Barry Blackwell: The anxiety enigma
Hector Warnes’ response to Barry Blackwell’s reply


            Barry’s reply to my comments triggered not only greater admiration for him as a person and as a scientist, but also allowed me to distance myselffrom any kind of closure, one-sidedness and/or reductionist approach to our evolving field.  He may have been misunderstood because of his air of eclecticism or outspokenness. I see Barry closer to George Engel’s biopsychosocialmedicine(Guillemin and Barnard 2015). It is very touching the way Engel’s father died, but even more touching is Barry’s openness and humanity to his life experiences,along withhis uniquetraining. He left no stone unturned in our vast territory,wherefrontiersare multiple (biology, sociology, philosophy, neurosciences, physics, evolutionism and so on).

            This is my own personal experience with Barry since Tom Ban introduced me to him. I want to convey a very brief portrait ofhim. I have a longer list of thoughts on AitorCastillo's 2015 reply on the "message"and items which were left out, such as neuro-vegetative dystonia andneurasthenia. Thereseemtobefashionsforpsychiatricdiagnosis.Somemonoblocks are stumbling.   Henri Ey wrote a wonderful chapter on anxiety asa core psychopathological symptom that may be the kernel of all the others(published as one chapter in his 1950 three-volumeEtudesPsychiatriques). I am notsurprised since H. Jackson considered the evolutionary strata of eachneuropsychiatric symptom from the negative (loss of function where the injuryis located) tothe positive (what consists of the compensatory mechanism to that loss) (Jackson 1884). The CNS is a hierarchy of three evolutionary levelsin which neural plasticity and the speed of neural connections (either chemical orelectromagnetic) aremuch dependent on the epigenome. It all goesback to the Eigenwelt(inner world), the Mitwelt(interactionalworld) and the Umwelt (environment): dasEigenpsychische(the self psychic), dasFremdpsychische(the foreign psychic) and the basic biological sciences - Naturwissenschaften.

            One distinctive trait of Barry, unlike most of us, is that he recognizes thelimits of our infant discipline and keeps on finding the boundariesof itseffectiveness, usefulness and abuses.  Should he have made a mistake helater corrected it. I would say that when I make a"mistake" I also try tocorrect it, as far as I can.Yet, the natural history of the illness;thedoctor patient relationship and the specificity of drug response based ondrug metabolism; genetic factors; and many other factors keep mewonderingforever why did I not helpaparticular patient. In medicine,there are so many illnesses that have an unpredictable outcome regardless ofthe best treatment and best doctor available, such as multiple sclerosis,rheumatoid arthritis, lupus, various types of cancer, encephalitis and soon. I dare say that the rest of medicine ismore likely to gloss overtheir failures than we do, but also that the patients and their families aremore likely to accept the dismal outcome of amedical or neurologicalpatient than thatof a psychiatric patient.  Maybe because we areintoxicated with so many theories regarding psychiatric etiology that thefamily always wonders whether the patient had the right treatment or not. Inmedicine or neurology practitionersnarrow therapy down to a few choices and hopefor the best while advising the families that the outcome is grievous or"reserved." But we have something in common with all our colleagues publishingin clinical journals:we are likely to publish successes or goodresponsiveness rather than failures.



Castillo A. Comment on Barry Blackwell’s Anxiety Enigma. INHN.controversies. September 3, 2015.

Ey H. AnxiétéMorbide. Étude Nº 15. In: Etudes Psychiatriques.Cercle de Rechercheet d’édition Henri Ey (CREHEY),Perpignan, France. 2006.

Guillemin M., Barnard E. George Libman Engel: The Biopsychosocial Model and the Construction of Medical Practice. In: Collyer F. (eds) The Palgrave Handbook of Social Theory in Health, Illness and Medicine. Palgrave Macmillan, London. 2015.

Jackson, JH. The Croonian lectures on evolution and dissolution of the nervous system.  Br Med J. 1884 Apr 12;1(1215):703-7.


November 15, 2018