Do We Need to See Inside the Box?

42
371

Recent reviews have painted a dismal picture of treatment development for mental disorders.  This week, Dr. Thomas Insel, Director of National Institute of Mental Health announced that new guidelines will be used to determine what research gets funded.  Treatment studies will be required to “test for target engagement itself as a potential mechanism of disease,” i.e., there will need to be a focus on a “target” (brain function) with any new treatment study.  The intention is to insure that research will “speed the translation of emerging basic science findings of mechanisms and processes underlying mental disorders.” This is part of Dr. Insel’s response to the “dismal picture of treatment development for mental disorder.”

I once took it as axiomatic that it was important to understand the brain in order to reduce suffering of those who experience extreme (or even mild) emotional distress. But I am no longer so sure. I have written about this before “Is it all in your head?” I revisited this again when discussing a New Republic article about loneliness studies, “Thoughts on the meaning of neuroscience.”

What brought me back to this again today was a lovely article in the New York Times written by Ron Suskind about his son Owen who has experienced communication problems typical of young person who is diagnosed with autism. Suskind eloquently describes not only the family’s despair but their efforts to make contact with their son. The route into his world was in the careful attention they paid to his fascination with Disney movies. He was obsessed with them and in a process he describes in the article as Disney therapy, they were able to turn this observation into a road map of discovery. Along the way, the family had the help of many technicians – doctors, teachers, therapists. But it seems that it was the family’s interactions, their dedication to finding a way in, their curiosity abut knowing Owen’s world, and Owen’s receptivity to their overtures that was so important.

I am not an autism expert. I do believe that the brains of people labeled with autism are different from those of us who do not have those sorts of problems. I also believe that autism is not likely to be one thing but many things and it exists in the world in many shapes and forms and people with this label have varying degrees of impairment. I am not anti-research that tries to understand this from a basic neuroscience perspective. I imagine that the families of children who experience these problems would want to understand why their children have such problems. I know I would. If this happened in my family, I would want to know if there was a way my child could have been spared. None of us want our children to suffer.

But with Dr. Insel’s new proposal, I do not think they would fund an investigation into why the Suskind’s were able to be so helpful to their son. At least they would not do it if they did not also link it to some sort of imaging protocol. How many kids might opt out for that reason alone? How many fewer kids could participate due to the expense put into the imaging or blood tests or whatever it was that was linked to the study?

My favorite researcher is Daniel Kahnemann who summarizes his work and that of many others in his remarkable book, “Thinking, fast and slow.” He is a Nobel prize winner and his field of research is cognitive psychology. Over many years, he and his colleagues have learned what influences us to form conclusions about the world and make decisions. Although some of the work ultimately linked to imaging studies, the core of the work did not require any understanding of how the brain work at a cellular or network level. Yet his work has profoundly informed and enriched our understanding of human behavior.

I have learned that there is rich and important work being done around the world. Many of us know of Open Dialogue. But there is more: reflecting therapies of northern Norway, Carina Hakansson’s Family Care Foundation, Emotional CPR, Intentional Peer Support, Hearing Voices Network to name just a few. I recently read Michael White’s Maps of Narrative Practice and Jim Wilson’s The Performance of Practice. These were books of great humanity and wisdom. Even Gerry Hogarty and Deborah Greenwald’s Cognitive Enhancement Therapy, although firmly nested in the neurodevelopmental model of schizophrenia, is nevertheless largely about social engagement and perception.  The basic research did not inform this work nearly as much of the observations about what was difficult for people.

Frankly, I surprise myself with the conclusion that it is not essential to understand the brain in order to be of help to people experiencing emotional distress even in its most severe forms. It counters assumptions that seemed fundamental to me for so long. Yet, I am no longer sure we need to see inside the box, although I understand why we want to look.  The brain is such a remarkable organ. But as Dr. Insel points out, funding is not unlimited and priorities need to be made. Psychiatry is nowhere near to being the clinical neuroscience that he envisions it to be, and prematurely acting that way is not without hazards.

Perhaps we would need resources outside of the federal government to explore them, but there are important avenues of exploration that – although less technological – are worthy of our interest.

