That the above two worlds do exist, that they can be studied separately, and that they cannot be reduced to each other, or fully explained each through the concepts that are specific to the other, there seems to be no doubt. But that they are independent from each other appears today implausible. The existence of the world of meanings, symbols and interpersonal relationships in which we human beings are immersed is only made possible by the complexity of our brains.  

The brain processes involved in the implementation of several aspects of social behavior (for instance, the generation and reception of facial and non-facial social signals; the perception and understanding of others’ mental states; the self-regulation of emotions in social contexts; the development and maintenance of social bonds) are now being elucidated. Furthermore, it is now clear that, not only brain damage or dysfunction can affect social behavior, but early social experiences can affect the development, structure and functioning of the brain, thereby conditioning the individual’s subsequent response to social events.  

Most mental disorders are likely to emerge from a dynamic interplay between the above “two worlds”, so that, not only neither neural dysfunctions nor problematic interpersonal relationships can fully “explain” those disorders, but even identifying what is “primary” and what is “secondary” may often be a useless and misleading exercise.  

We human beings are “embodied subjects”, i.e. our existing as objects (or bodies, including brains) in a physical world and as subjects in an interpersonal world are inextricably interlinked. As a consequence, mental disorders require an interdisciplinary research frame and an integrative clinical expertise. 

The fact that we are “embodied subjects” is of course relevant not only to psychiatry, but to the whole of medicine. Physical diseases, even if unequivocally located in the body, may often have an interpersonal component in their determination, manifestations and course. This component may need to be recognized in clinical assessment and taken into account in management, as well as in interpreting treatment response.  

In this light, psychiatry may cease to represent an “exception” in the realm of medicine, and even represent a “model” on which to reflect and from which to learn.  

—The author is the Past President, World Psychiatric Association (WPA)