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In Reply: The central argument by Drs Spitzer and First is that for most psychiatric disorders, the etiology is unknown. I disagree with this assumption.

They restrict their concept of etiology to "pathophysiological processes." But many mental disorders derive not from brain pathology but from brain-mediated issues of assumption, accident, manner, and choice leading to personal misdirections and misadventures, concepts that form the core of cognitive behavioral therapy and the psychology of personality, motivation, and social learning.

Contemporary psychiatric research and evolving treatments advance by etiologic conceptions. If this were not true, all investigations would be fishing expeditions and all prescriptions would rest on guesswork. Progress in explaining schizophrenia—from the first recognitions of its brain pathology and links between planum temporale and auditory hallucinations^1-3 to the contemporary investigations into functions of serotonin transporter mechanisms⁴—are based on the etiologic assumption that schizophrenia is a neuropsychiatric disease generated and sustained . . . [Full Text of this Article]

Paul R. McHugh, MD
pmchugh1@jhmi.edu
Department of Psychiatry and Behavioral Sciences
Johns Hopkins School of Medicine
Baltimore, Md

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