***

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.

***

Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.

42 COMMENTS

  1. Thank you Sandra for this most beautiful post, describing some very essential things about being a human and the problems which come when we tend to behave as if it would be possible to catch human life into a box and give a name to it. Former Tom Andersen used to talk about how language sometimes bewitch us in the sense that we give a name to a phenomena as if we by doing so think we know the truth. As for example the psychiatric diagnosis used each and every day by a lot of people as IF something called schizophrena or ADHD really exists.
    My experience from many years of practice, research and lived life is what you describe, the importance of presence and participation and to come from an authentic place when meeting another person. This does not mean that we shall not try our very best to understand human dilemmas and difficulties, but it means that we have to find out a better way to do it. As for example what is done on this webpage started by Robert Whitaker in order to examine research and practice. and in lots of other ways and places all over the world. We “just” have to see and value that it exists and that it is a brilliant alternative to the still dominant way of relating to human beings and human life.

    Report comment

  2. Perhaps Dr. Insel needs reminding that the brain is not the mind, nor the spirit. Families can be a great source of help, were we not so routinely discouraged by the professionals. In the Disney therapy article, Ron Susskind writes: “The speech therapist tamped down our enthusiasm. Dr. Alan Rosenblatt, our trusted developmental pediatrician, did, too. He explained that echolalia is a common feature in kids like Owen.” The Disney article reminds me a lot of the wonderful memoir, The Horse Boy, by Rupert Isaacson. Isaacson tells an unusual story of riding horses in Mongolia and visiting Siberian shamans in a search of healing. He had early on noticed that his son had an affinity with horses and shamans so decided to immerse himself in what his son was interested in to see if this had a curative effect. Isaacson makes the point that if your son or daughter is interested only in trains and numbers, then indulge their love for trains and numbers by joining them in their pursuits. The same applies to other mental health labels. Find out what your relative loves, and indulge them in their pursuit. Unfortunately, family empowerment is not the stuff that gets funded by the NIMH. If not supported in their efforts, families can be easily eroded in their beliefs that there relative can fulfill their potential. Support can simply take the form of hearing how others have helped their own family members. Not sexy enough for the NIMH since it doesn’t involve hard science.

    Report comment

  3. CBT is a straighforward psychotherapy that works for ‘Schizophrenia’. This means that ‘Schizophrenia’ is for the most part psychological or emotional. Or that ‘Schizophrenia’ does not really exist.

    I think the ‘Diagnosis’ and the Brain Research is just a Fraud on the Tax Payer. Theres enough evidence now to say that with basic help most people can recover productive lives.

    Report comment

  4. Thanks, Carina and Rossa for reading and for your comments.
    Fiachra – I could have added CBT to the list. But to me, knowing that something can be impacted by a psychotherapeutic approach does not mean that brain mechanisms are not involved. Our brain is the mediator of these changes. My point is that we do not need to understand how these changes occur or where exactly they occur or what genes are involved in order to develop approaches that are helpful. This is an urgent matter to me since it may take a very long time to get to where Insel want to get and even then, it is not clear the kind of insights he values will be as helpful as he thinks they will be.
    I do agree that “schizophrenia” is a construct. It was a name that arose a hundred years ago when psychiatrists thought that naming something and describing it was the first step to understanding it. What we have learned in these hundred years is that the brain and body are so complex; many of our classification systems – in much of medicine, really – hold us back rather than advance our understandings.
    I do not know of any thoughtful person – in or out of psychiatry – that considers schizophrenia to be one “thing”. It is an umbrella term that captures many things and, to say it again, I have come to the belief that it has long out lived whatever usefulness it might have had at one time.

    Report comment

      • If the solutions are through human based help, then all the brain research is just a distraction. The problem is that there’s a huge false economy feeding off it, and they expect to keep feeding off it at one level or another. I think this is where the real problem is.

        Report comment

    • “I do not know of any thoughtful person – in or out of psychiatry – that considers schizophrenia to be one “thing”. It is an umbrella term that captures many things and, to say it again, I have come to the belief that it has long out lived whatever usefulness it might have had at one time.”

      Sandra, I must admit you have a pretty strict filter on who you consider thoughtful. Maybe it’s a good thing. 😉

      In any case, yeah, in Finland the leading official authorities talk things to the public such as “schizophrenia is considered to be a brain degrading cellular level disease” .. “there’s also some proof that taking atypical neuroleptic drugs will reverse this condition”. When I sent email to this authority and asked about it, he sent me back one of those earlier monkey studies where they still thought Zyprexa was “more protective than haloperidol”, because it had less of brain shrinkage.

      In any case… of course there are many thoughtful people out there who believe schizophrenia is a single cellular level disease which forcibly causes people to act violent. They perhaps haven’t heard the dialogue! If even after that they insist it .. maybe they’re not very thoughtful.

      Report comment

      • I stand by my words. Even within the so-called biological model, there is an open discussion on the utility of categories such as schizophrenia and bipolar disorder. There have been entire issues of the journal Schizophrenia Bulletin devoted to this. Even Eugen Bleuler (and any historians here can correct me if I am wrong) – the man who gave us this term – used the word schizophrenias not schizophrenia. It has always been a placeholder awaiting some deeper understanding.

        Report comment

        • Yes, I at least agree with you that schizophrenia is a “placeholder”. Heh, I got that diagnosis for a while because of misunderstandings and severe effects of neuroleptics (“negative + cognitive”) even though I haven’t ever had any hallucinations or, in my opinion, any severe psychotic symptoms. And once they thought I had psychosis or “schizophrenia”, they started to interpret everything in a way that validated their belief. For instance, they thought my answers to Rorscach test meant I was hallucinating. Now that the stupid label is there in my official papers and will haunt me for the rest of my life. In a way, once you get a diagnosis like that, it’ll often influence the thoughts of professionals to the point where they start to see all kinds of things as symptoms of the disease. So in this sense I also agree with you that the diagnosis may often be harmful.

          But reading through all these things professionals and non-professionals write everywhere often makes me pessimistic. The view of schizophrenia as some kind of a reverse Parkinson’s disease is just so wide spread. And the same kind of thing is true with bipolar, etc. They’re all being treated the same way anyway, with SSRI and neuroleptics. Maybe it’d be easier if they simply created a single category “mental illness” and prescribed neuroleptics for it as the first line treatment.

          Report comment

  5. Thank you for this article. Even though Insel has criticized the DSM 5, this “research” initiative supports its nonsense just the same.

    I actually believe that in a few situations, the distress and dysfunction that some people have living in the world probably has a physical basis, and maybe studying that might be helpful.

    As for the other 95% of the emotional problems people may have, the NIMH initiative really means nothing, or worse. A child talking back to her parents or an elderly man grieving the loss of his wife of sixty years don’t have “disorders” or brain dysfunction, and of course I’m not saying anything here that pretty much any reader of MIA would disagree with. But the question is, what if anything does psychiatry have to offer for these problems?

    Brain studies, if done honestly, will be useless, and there is no reason to doubt either that results showing a correlation between brain function and emotional distress will be announced as showing causation.

    How do we move forward to a system of genuine helping or really, a society where people take their responsibility to their fellow human beings seriously?

    I am just groping with these questions myself now, but I do think we need less intellectual analysis and more moral commitment to find our way to that kind of helping.

    I apologize for this vagueness, but I think issues like this will always force us to struggle to find an answer. I wouldn’t trust anyone, including myself, who would claim to know what to do.

    Anyway, thank you again for this article.

    Report comment

    • Thank you, Ted.
      What I find so appealing about Open Dialogue and related endeavors is that respect and consideration for the person with whom one is interacting is front and center from the moment the person makes contact with the “system”. There should be nothing controversial about that.

      Report comment

      • hi Sandra
        The importance of respect and consideration for the person is, as I think nothing new when it comes to ideas and experience in the field of therapy and social work. Also in the “system”. There are a many skilled and passionated professionals belonging to different theoretic schools who have a lot of to tell about this.
        What I find radical in OD is the combination of this knowledge and attitude with the idea to reduce or take away drugs. That is what needs to be in focus as I Think, and hope for future.

