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March 22, 1976

The Psychiatrist as Physician

Author Affiliations

San Antonio, Tex

JAMA. 1976;235(12):1211-1212. doi:10.1001/jama.1976.03260380015011

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To the Editor.—  In his commentary on "The Psychiatrist as Physician" (234:603, 1975), Dr Ludwig suggested that we define mental illness as any debilitating cognitive-affective-behavior disorder due primarily to known, suggestive, or presumed biological brain dysfunction. In his proposed concept of mental illness, he includes alcoholism, drug dependence, and anxiety neurosis. He excludes social adjustment reactions, character disorders, and some other conditions because, he presumes, these occur with intact neurophysiological function and are produced primarily by psychosocial variables.Anxiety neurosis may indeed, as Dr Ludwig implies, arise from brain dysfunction, but in modern textbooks of psychiatry, its cause is usually attributed to adverse psychosocial experience. Character disorders may also arise from brain dysfunction, but their cause is often attributed to psychosocial experience. Since presuming is allowed, we could presume that chronic psychosocial stress leads to persisting electrochemical dysfunction in the brain, and that this brain dysfunction then continues to produce