In my initial post in 2018, a 2024 post, and a recent post, I faulted psychiatry for continuing its pursuit of brain diseases as causes for mental disorders when they have not found any in this century. But, in fairness, there’s a good reason for expecting a disease to cause mental disorders.

In the 17th century, Descartes’s mind-body split theory established medicine’s primary interest in the physical body, which would later extend to its physical diseases. It also shunted aside the mind so that psychological and social issues and mental illnesses would be peripheral in medicine. But the theory had little initial impact on clinical care. Clinicians would continue to be guided by the ancient theory that explained disease as an imbalance of the four humors, which bloodletting could rebalance, until the 20th century.

But the first chink in the armor of the four humors idea came in the 18th century. Autopsies played the key role in replacing imbalances of the four humors as a disease explanation. Giovanni Battista Morgagni (1682–1771) launched this revolution1 by conducting 700 autopsies that he correlated with patients’ symptoms (obtained from clinical records).2,3 He recognized that the abnormal appearances of different body organs correlated with different symptoms, for example, cough and chest pain where the autopsy showed fluid and consolidation in a lung, or abdominal pain and vomiting where the autopsy showed growths in the stomach and an enlarged, bloody liver. Clinicians recognized, for the first time, that the abnormal appearing organs observed at autopsy represented disease and caused patients’ symptoms and death. This linkage of........

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