NEUROCENTRISM Feld, Meca, & Sauvigné, in Press)

NEUROCENTRISM feld, Meca, & Sauvigné, in press). In its Neurocentrism: Implications for Psychotherapy most extreme form, neurocentrism regards Practice and Research the CNS as essentially the only adequate level of analysis for conceptualizing and treating psychological phenomena. Scott O. Lilienfeld, Emory University The early 21st century is also awash in talk of psychological conditions as “brain Seth J. Schwartz and Alan Meca, University of Miami disorders.” For example, in a 2013 TEDx talk, Thomas Insel, director of the National Katheryn C. Sauvigné, Georgia State University Institute of Mental Health (NIMH), argued Sally Satel, American Enterprise Institute that “what we need conceptually to make progress here is to rethink these disorders [mental disorders] as brain disorders” (Insel, 2013; see also Insel & Cuthbert, 1989, SAMUEL GUZE, then one of the damental level of analysis—the brain. IN 2015). doyens of American psychiatry, laid down Hence, it is only at this level, Guze main- But is neurocentrism helpful in clarify- the gauntlet to his academic colleagues in a tained, that research will ultimately bear ing our thinking about the causes and provocative article, entitled “Biological fruit in understanding, treating, and pre- treatment of mental disorders? What are its Psychiatry: Is There Any Other Kind?”, venting mental afflictions. implications for psychotherapy practice published in a prestigious medical journal. Over a quarter of a century later, we find and research? On the opening page, Guze answered his ourselves confronting the same question own question with a resounding “no”: raised by Guze, but with respect to psy- The Long Swing of the Pendulum “There can be no such thing as a psychiatry chology. We also find ourselves in an era of which is too biological” (Guze, 1989, p. creeping neurocentrism. By neurocen- While an undergraduate at Cornell 316). For Guze, the study of mental illness trism, we mean the propensity of scholars University during the late 1970s, the first must focus squarely on the brain as the to embrace the brain and remainder of the author enrolled in a course on psy- principle, if not the exclusive, level of expla- central nervous system (CNS) as inherently chopathology. The professor, a clinical psy- nation. Because all psychiatric conditions the most appropriate level of analysis for chologist by training, confidently informed are ultimately instantiated in neural tissue, conceptualizing and treating psychological the class that infantile autism (today he insisted, they are all physiological disor- phenomena, including mental disorders known as autism spectrum disorder; ders once one drills down to the most fun- (Satel & Lilienfeld, 2013; Schwartz, Lilien- American Psychiatric Association, 2013) Finally, the App that delivers YOUR homework. 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Researcher or therapist can install a security Free, and ad-free. password to prevent alteration by the user. Capable of virtually any non-branching Ecological Momentary Assessment research. Produced as a gift to the CBT community by: Capable of recording any CBT Activity Schedule, Cognitive Behavioral Institute of Albuquerque, LLC Thought Record, or Worksheet in the real world. Bradford C. Richards, Ph.D., ABPP Director and Supervising Psychologist Clean, no-nonsense user interface. October • 2015 173 LILIENFELD ET AL. was a disorder of purely environmental eti- analysis, such as the traditionally persono- and the National Institute on Drug Abuse ology. Autism, he assured us, is a conse- logical, social, and cultural levels. (NIDA) that appear to signal a marked quence of inadequate or neglectful parent- Psychiatrist Kenneth Kendler (2014) shift toward neurocentrism. For example, ing. To buttress his point, he assigned similarly warned of “fervent monism” or the draft of the NIMH’s (2014) new Strate- Bruno Bettelheim’s (1967) The Empty the undue reliance on only one explanatory gic Plan informs readers that this agency’s Fortress, an impassioned tome that identi- level, whether neural or psychological, for major objectives comprise “defining the fied “refrigerator mothers” as responsible understanding human nature (see also biological baSiS of complex behaviors” (p. for autism (this theory, originated by child Craddock, 2014, for a discussion of the 15), “describing the molecules, cells, and psychiatrist Leo Kanner, 1943, has since need to accommodate both neuroscientific neural circuits associated with complex been debunked). and social levels of analysis in psychiatry). behaviors” (p. 17), and “mapping the con- This kind of thinking was hardly Concerns regarding fervent monism were nectomes for mental illness” (p. 18). As of unusual at the time. As a number of com- also expressed by a recent past president of this writing, the “Director’s Page” for mentators have observed, much of clinical the Association for Psychological Science, NIDA, which highlights the work of direc- psychology and psychiatry in that era could Nancy Eisenberg (2014), who lamented the tor Dr. Nora Volkow, states that “Dr. best be described as largely “brainless” “increasing tendency to assume that study- Volkow’s work has been instrumental in (Eisenberg, 1986). Many mainstream ing genetic/neural/physiological processes demonstrating that drug addiction is a dis- authors conceptualized human nature as is more important than research on behav- ease of the human brain” (http://www. something akin to a “blank slate,” often ior and psychological processes per se drugabuse.gov/about-nida/directors- according scant consideration to the because biological findings will eventually page/biography-dr-nora-volkow). Con- genetic or neurobiological context of explain most of human psychological func- spicuously, this web page provides visitors behavior (see Lykken, 1991, Pinker, 2003, tioning” (p. 1). She noted that this trend is with no mention or even hint of research- for discussions). A provocative book enti- evident in “the funding priorities at some based or conceptual criticisms of this view, tled Not in Our Genes (Lewontin, Rose, & of the National Institutes of Health … it which demonstrate that drug addiction, Kamin, 1984), which argued forcefully can also be seen in the hiring patterns of although genetically influenced in many againSt genetic and other biological influ- many psychology departments that place a cases, is often highly responsive to external ences on intelligence, schizophrenia, and priority on hiring people who study biolog- incentives, classically conditioned cues, behavioral phenotypes more generally, was ical processes or aspects of cognition that and other nonbiological environmental widely read and taken seriously by scores of can be tied to neuroscience” (p. 1). influences (Lewis, 2015; Satel & Lilienfeld, academic psychologists of a radical envi- 2013). ronmentalist bent. How times have Evidence for the Ascendance of To fully appreciate the logical assump- changed. Neurocentrism tions underpinning neurocentrism and its implications for psychotherapy practice As the pendulum has—thankfully— In a recent article, we (Schwartz et al., in Swung away from the often “brainleSs” pSy- and research, however, we first need to press; see also Kagan, 2013; Miller, 2010, examine the oft-misunderstood concept of chology and psychiatry that were wide- for similar arguments) laid out several lines spread only a few decades ago, a growing reductionism. It is to this thorny concept of evidence suggesting that mainstream that we now turn. cadre of scholars, ourselves included, have psychology is increasingly adopting a neu- expressed concerns that these disciplines rocentric approach to human nature. Reductionism and Its Two Flavors now risk becoming “mindless” (Eisenberg, Among other things, we pointed to a dra- 2000; Lipowski, 1989; Satel & Lilienfeld, matic recent upturn in the proportion of Many psychologists routinely decry 2013). Because mental phenomena carry academic positions calling for expertise in “reductionism” as a scientific approach. negative connotations in some domains of neuroscience, many of which even man- But such criticism overlooks a key point: psychology, such as radical behaviorism date functional brain imaging skills; to the Reductionism is not one thing (Robinson, (e.g., McDowell, 1991), we should be growing number of elite psychology 1995). In particular, we must be careful to explicit about what we do and do not mean departments (e.g., Indiana University, Uni- distinguish constitutive from eliminative in this regard. First, by “mind,” we do not versity of Colorado at Boulder) that have reductionism (Ilardi & Feldman, 2001; imply a spooky, metaphysical essence

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