{"id":1107,"date":"2015-12-12T12:17:17","date_gmt":"2015-12-12T20:17:17","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1107"},"modified":"2015-12-12T16:24:55","modified_gmt":"2015-12-13T00:24:55","slug":"are-psychiatric-disorders-brain-diseases","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1107","title":{"rendered":"Are psychiatric disorders brain diseases?"},"content":{"rendered":"

\"brain\"<\/a>Some maladies that attract psychiatric attention are unequivocally\u00a0brain diseases. \u00a0Huntington’s disease. \u00a0Brain tumors. \u00a0Lead poisoning. \u00a0However, these are not psychiatric<\/em> diseases. \u00a0Huntington’s is a genetic abnormality diagnosed and treated by\u00a0neurologists. \u00a0Brain tumors\u00a0are managed by neurosurgeons and oncologists. \u00a0Lead toxicity is treated by internal medicine. \u00a0Indeed, a long list of\u00a0medical and surgical diseases include psychiatric\u00a0features: stroke, anoxic brain injury, meningitis, lupus, diabetic ketoacidosis, and febrile\u00a0delirium to name a few. \u00a0One important job of the psychiatrist is to recognize such\u00a0problems, treat the psychiatric manifestations when appropriate, and refer the case to one’s colleague \u2014 neurologist, internist, surgeon \u2014 for treatment of the underlying problem.<\/p>\n

Of the conditions deemed inherently psychiatric, some seem<\/em>\u00a0rooted in biological brain dysfunction. \u00a0Schizophrenia, autism, bipolar disorder, and severe forms of obsessive compulsive disorder and melancholic depression are often cited. \u00a0It’s important to note that their apparently\u00a0biological nature derives from natural history and clinical presentation, not from diagnostic tests, and not because we know\u00a0their root causes. \u00a0Schizophrenia, for example, runs in families, usually\u00a0appears\u00a0at a characteristic\u00a0age, severely affects a diverse\u00a0array\u00a0of mental functions, looks very similar across cultures, and brings\u00a0with it reliable if non-specific neuroanatomical changes. \u00a0Even though schizophrenia\u00a0cannot be diagnosed\u00a0under the microscope or on\u00a0brain imaging, it is plausible that a biological mechanism eventually will be found. \u00a0(The same type of reasoning applied to AIDS before the discovery of HIV, and to many other medical diseases.) \u00a0A similar argument can\u00a0be made for other\u00a0putatively biological psychiatric disorders.<\/p>\n

Lately, however, some big names in psychiatry have taken a more ideological stance, declaring that psychiatric disorders in general are\u00a0brain diseases \u2014 right now, no further proof needed. \u00a0Dr. Charles Nemeroff, widely published professor and chairman of psychiatry at the University of Miami Miller School of Medicine,\u00a0writes<\/a>:<\/p>\n

In the past two decades, we have learned much about the causes of depression. We now know from brain imaging studies that depression, like Parkinson\u2019s disease and stroke, is a brain disease.<\/em><\/p><\/blockquote>\n

Dr. Thomas Insel, recent\u00a0director of the National Institute of Mental Health (NIMH) wrote<\/a>:<\/p>\n

Mental disorders are biological disorders involving brain circuits…<\/em><\/p><\/blockquote>\n

Psychiatrist and\u00a0Nobel laureate Dr. Eric Kandel says<\/a>:<\/p>\n

All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases.<\/em><\/p><\/blockquote>\n

These claims by\u00a0prominent psychiatrists agitate\u00a0critics<\/a>. \u00a0No biomarker for any psychiatric disorder has yet been identified. Genetic vulnerabilities have been discovered, but nothing resembling a smoking gun. \u00a0Functional brain imaging reveals\u00a0biological correlates<\/em> of mental impairment, not etiology, and no such\u00a0imaging can\u00a0diagnose a specific psychiatric condition. \u00a0Our best account for most mental\u00a0disorders remains\u00a0a complex interaction of innate vulnerability and environmental stress,\u00a0the “diathesis-stress model”. \u00a0These psychiatric leaders\u00a0know the research\u00a0as well as anyone.\u00a0How can they\u00a0call psychiatric disorders\u00a0brain diseases\u00a0without\u00a0scientific\u00a0proof?<\/p>\n