        Report comment

        • Thanks for the clarification. I certainly did not mean to imply that OD is the only approach that values respect and consideration. I am primarily saying that in my learning about OD, it has refocused my attention on how important that is as a primary concern. I am talking as much about myself, I guess, as about OD. Also, there is probably no practitioner in the world who thinks her approach is not embedded in respect. But something happens with so many of us where the “system” or our convenience or something else seems to gain primacy. I still think there is something embedded in OD (and it may be embedded in other practices as well) that helps people to keep from straying from that “person centered” perspective.
          And yes, the shift away from the primacy of drugs is also important. 🙂

          Report comment

    • “How do we move forward to a system of genuine helping or really, a society where people take their responsibility to their fellow human beings seriously?”

      Right, Ted. The Quakers had a pretty good success rate with their “moral therapy” in which they treated people like human beings and supported them until they were able to engage fully with life once again. It’s not rocket science. I agree with Sandra; we don’t necessarily need to know how everything works to be able to walk with people into healing and well being.

      Report comment

  6. Thanks for the thoughtful article. I have to say, I think Insel’s observation of the truth regarding the DSM is quite on target, but his solution continues to be based on an unproven assumption, namely, that out mind and our brain are synonymous. (I think Rossa said something similar above). It denies the obvious impact of what for lack of a better word I will call the spiritual being on the body and specifically the brain. I am not going to indulge in speculation on the nature of this apparent being, but merely point out that whatever it is, it appears to have a profound influence on our health and well-being. Or perhaps it is more correct to say that it is the agency that DETERMINES what health or well-being even means to us.

    To be more explicit, let’s take the “placebo effect.” Apparently, believing that something can help us can actually help us. So a BELIEF is healing. It should be obvious, and has been shown also, that beliefs can also be harmful or debilitating. How would any of this be “measured” in the brain? What is the target area for “trust” or “confidence” or “sense of purpose?” These things have no apparent correlates in the brain. And yet they obviously impact how we think, feel and behave, every bit as much and moreso than the profession’s sacred psychiatric pills.

    Another example is neurofeedback – apparently, a person can intentionally alter his/her own brainwaves to fit a particular pattern if they get feedback about when they’re being successful in approximating that pattern. And a person can be trained to do this eventually without any further feedback. So WHO IS ALTERING THE BRAINWAVES? If the brain is all, how can the brainwaves alter themselves? Obviously, there is an agent external to the brain, or superior to it, that can tell the brain what to do.

    Again, I don’t pretend to know what this agency is, but it is apparent that human beings have an agency that is able to dramatically influence brain function, both intentionally and unintentionally. If we only study the brain, we miss that boat completely before we even start. Which is why no one will every get money to study why “Disney Therapy” worked for that family. There is something at work in that example that transcends brain function. Something to do with meaning and dedication and purpose and unbending intention to solve the problem. There is no measurement of such things and no “genetic or molecular target” for them, either. They are aspects of the human spirit, whatever that is. And the human spirit, in my view, is something that measures, not something to be measured, and it will always transcend any efforts to quantify it. Until we admit that simple and obvious fact, our “research” efforts are doomed to failure.

    Sometimes it has nothing to do with the box at all. It has to do with who is controlling what goes in the box.

    —- Steve

    Report comment

    • Excellent points, Steve, and so articulately stated! I think you’ve hit on perhaps the central rotten core underlying all the peripheral problems in conventional biopsychiatry: the assumption, with apparently no acknowledgement that it is an assumption, that “we are our brains”. Or as one of my grad school psychology professors stated was the belief of some researchers, “all human behavior can be described as ‘squirts and twitches'” (i.e., neurons in action).

      So, am i my brain, or do i have a brain? And if it’s the latter (which i believe), what is this “i” that has the brain…and all the other intricately interrelated parts that comprise my incredibly complex physical body? Even if you leave out the spiritual dimension (which i do not) and deal strictly with the phenomenon of consciousness, it should be clear that human consciousness is not a biological entity. It seems that modern Western culture has been so steeped in materialism and reductionism that it can neither recognize or appreciate the absurdity of this!

