Neuroscientific research has substantially increased our knowledge about mental disorders in recent years. Along with these benefits, radical postulates have been articulated according to which understanding and treatment of mental disorders should generally be based on biological terms, such as neurons/brain areas, transmitters, genes etc. Proponents of such a ‘biological psychiatry' claim that mental disorders are analogous to neurological disorders and refer to neurology and neuropsychology to corroborate their claims. The present article argues that, from a clinical-neuropsychological perspective, ‘biological psychiatry' is based on a mechanistic, ‘cerebrocentric' framework of brain (dys-)function which has its roots in experimental neuroscience but runs up against narrow limits in clinical neurology and neuropsychology. In fact, understanding and treating neurological disorders generally demands a systems perspective including brain, organism and environment as intrinsically entangled. In this way, ‘biological' characterizes a ‘holistic', nonreductionist level of explanation, according to which the significance of particular mechanisms can only be estimated in the context of the organism (or person). This is evident in the common observation that local brain damage does not just lead to an isolated loss of function, but to multiple attempts of reorganization and readaptation; it initiates new developments. Furthermore, treating brain disorders necessarily includes aspects of individuality and subjectivity, a conclusion that contradicts the purely ‘objectivist', third-person stance put forward by some proponents of biological psychiatry. In sum, understanding and treating brain damage sequelae in the clinical neurosciences demands a biopsychosocial perspective, for both conceptual and historical reasons. The same may hold for psychiatry when adopting a brain-based view on mental disorders. In such a perspective, biological psychiatry seems an interesting project but falls short of its original claims.

1.
Kandel ER: A new intellectual framework for psychiatry. Am J Psychiatry 1998;155:457-469.
2.
Cowan WM, Kandel ER: Prospects for neurology and psychiatry. JAMA 2001;285:594-600.
3.
Hobson JA, Leonard JA: Out of Its Mind: Psychiatry in Crisis: A Call for Reform. New York, Basic Books, 2001.
4.
Insel TR, Quirion R: Psychiatry as a clinical neuroscience discipline. JAMA 2005;294:2221-2224.
5.
Kandel ER, Markram H, Matthews PM, Yuste R, Koch C: Neuroscience thinks big (and collaboratively). Nat Rev Neurosci 2013;14:659-664.
6.
Markram H: Seven challenges for neuroscience. Funct Neurol 2013;28:145-151.
7.
Martin JB: The integration of neurology, psychiatry, and neuroscience in the 21st century. Am J Psychiatry 2002;159:695-704.
8.
Banner NF: Mental disorders are not brain disorders. J Eval Clin Pract 2013;19:509-513.
9.
Paris J: Psychiatry and neuroscience. Can J Psychiatry 2009;54:513-517.
10.
Graham G: The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness. London, Routledge, 2013.
11.
Duncan J, Owen AM: Common regions of the human frontal lobe recruited by diverse cognitive demands. Trends Neurosci 2000;23:475-483.
12.
Liakakis G, Nickel J, Seitz RJ: Diversity of the inferior frontal gyrus - a meta-analysis of neuroimaging studies. Behav Brain Res 2011;225:341-347.
13.
Frisch S: How cognitive neuroscience could be more biological - and what it might learn from clinical neuropsychology. Front Hum Neurosci 2014;8:541.
14.
Desmurget M, Bonnetblanc F, Duffau H: Contrasting acute and slow-growing lesions: a new door to brain plasticity. Brain 2007;130:898-914.
15.
Fanning JP, Wong AA, Fraser JF: The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med 2014;12:119.
16.
Walter H: The third wave of biological psychiatry. Front Psychol 2013;4:582.
17.
Stern Y: Cognitive reserve. Neuropsychologia 2009;47:2015-2028.
18.
Stern Y: Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol 2012;11:1006-1012.
19.
Klonoff PS, Lamb DG, Henderson SW: Outcomes from milieu-based neurorehabilitation at up to 11 years post-discharge. Brain Inj 2001;15:413-428.
20.
Gracey F, Ownsworth T: Editorial. Neuropsychol Rehabil 2008;18:522-526.
21.
Armstrong TS, Cron SG, Bolanos EV, Gilbert MR, Kang DH: Risk factors for fatigue severity in primary brain tumor patients. Cancer 2010;116:2707-2715.
22.
Van Eijsden HM, van de Port IG, Visser-Meily JM, Kwakkel G: Poststroke fatigue: who is at risk for an increase in fatigue? Stroke Res Treat 2012;2012:863978.
23.
Passier PE, Post MW, van Zandvoort MJ, Rinkel GJ, Lindeman E, Visser-Meily JM: Predicting fatigue 1 year after aneurysmal subarachnoid hemorrhage. J Neurol 2011;258:1091-1097.
24.
Hughes V: Science in court: head case. Nature 2010;464:340-342.
