Monday, February 17, 2020

Disinvesting in neuroscience in psychiatry

David Kingdon (who I've mentioned in a previous post) asks in a BJPsych Bulletin Against the Stream article 'Why hasn’t neuroscience delivered for psychiatry?' As he says, "it is still not possible to cite a single neuroscience or genetic finding that has been of use to the practicing psychiatrist".

As he explains,
The neuroscience tools we have available and indeed, those that are likely to become available in the foreseeable future, are far too insensitive to achieve an understanding of the complexities of human pathological emotional reactions. Can we really expect neuroscience to illuminate the aetiology, to take a common example, of a severe depressive illness in a recently widowed woman who has hated her husband for the last 20 years of his life? Will not a clinical interview always shed more light and lead to more effective interventions in such a scenario than an assessment based on neuroscience?
He goes on:
Might it not be that the difference with other areas of medicine is that there are demonstrable and incontrovertible biological abnormalities in neurological disorders, dementia and so on? No such clear causative changes exist in severe mental illnesses such as depression, anxiety, bipolar disorder and schizophrenia. 

Like me (see eg. previous post), he thinks we may well be setting up unachievable expectations for new entrants to psychiatry by focusing on neuroscience in recruitment. He concludes that "the time has come to challenge the justification for such relatively high levels of investment of time, expertise and resource in neuroscience for mental disorders". I couldn't agree more.

No comments: