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August 10, 1984

A sharper focus for psychotherapy

JAMA. 1984;252(6):741-749. doi:10.1001/jama.1984.03350060005002

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"To separate psychological distress into psychiatric problems caused by chemical and structural defects in the brain and `problems of living' is an unwarranted dichotomy," according to Michael F. Basch, MD, professor of psychiatry, Rush Medical College of Rush University, Chicago.

Considering the brain as analogous to a computer— a reasonable analogy, in Basch's view—"you have hardware and software. What the psychopharmacologic discoveries of the past 20 years or so have done is enable us to begin to deal with the hardware problems, or brain itself. The so-called problems of living are part of the software, the programs people develop to cope with life.

"If that development has been interfered with by significant failures in empathy and communication, then people develop ways to protect themselves by adaptations that are ultimately counterproductive. "But where do these `problems of living' come from?" asks Basch, who is also author of Doing Psychotherapy (New York,