      Report comment

  7. Hi Steve,
    Thank you for carefully articulating your thinking on this. I would guess that most psychiatrists – including me- do not agree that there is some other agency involved. They – and I – would say that there is some neural process that would account for placebo effects, that would account for belief.
    However, my point is that to some extent it does not matter if you and I agree. We could set this debate aside and still agree that observing and studying from the outside is of value.
    It may be important to find areas of agreement rather than areas of disagreement so that we can join together to advocate for the kind of research and study that we both agree is important.

    Report comment

    • Ah, but I think you have made my point for me – you guess that most psychiatrists, you included, don’t agree that there is some other agency involved. You would SAY that there is some neural process that would account for belief. But WHY would you say that? What evidence is there to support your claim? Is that claim not just as much reflecting a philosophical/religious viewpoint as the claim that the spirit is a separate entity that occupies and manages the body? Unless you can provide evidence for your belief, it amounts to nothing more than a generally-held belief within the psychiatric community, no more scientific than someone’s belief in angels or the afterlife.

      I do think this point is vital – not that you agree with me about the nature of or even the existence of a transcendent agency capable of controlling the brain (for which I acknowledge there is no direct evidence, but whose presence I infer from other events), but that your belief is not somehow more important or accurate or scientific than mine because a bunch of other psychiatrists agree with you.

      I absolutely respect you and your important work, or I would not bother having this conversation with you. I want to challenge you to ask on what basis you and your psychiatric colleagues hold that belief. Is there one shred of science telling you that the placebo effect is accounted for by a “neural process?” If so what is it? Is it anything other than pure speculation that such a process exists?

      It is my observation that this absolute and unfettered need to believe that everything about human behavior can and must be explained by a neural process is central to psychiatry’s absolute blindness to other options besides chemical manipulation of the brain. And for me, as a scientist (a chemist by training), it has not the slightest degree of scientific validity. It is an assumption that is so accepted that anyone who questions it is automatically considered “not scientific,” but it is an untested assumption.

      Biological psychiatry has on occasion been compared to a church or religious community (and interestingly, the DSM has been dubbed the psychiatric “bible” spontaneously by many in the mental health community!), and I find that the dedication to this particular belief is what gives it that churchlike quality. I am very interested to hear if you are able to consider the possibility that it is nothing more than a belief that is unsupported by known evidence, or if you in fact have evidence that I am unaware of to share.

      Again, I have the utmost respect for you and your work, and really appreciate your posts. I hope you will take this in the spirit (forgive the pun!) in which it is given. I really want to hear your response.

      —- Steve

      Report comment

      • This is much like the situation with the near death experiences that some people have. This is the experience of going down the tunnel with the bright light at the end, of seeing loved ones who’ve died before the person having this experience, the tinkling and soft chiming of the bells etc. and then the being drawn back into their body. As a chaplain I ran into a number of people who’d experienced this. My mother experienced this when she gave birth to my first brother.

        I am not bringing this up for religious or even spiritual reasons but for the fact that after a number of these stories had surfeced and were accepted many psychiatrists and some neuroscientists began claiming that this was an hallucination caused by the brain and not any spiritual experience at all. I always wondered how in the world they knew this and wanted to know what proof they had. Of course, the proof was never produced, at least not that I’ve heard. I couldn’t figure out why they felt they had to jump in there and contradict the experiences of these people. Personally, I don’t care whether these were “real” experiences or not. What I do know is that they had very profound effects on the lives of the people who had the experience, almost all for the good. So why did some psychiatrists feel that they had to jump in there and proclaim that this was all caused by the brain and was no true experience at all? Where is their proof?

        Report comment

      • Steve,
        I do not feel offended or unfairly challenged. We agree. I have a perspective – a belief system if you will – that is fundamentally materialist. You may not share that belief.
        My point is that we do not need to argue. I do not care who is “right” in this discussion. And focusing on that point might distract us from something important. Namely, we do not need to resolve that argument BEFORE we decide that we can ignore it and still learn many useful things about how to be of help to people.