The brain mediates all mental activity, normal or not. \u00a0Consequently, any psychiatric\u00a0intervention \u2014 or influential life experience \u2014 acts upon the brain. \u00a0This is not a new discovery. \u00a0A century ago, Sigmund Freud wrote “Project for a Scientific Psychology,” in which he proposed\u00a0that ultimately the mind would be understood biologically. \u00a0No modern studies of brain tissue, no genetic testing, no advanced\u00a0brain imaging were needed\u00a0for the father of psychoanalysis to posit that mental activity arises from\u00a0biology. \u00a0It is a philosophical position, monism as opposed to Cartesian dualism, not a scientific finding. \u00a0Note that Freud\u00a0could then have made it a point\u00a0to declare, as Drs. Insel and Kandel do now, that all mental disorders are biological diseases. \u00a0No additional science was required even a century ago.<\/p>\n

He didn’t because there was nothing to gain. \u00a0The best treatments at the time were psychological, not biological. \u00a0There was no grant money at stake, no research agenda to support. \u00a0The status and livelihood of early psychoanalysts\u00a0did not depend\u00a0on their treatment being biological.<\/p>\n

Psychiatric “brain disease” is neither an exaggeration nor a lie. \u00a0It does not require scientific proof \u2014 and brain imaging has neither strengthened nor weakened the case.\u00a0\u00a0For as long as one is not a philosophical dualist, it is surely true. \u00a0In theory, all\u00a0psychology can be reduced to electrochemical events in brain cells. All psychopathology can be reduced to aberrant electrochemical events, i.e., brain disease.<\/p>\n

Without\u00a0elucidating the causative\u00a0mechanisms, however, this reductionism amounts to\u00a0little\u00a0more than political rhetoric. \u00a0Calling psychiatric disorders brain diseases serves no clinical or research\u00a0purpose, it\u00a0only serves political\u00a0ends: bringing psychiatry into the fold as a “real” medical specialty, impressing Congress and other funding sources, perhaps allaying stigma. \u00a0As\u00a0a\u00a0tactic it smacks of\u00a0insecurity and self-aggrandizement,\u00a0wholly unbefitting a serious medical specialty.<\/p>\n

Freud’s psychoanalysis acts on brain cells, and ultimately alters\u00a0chemical bonds in those brain cells.\u00a0 We could rename\u00a0psychoanalysis and psychotherapy\u00a0“verbal neuromodulation.” \u00a0But to what end? \u00a0A\u00a0reductionistic account of this sort, festooned with\u00a0pseudoscientific verbiage,\u00a0has no practical significance.<\/p>\n

Brain\u00a0research\u00a0is a young field. \u00a0It should be vigorously pursued for what will surely be learned. \u00a0If history is any guide, many conditions currently considered psychiatric will eventually be explained biologically \u2014\u00a0and ironically, they will no longer be<\/a> psychiatric conditions, as was the case with\u00a0Huntington’s disease, brain tumors, lead poisoning, and many other diseases that now belong to other medical specialties.<\/p>\n

Stumping for\u00a0psychiatry as clinical neurobiology will be justified when basic research in this area affects clinical practice. Until then, “brain disease” is\u00a0only a philosophical technicality, a spin,\u00a0to give our clinical work and the institution of psychiatry\u00a0an air of scientific credibility. \u00a0Particularly in light of how diseases leave psychiatry once they are well understood, the field\u00a0should\u00a0embrace uncertainty<\/a>, not preempt\u00a0it with the premature use of brain disease\u00a0language.<\/p>\n

Image courtesy of dream designs at\u00a0FreeDigitalPhotos.net<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Some maladies that attract psychiatric attention are unequivocally brain diseases. Huntington’s disease. Brain tumors. Lead poisoning. However, these are not psychiatric diseases. Huntington’s is a genetic abnormality diagnosed and treated by neurologists. Brain tumors are managed by neurosurgeons and oncologists. Lead toxicity is treated by internal medicine. Indeed, a long list of medical and surgical […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[7,51],"tags":[52,45,43],"class_list":["post-1107","post","type-post","status-publish","format-standard","hentry","category-psychiatric-diagnosis","category-psychiatry-in-general","tag-neuroscience","tag-psychiatric-research","tag-uncertainty","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1107","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1107"}],"version-history":[{"count":15,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1107\/revisions"}],"predecessor-version":[{"id":1124,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1107\/revisions\/1124"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1107"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1107"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1107"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}