineteenth century postmortem studies. Adolf Meyer's work is currently largely neglected in the modern biological consensus in psychiatry. His warning against going beyond statements about the person to wishful "neurologising tautology" about the brain may still be just as valid. The understanding of schizophrenia is more likely to be progressed by more rigorous and creative conceptualisation and evaluation of the evidence than uncritical application of neuroimaging methods.



1. Editorial: Searching for the Neuropathology of Schizophrenia: Neuroimaging Strategies and Findings. Am J Psychiatry 1999; 156:1133-1136 [Full text]

2. Eisenberg L: The social construction of the human brain. Am J Psychiatry 1995; 152:1563-1575

3. Meyer A: Collected Papers. Edited by Winters E. Baltimore, John Hopkins Press, 1951 & 1952