        Report comment

        • The greater good of “learning how to be of help to people” supercedes personal beliefs. It’s like somehow getting every group in this hodge podge collecttion of people in our movement to focus on that ultimate goal rather than on whether or not we have common and absolute agreement among each and every one of us. It’s like forming a coalition from disparate groups that have difficulty getting along.

          Report comment

        • I agree 100%. When I object is when so many of your colleagues assume and assert that their perspective – which to me sounds very much like I am an illusory effect of neural firing and that I have no free will or control over my own brain chemistry – is the only perspective worth having, and that anyone who disagrees is anti-scientific or superstitious. You obviously don’t take the perspective to that extreme, and appear willing to acknowledge that it is a philosophical position that others don’t need to agree with. This is absolutely not my experience with the bulk of the psychiatrists I’ve known, and increasing numbers of psychologists and counselors of various stripes are beginning to act similarly.

          I think what we do agree upon is that we should focus on what actually WORKS, and that “WORKS” should be defined from the point of view of the person being acted upon by our purportedly helpful interventions. I am essentially a pragmatist at heart – if someone does a spirit dispossession, and the “client” gets better (and I know this does really happen), well, let’s find out what was done that worked and see if it works on someone else. Real science doesn’t exclude possibilities because they conflict with our basic assumptions about reality. Science is designed to cut through those philosophical assumptions and show us what is actually KNOWN.

          Anyone who attacks someone else’s integrity for not being a materialist or a spiritualist or a populist or whatever “ism” they favor is not being a scientist at all. What bothers me is that the psychiatric community as a whole (present company excepted) gets away with claiming it is the “true science” while pointedly ignoring scientific data such as Harrow and Wunderlink.

          Nobody needs to agree with my philosophy. They do need to show me the data to back up the idea that their philosophy leads to a workable solution. But I don’t think we disagree on that point.

          —- Steve

          Report comment

        • Where, indeed? And why is it so important for them to invalidate these experiences? Is it threatening to the psychiatric hierarchy to allow that there are huge unknowns in the world of the mind? Is the whole materialistic approach simply a way of reducing anxiety in the face of the mystery of life?

          —- Steve

          Report comment

          • One thing I would add here and perhpas this is quibble is that this notion – I guess I called it materialist although I am not enough of a philosphyer to know if I am using the term correctly – is not a belief that is solely in the provence of psychiatry or even of medicine. It is the manefestation of a large belief that is at the heart of the enlightenment, I believe. Psychiatry is just the embodiment of that belief system in one area. The power that psychiatry has in society is not merely taken – it is given that authority.
            There are many people oustdie of psychiatry who share this view and actually clamor for the treatments modern psychiatry has to offer. This is not to minimize the role psychiatrists have in being honest about the limitations of our knowledge buti t is an attemtpto put some of this in a larger cultural context. The people on this web site do not speak for everyone who experiences emotional distress and I do not think it is a good idea to ignore that.

            Report comment

          • I think the point is very well taken. “Science” (in my view) has in many ways taken over the role that religion once held in society. I still recall the visions of endless scientific/technological progress were ubiquitous in my childhood. I remember the depictions of the year 2000 involving self-driving cars and moving sidewalks outside every downtown building, and presentations on the incredible promise of clean energy presented by nuclear power.

            There is a very deep-seated belief in many that technology is the answer, and that belief does result in large degree from the position of scientific materialism. I would submit, however, that the Age of Enlightenment thinkers did not as a whole dismiss the idea of a creator or of the possibility of spiritual realities that transcend the physical.

            But I digress. I was not making arguments against materialism per se, but arguing that accepting a particular philosophical viewpoint as “inherently obvious” and therefore not subject to falsification does not allow the science we all want to believe in to do its job.

