O problema da explicação dos transtornos mentais na neuropsiquiatria cognitiva

Abstract

Psychiatry qua medical science faces since its early beginnings a number of questions when it tries to delineate a medical object at the level of mental phenomena. These problems arise from the very ambiguity of the concept of mental illness. Throughout its history the main theories have belonged to two antagonistic perspectives. On one side, psychogenetic perspectives that seek the genesis of psychopathologies inside the internal dynamics of the mind. On the other side, biological perspectives that seek in pathological changes of the functioning of the human body, mainly in the brain, the pathogenesis triggering psychiatric symptoms. In the last two decades of 20th century, the biological perspective has become dominant in the context of psychiatric ideas and practices. However, this psychiatry has neglected psychological investigation and elaboration of psychological theories integrated to biological theories of psychiatric symptoms. It is in this context that in the early 1990s cognitive neuropsychiatry became institutionalized by proposing the formulation of cognitive models of symptom formation as an indispensable stage to find the neural structures that realize cognitive functions. From the discussion on the mechanistic model of explanation current in the life sciences, the neurosciences and the cognitive sciences, the problem and the strategies of explanation of psychopathological phenomena is addressed. The original project of cognitive neuropsychiatry, which sustains the autonomy of cognitive models regarding the knowledge of brain functioning, is contraposed to the proposition of integration between psychiatry and cognitive neuroscience. It is defended that this “neurocognitive psychiatry” has a greater potential to solve the theoretical obstacles that challenge psychiatry. It allows an integration between neuroscience and cognitive theories including in its scope data about the phenomenology of psychiatric symptoms. Nonetheless, this psychiatry faces some difficulties to elaborate multilevel mechanistic explanations of certain psychiatric symptoms due to the nonmodular nature of some cognitive systems involved in its formation. Finally, we highlight that this new biological perspective is still a research program to be accomplished. Although it looks promising in the explanation of some symptoms, like delusional phenomena, it still has not proven its theoretical and empirical solidity regarding the explanation of other central psychopathological phenomena.