Judith Shulevitz, the science editor for The New Republic recently wrote an interesting article on loneliness (here).
It caught my eye because it started with a nod to Frieda Fromm-Reichmann, the psychoanalyst who was immortalized in Joanne Greenberg’s fictionalize memoir of her recovery from psychosis, I Never Promised You a Rose Garden. Ms. Shulevitz goes on to describe the field of loneliness studies from a psychological to a neuroscience perspective.
I have been struggling with the notion of the medical model as it applies to human suffering as well as the ability of basic science research to inform the work we do. There has been a lively discussion on this website about this (here, here, and here).
For me there are at least four separate questions to be addressed. The first is whether neuroscience is capable of understanding human emotion and higher level cognitive experiences. The second is the extent to which that understanding – even if it is achievable – is critical to our being able to help people in distress. The third is whether it is correct to assume, as many people seem to do, that if we come to some basic understanding of brain function as it pertains to core human emotion and suffering that this will automatically translate into treatments that are commonly thought of as “biological,” such as drug treatment. The fourth relates to the limitations and relevance of studying the brain in isolation when we are constantly in interaction with our environment.
The Shulevitz article provides a good platform from which one can address these questions. She begins with a discussion of Fromm-Reichmann’s assertion that loneliness – and by this she meant the subjective experience of want of intimacy – was “at the heart of nearly all mental illness”. She then reviews all of the effects loneliness has not only on the psyche but the body. This is followed by a review of modern research into this field which traces the effects of loneliness in humans from a social perspective to the effects of social isolation and rejection on brain functioning.
I found the article and the studies described to be of interest but inherent in the narrative is the notion that we needed the evidence of brain changes to legitimize Fromm-Riechmanns’s initial observations. The recommended “solutions” are primarily social; the author describes studies that showed the benefits of providing enrichment to young children and their families and she reports on an ongoing study in which researchers are teaching soldiers about social cognition with the hope of reducing post-traumatic stress. The implication, however, is that the basic science data were necessary to legitimize this area of inquiry.
For those of you who reject the notion that neuroscience research might inform our understanding of human distress, I suggest this thought experiment. I was talking recently to a colleague who studies headache. He explained how researchers in this field worked for years without being able to find biomarkers. They then decided to model a diagnostic system after the DSM. This allowed them to do research that provided preliminary data which they hope will improve their funding. They propose that understanding the neural substrates of head-ache will yield clues on how to provide more benefit to those who suffer from what for many is a debilitating affliction. At the same time, he understands how the experience of headache is not based entirely within the person; that the experience can be modified by external experiences. He is not entirely wedded to finding drugs that will reduce headache; he understands that altered environments might also help. But he nevertheless, believes that this basic research will be informative.
If this seems legitimate, I would ask how in any way this differs from a similar approach to something like anxiety? Anxiety is an experience that can range from mild and transient to persistent and debilitating. It is experienced in the subjective realm and it has correlates throughout the body. It can sometimes be reduced dramatically with drugs but it can also be exquisitely impacted by environmental changes. If basic neuroscience research is legitimate to further our understanding of headache, why is it less important to further our understanding of anxiety?
I find it interesting to learn of the neural correlates of core human experience. In the true spirit of science, we do not know where the research will lead. I think it is incorrect to assume that neuroscience research will only result in treatments approaches that are “biological”; i.e., contained in a capsule. However, I am not convinced this work is required to legitimize investigation into the value of social connections on our well-being and I do not think we need to wait until we have mapped out the brain before we invest time and money into learning more about this.
That to me is the crux of the issue. I do not dismiss, a priori, that we might someday completely untwist the fundamental workings of the brain. However, I do not think this is where all of our research dollars should go. For me, there is ample evidence that social connections matter. We can invest money into understanding why some of us struggle more and how those of who struggle might learn to make more connections. We can try to understand how our social system maximizes health and well being. We can invest in understanding treatment approaches that appear to have had good outcomes even if they are not premised on the fundamental biological paradigms of the day.
At the same time, I think it benefits all of us to listen openly to as many perspectives as possible as we join together in re-imagining how best to engage with people who are struggling with extreme states. I do not want to be privileged in my authority to speak merely because I am a physician; my experience has taught me the profound limitations of my knowledge. But we will not know until we know what neuroscience can and can not teach us. I am hesitant to walk away. I think I write this in the spirit of Robert Whitaker’s work; honest and open inquiry is what should be privileged not an authority or the particular framework from where that inquiry emanates.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.