Bruce Pennington has written a book that
will prove very useful in thinking about psychopathology. How dare one claim
something like that amidst a virtual flood of books on this topic? Well, this
book stands out from mere handbooks, because the author’s intention is not
merely to present data. It is written with a more challenging aim. The author
first and foremost wants us to think about the basic problems of
psychopathology research and treatment. Throughout the book – with its first
and last chapters devoted exclusively to that — he tries to put data in
broader interdisciplinary perspective (including philosophy of science), not
forgetting to critically review them.

In accordance with this, the book opens
with a chapter on basic topics, proceeds with a chapter on methods of data
gathering, moving to three chapters devoted to specific disorders (of
motivation, of action regulation, and of language and cognitive development).

The most important (for the author) among
the basic topics is developmental approach. He claims that all of the psychopathological
disorders are developmental in nature, and that "’disease’ is simply the
inability to achieve one or more goals of development" (p. 33). Therefore,
"the only way to understand how to get from the risk factors to the adult
brain and behavioral phenotype is to see how these risk factors change brain development"
(p. 22).

He proclaims that mind-body problem
in psychopathology is the key issue of his book (p. 1). The book is full of
"hard-science" approach, but is not blind to other important contributions.
The author explicitly takes a non-reductionist stance – "Our claims about the relevance of
neuroscience for purely social pathologies are integrative rather than
reductionistic" (p. 5) – as well as the position of neutral monism –
"The familiar clinical distinction between ‘functional’ and ‘organic’ is
misleading" (p. 4) – and multicausality (p. 30).

The
author claims that in dealing with psychopathology we need to include four
levels of analysis: 1. etiology (genetic and environmental mechanisms that
cause the psychopathological phenomena to occur); 2. the brain mechanisms; 3.
neuropsychology; 4. symptom analysis. 
It seems very fruitful to have on one’s mind the author’s suggestion
about "bi-directional nature of the relations between levels" (p.
311), which excludes the possibilities of biological reductionism or
insufficiently grounded constructivism. And this is not the author’s position
regarding treatment only, as he will also suggest that "the etiology of a
disorder does not necessarily dictate its treatment" (p. 323).

Regarding methodology, Pennington uses
four methods of syndrome analysis: 1. epidemiology; 2. behavioral and molecular
genetics; 3. neurobiology; 4. neuropsychology. In the second chapter of the
book, they are all discussed in detail. It seems to me that Pennington is a
kind of an expert in several among these different disciplines (I can not be
certain on this point, since I am not one myself), so there is a lot to learn
from him in this section.

The main part of the book is devoted
to three large categories of psychopathological phenomena. The organization of
each of them is basically the same: each starts with definition, going through
already mentioned epidemiology, etiology, brain mechanisms, and
neuropsychology, to end with treatment. Although these are all excellently
written, it is now obvious that this is more of a book for researchers than for
clinicians practitioners. The scope of data revealed is impressive, but the
book contains almost no traces of a living patient. Still, everyone can learn a
lot here, and, more importantly, find substantial evidence that the science of
psychopathology has taken an impressive step ahead.

Although advocating this approach,
the author is aware of possible criticisms. This is most evident when he writes
about the diagnostic system (see pp. 13-19). And it is clear that he is
informed on new trends outside his area of interest when he writes about
different types of reification errors, the sharp boundary between
psychopathology and normality being the most important one (p. 30). He also
thinks critically about cognitive science and states that "to deal with
the development of psychopathology, cognitive neuroscience needs to be
broadened in three key ways: (1) It must focus explicitly on individual
differences; (2) it must integrate emotion and social influences into the study
of cognition; and (3) it must incorporate development" (p. 2).

It seems that the main problem of
the book is the second point of this list, that emotional and social spheres
are viewed from the cognitive and neuropsychological standpoint only. Although
he emphasizes that "we cannot reduce psychopathology simply to
genes, early environmental experiences, neural synapses and networks,
psychological processes, or social contexts. Instead, we need all these
levels of analysis to understand the development of psychopathology" (p.
xiv), it seems that this is still far from reach. The author uses subpersonal
explanations too often, and it remains unclear what is psychological for him
besides neuropsychology.

Nevertheless, the weak points of
this book are outside the area it is devoted to, being in what the author
omitted. Concerning what he intended to cover, he did in a highly respectable
fashion. The reader should expect to learn a lot and to broaden his/her general
understanding of the topic, but he or she must go on reading after closing this
book.

© 2003 Aleksandar Dimitrijevic

Aleksandar
Dimitrijevic, Faculty of Philosophy, Department of Psychology, Belgrade,
Yugoslavia.

Categories: Psychology