Thursday, March 30, 2017

Genuine interdisciplinarity in neuroscience research

I have been reading Neuro by Nik Rose and Joelle Abi-Rached. Like me (see previous post), they hope that neuroscience can become a genuinely human science. I like their notion of 'critical friendship' between social sciences and neuroscience. Some of the proper motivation for this friendship may be to share the money going into neuroscience research. It may also be important not to minimise the degree to which neuroscience funding is being wasted on the unattainable. However, there is a need for genuine interdisciplinarity to take the neuroscience research agenda forward. As they say:-
[W]e should not be surprised to find, in contemporary neurosciences, all the features of inflated expectations, exaggerated claims, hopeful anticipations, and unwise predictions that have been so well analyzed in other areas of contemporary biotechnologies.

Social sciences have nothing to fear about the 'neuro-turn' in modern culture (see previous post) and polarised attitudes in the debate are unhelpful (see another previous post). Pressures to translate research findings to clinical applications are also creating perverse effects. To quote again from Neuro:-
Neuroscientists might well be advised to be frank about the conceptual and empirical questions that translation entails, rather than suggesting that the outcome of a series of experiments with fruit flies or feral rats has something to tell us about human violence, or that brain scans of individuals when they are exposed to images of differently colored faces in an fMRI machine has something to tell us about the neurobiological basis of racism.

I also agree that the neuro-turn may be affecting how we view ourselves but that it "is too early to diagnose the emergence of a full-blown ‘neurobiological complex,’ or a radical shift from psy- to neuro-". Critical psychiatry has something to offer to the Neuroscience Project at the Royal College of Psychiatrists (see previous post).

Saturday, March 25, 2017

The faith of mainstream psychiatry

As I've said before (eg. see previous post), it seems obvious to most people that mental illness is due to brain disease. Critical psychiatry doesn't stand a chance! It must be wrong to question this assumption. But, of course, critical psychiatry isn't saying that mind and brain are separate (see previous post). What it is saying is that minds are enabled but not reducible to brains. It's got the weight of philosophy behind it.

Furthermore, it is also saying that the assumption that mental illness is due to brain disease is not based on logic, but rather on faith, desire and wish fulfilment. As I've also said before (see previous post), psychiatry is more like a religion than a science. It's much simpler to believe that brain pathology is the basis for mental illness and that its nature and cause will eventually be discovered. Believing this can be a way of justifying psychiatric treatment.

Actually, there's no need to justify treatment in this way. Mental health problems exist and professional expertise may be beneficial in treatment. The problem is that objectifying people through reducing their problems to brain disease may make psychiatry part of the problem rather than necessarily the solution to these problems.

Tuesday, March 14, 2017

The contested nature of psychiatry

Charles E. Rosenberg has an interesting paper on how psychiatry expanded in the last third of the 19th century to "include an ever-broader variety of emotional pain, idiosyncrasy, and culturally unsettling behaviors". Our modern somatic understanding of illness had to accommodate older "[h]umoral explanations of temperamental peculiarity", such as hypochondriasis, hysteria and melancholy. It began to do this at the beginning of the 19th century, by, for example, Benjamin Rush seeing hypochondria as having a corporeal cause. These "reductionist, mechanism-oriented, and antivitalist" ways of viewing illness created hypothetical disease entities, such as neurasthenia, regarded by George Beard in 1869 as a somatic condition which would eventually be confirmed by postmortem pathology.

As Rosenberg says:-
The dominance of reductionist styles ... has an extraordinarily salient place today. We have never been more infatuated with visions of molecular and neurochemical — ultimately genetic — truth.
As he also says, "yet at the same time we are reflexive [and] critical ... in our approach", even if this is a minority perspective. As discussed in my previous post, psychiatry is polarised about the nature of mental illness. Psychotropic medication has helped legitimate the specific disease entity model of mental illness. This is a "phenomenon that is always in process, always contested, and never completed". With the expansion of the "range of human dilemmas that we ask medicine to address", to quote from Rosenberg:-
[I]t is ... inevitable that the powerful concept of disease specificity has been — and will continue to be — employed as a tool for the ideological management of problematic emotions and behaviors.

(With thanks to a tweet from Richard Hassall)

Monday, March 13, 2017

Polarisation in the debate about mental illness

I have mentioned Mike Owen in a previous post. In a recent blog, he argues for less polarisation in the debate about the nature of mental illness. I couldn't agree more.

However, Mike does need to represent his opponents correctly if there is going to be a rapprochement. He says, "They assume, implausibly, that mind and brain are separate entities rather than different aspects of the same thing". This isn't true. The argument being made is not Cartesian. As Steven Rose says, "That brains enable minds is uncontroversial. That they 'are' the mind is a reductionism too far" (see Lancet article).

Similarly, Mike also says "They also fly in the face of a large body of evidence indicating the importance of genes and altered brain states in contributing to disorders of mental health". Again, not true. The critiques are evidenced-based. Genes, of course, set the boundaries of the possible but environments define the actual. More caution is needed in interpreting so-called altered brain states.

It is important that Mike understands what people are saying who are critical of his view. As Steven Rose says, people like Mike should not "dismiss without a backward glance not only millennia of philosophical debate but also a huge current literature on mind/brain relationships". There is a "conceptual innocence" about his position, although he is, of course, trying to dismiss any criticism. Despite what he may think, modern psychiatry has not solved the mind-brain problem.