            And I agree, psychiatry has been granted the authority it has by a society that believes psychiatry to be a scientific enterprise that is interested in coming up with a workable model that will help us understand and solve problems of the mind. Which is all the more reason many folks feel so dramatically betrayed when they discover the lack of actual scientific rigor in the theories underlying psychiatric practice. And it also speaks to the very much higher level of responsibility the profession has to be scientifically sound and thorough and not to deny inconvenient facts – if people have entrusted you with this kind of authority, integrity demands a much higher level of rigor to merit the trust the profession has been granted.

            My argument is that we need to apply scientific thought rigorously, and not allow our assumptions regarding the nature of the mind, which may widely vary, interfere with our honest assessment of the facts we’re presented with, which vary a whole lot less.

            —- Steve

            Report comment

    • I personally think almost all of what we experience in our normal (or abnormal) consciousness is very directly related to stuff that happens in our brain, the action potentials, etc. That’s why neuroleptics affect the experience, often in an adverse way! If there’s just the mind independent and strong, it shouldn’t be strongly affected by neuroleptics. But it is. I know about the problem of subjective experience and so on, and I don’t have a solution for it. At the same time, I don’t think the “mind outside of body” thing is a very good argument against neuroleptics in many or most cases.

      Report comment

      • I hear you, and don’t really disagree that it is impossible to pull mind and body apart as Aristotle attempted to do. But again, you are speaking out of your personal beliefs, which I am, too, but that is not science.

        I suppose the next scientific question I’d have for you is this: while it is a given that mind and body are interrelated and in a sense inseparable, how is it that we control our brains? And who is it that is controlling the brain (as in my examples of neurofeedback and the placebo effect, or the known impact of meditation in actually changing the size and structure of the brain)? I suppose we could postulate that some higher part of the brain is generating these controlling impulses, but that leads to an endless chicken-and-egg dilemma: What or who controls those higher functions?

        I am not saying I know the answer to that, or that it is necessarily a function outside the brain. I am saying WE DON’T KNOW. I’m saying it is a mystery, and simply saying “we think it’s all happening in the brain” is a total punt and abdication of responsibility, which allows professionals to continue to engage in ineffective practices with impunity. An honest professional acknowledges the limitations of his/her knowledge, because s/he knows others are depending on him/her and s/he does not want to mislead those who have placed their trust in him/her. That’s my view, anyway. I think we’d all be served a lot better by admitting what we don’t know, and the nature of the mind remains a pretty damned big mystery, which is not likely to be solved, IMHO, by spending all of our energy studying and manipulating the brain when we don’t actually understand or even know what is happening up there.

        And just to throw another monkey wrench into the works, what about the “second brain” in the gut?

        http://www.scientificamerican.com/article/gut-second-brain/

        No need to abandon materialism to study that possibility, and yet the profession still maintains we’re all brain…

        —- Steve

        Report comment

        • I know about the problems of consciousness in philosophy of mind, and as I said, I don’t have an answer to them. I don’t understand how we get this subjective consciousness. As for the gut thing, see what I wrote below:

          “Actually, when talking of biology, I’ve lately been much more interested in what’s happening in our bodies also outside the brain, things such as metabolism, liver, glucose, ketogenic amino acids, cytokines, inflammation, fatty acids, etc. Also things such as epigenetic changes in body. I guess some of that stuff has been more useful than much of the neurostuff related to psychiatry, since they at least can help a bit in navigating the optimal things that may help.”

          Report comment

        • You speak to the fact that much of life is a mystery that cannot adequately be explained by science, or psychiatry, or medicine, or even philosophy.

          I believe that some of the distress experienced by people in our society today stems from the fact that there is little if any “mystery” to be had in a materialistic society which cares little for philosophy or mystery or any of that esoteric stuff.

          Mystery, for me, enriches life and gives it color and vibrancy. I can stand in awe of how complex all of this truly is and that I have a part to play in all of this. I don’t always understand all of it but am grateful. Rudolph Otto’s idea of the “Mysterium Tremendum” in the presence of which we are all overwhelmed has something to say for it.

          The Enlightenment and Modernism, with all the science and materialism that both movements support, have worked to smash and tamp down all mystery so that everything can be explained in one dimension by science.

