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Utena, H. (1996). Loss of Freedom in Mental Disorders: A Biopsychosocial Conception. Ann. Psychoanal., 24:131-137.

(1996). Annual of Psychoanalysis, 24:131-137

Loss of Freedom in Mental Disorders: A Biopsychosocial Conception

Hiroshi Utena, M.D.

The problem of “psychosomatic correlation” has been discussed by many researchers from the point of view of such dichotomies as “body and mind” or “brain and consciousness.” It can hardly be assumed that any unitary viewpoint could create a satisfactory synthesis. For instance, when medical students happen to ask me whether psychiatry would eventually become reduced to neurology or when psychology students raise the question of whether clinical psychology might be a future state of psychiatry, I, an old psychiatrist, answer both questions with a simple “No.” My answer is based upon our need as clinicians to envision the patient as a whole person. Let me elaborate.

I hope to deepen our understanding of the problem of making psychosomatic correlations by employing three distinct ways of thinking that might then allow us to investigate and bridge psyche and soma. My thoughts concern the following: (1) our conception of biological evolution, (2) our ideas (compounded with words or special terms) regarding the interface of mind and brain, and (3) our therapeutic assumptions as clinicians.

Keeping these three perspectives in mind, I would like to discuss the concept of “freedom.” On the one hand, freedom is a common word with multifarious meanings; on the other hand, the word invites us to think about different facets of the idea. According to context, it signifies a definable, yet wide, range of meanings, from “free will” to “political freedom.” In this chapter, I will deal with the concept of freedom, including freedom of choice in terms of “procedural operations.”

In Japan, Yasugi and Ohshima (1992) have advocated the idea of “a correlative expansion of freedom and determinism.” According to Yasugi and Ohshima, freedom has expanded in parallel with the hierarchical development (i.e., evolution) of the central nervous system.

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