25.
Lezak MD: Neuropsychological Assessment. Oxford, Oxford University Press, 2004.
26.
Burns A, Iliffe S: Dementia. BMJ 2009;338:b75.
27.
Stier M: Normative preconditions for the assessment of mental disorder. Front Psychol 2013;4:611.
28.
Margree V: Normal and abnormal: Georges Canguilhem and the question of mental pathology. Philos Psychiatry Psychol 2002;9:299-312.
29.
Rosslenbroich B: Outline of a concept for organismic systems biology. Semin Cancer Biol 2011;21:156-164.
30.
Lindquist KA, Barrett LF: A functional architecture of the human brain: emerging insights from the science of emotion. Trends Cogn Sci 2012;16:533-540.
31.
Edelman GM, Gally JA: Degeneracy and complexity in biological systems. Proc Natl Acad Sci USA 2001;98:13763-13768.
32.
Kitano H: Biological robustness. Nat Rev Genet 2004;5:826-837.
33.
Young JE, Klosko JS, Weishaar ME: Schema Therapy: A Practitioner's Guide. New York, Guilford Press, 2003.
34.
Kirmayer LJ, Gold I: Re-socializing psychiatry critical neuroscience and the limits of reductionism; in Choudhury S, Slaby J (eds): Critical Neuroscience: A Handbook of the Social and Cultural Contexts of Neuroscience. Hoboken, Wiley-Blackwell, 2012, pp 307-330.
35.
Brigandt I, Love A: Reductionism in Biology; in Zalta EN (ed): The Stanford Encyclopedia of Philosophy (Fall 2015 Edition). URL = http://plato.stanford.edu/archives/fall2015/entries/reduction-biology/.
36.
Craver CF: Beyond reduction: mechanisms, multifield integration and the unity of neuroscience. Stud Hist Philos Biol Biomed Sci 2005;36:373-395.
37.
Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136.
38.
Bertalanffy LV: General System Theory: Foundations, Development, Applications.New York, Braziller, 1968.
39.
Gray W, Duhl FJ, Rizzo ND: General Systems Theory and Psychiatry. London, Little Brown GBR, 1969.
40.
Goldstein K: The Organism: A Holistic Approach to Biology Derived from Pathological Data in Man. New York, American Book Company, 1939.
41.
Bertalanffy LV: General theory of systems - application to psychology. Soc Sci Inform 1967;6:125-136.
42.
Pilgrim D: The biopsychosocial model in Anglo-American psychiatry: past, present and future? J Mental Health 2002;11:585-594.
43.
Moran D: Introduction to Phenomenology. New York, Routledge, 2000.
44.
Spiegelberg H: Phenomenology in Psychology and Psychiatry. Evanston, Northwestern University Press, 1972.
45.
Goldstein K: The effect of brain damage on the personality. Psychiatry 1952;15:245-260.
46.
Prigatano GP: Challenging dogma in neuropsychology and related disciplines. Arch Clin Neuropsychol 2003;18:811-825.
47.
Armento ME, Stanley MA, Marsh L, Kunik ME, York MK, Bush AL, Calleo JS: Cognitive behavioral therapy for depression and anxiety in Parkinson's disease: a clinical review. J Parkinsons Dis 2012;2:135-151.
48.
Pachana NA, Egan SJ, Laidlaw K, Dissanayaka N, Byrne GJ, Brockman S, Marsh R, Starkstein S: Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease. Mov Disord 2013;28:1930-1934.
49.
Mohr DC, Lovera J, Brown T, Cohen B, Neylan T, Henry R, Siddique J, Jin L, Daikh D, Pelletier D: A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology 2012;79:412-419.
50.
Pagnini F, Bosma CM, Phillips D, Langer E: Symptom changes in multiple sclerosis following psychological interventions: a systematic review. BMC Neurol 2014;14:222.
51.
Mitchell PH, Veith RC, Becker KJ, Buzaitis A, Cain KC, Fruin M, Tirschwell D, Teri L: Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke 2009;40:3073-3078.
52.
Hermann B, Jacoby A: The psychosocial impact of epilepsy in adults. Epilepsy Behav 2009;15(suppl 1):S11-S16.
53.
Yeates GN, Gracey F, McGrath JC: A biopsychosocial deconstruction of ‘personality change' following acquired brain injury. Neuropsychol Rehabil 2008;18:566-589.
54.
Zasler ND, Martelli MF, Jacobs HE: Neurobehavioral disorders. Handb Clin Neurol 2013;110:377-388.
55.
Ghaemi SN: Paradigms of psychiatry: eclecticism and its discontents. Curr Opin Psychiatry 2006;19:619-624.
56.
Alvarez AS, Pagani M, Meucci P: The clinical application of the biopsychosocial model in mental health: a research critique. Am J Phys Med Rehabil 2012;91:S173-S180.
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