          This is all my opinion of course, but I’d rather live with a little mystery in my life than to know and understand everything. I don’t believe it was meant for us to know and understand everything. But of course, neither am I an expert on anything but my very own life.

          Report comment

  8. I haven’t really tried any of these official therapies, but as an analogy, I’ve greatly benefitted from my own system of diet, exercise (trekking, hiking, train running), basic stuff about creating new habits and meditation, all of these interrelated. I’ve read through books such as James Austin’s Zen and the Brain, which I’ve found quite interesting, though they haven’t probably greatly influenced the way I practice. It’s mainly interesting to me, though I guess there are some general level ideas about how the body or brain work that have been useful, things such homeostasis, neuroplasticity, etc. Actually, when talking of biology, I’ve lately been much more interested in what’s happening in our bodies also outside the brain, things such as metabolism, liver, glucose, ketogenic amino acids, cytokines, inflammation, fatty acids, etc. Also things such as epigenetic changes in body. I guess some of that stuff has been more useful than much of the neurostuff related to psychiatry, since they at least can help a bit in navigating the optimal things that may help.

    Report comment

  9. We are born to search for meaning, to reach out and to communicate with the world that surrounds us and do that our brain and mind are capable of changing and adapting to the environment we find ourselves in, in amazing ways. This does not occur in a vacuum. Our relationships are of such profound importance that our very lives depend on it including whether we grow into those we are meant to be or become stunted struggling to survive. Alice Miller talks about the fact that a child who grows up in a cruel and unloving family will have a different brain than that of a child who grows up in a kind and loving home. That to me is just so obvious yet, to look into the brain, scan it and see what lights up, add chemicals, shock it and cut and slice it up, is psychiatric everyday practice but that will never reveal just where in the brain the life story of a person can be found. Psychiatry has done untold damage by its insistence that the brain is a crude machine with a simple neurochemical wiring that they can ‘fix’.

    So no, we do not need to look inside “the box”, because the box is constantly changing to adapt to peoples unfolding life stories and peoples unfolding lives is something we can and do affect every single day through our relationships. Thank you for your post.

    Report comment

    • Olga

      I agree with what you say and appreciate the beauty of how you express it so very well.

      I’d like to hear how psychiatry accounts for neuroplasticity and the wonderful things it can accomplish for people. I suspect it throws a big monkey wrench into their little “chemical imbalance” theory.

      Report comment

      • Hi Stephen,
        I think that psychiatrists long ago abandoned the monoamine theories aka “chemical imbalance”. I know this is disputed here and elsewhere but if you look in the literature, you see discussions of neuroplasticity going back a couple of decades.
        In fact, I think it is one of the great misconceptions to equate drug treatment as only being effective if there is some inborn fixed type of lesion and psychosocial treatments as only being effective if there is a “non-biological etiology.
        I guess Insel would say that it is important to understand underlying mechanisms (and they can be fluid, changing mechanisms, because it will help us to design better treatments. But I do not think this is axiomatic. I think we can look from the outside and figure out ways to be of help even if we do not know exactly what the cellular process is the effect that change.
        We should all hold our theories lightly.

        Report comment

  10. Sandy,

    If you are still around for this post, I would like to ask you if you are aware of the new book, Grain Brain

    Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers Hardcover

    by David Perlmutter (Author) , Kristin Loberg (Contributor)

    1,385 customer reviews

    Report comment

  11. Hi Sandy,

    I posted this above by accident before I completed it. Anyway, you may know that the author of this book, Dr. David Perlmutter, is a neurologist and he has been speaking on PBS about the nasty effects of wheat, gluten, bad carbs, sugar and the usual suspects that can contribute to many of the so called “mental illnesses” including “ADHD,” “schizophrenia,” “depression,” “bipolar,” etc. (As you must know it kills me to use these stigmas so they are in quotes! Grin.)

    Anyway, Dr. Perlmutter like many doctors including Dr. Mark Hyman, Dr. Joel Fuhrman and many others believe that diet/exercise plays a huge role in eliminating or exacerbating these symptoms. The web site Safe Harbor (Alternative Mental Health) takes a similar approach with mental health. I am very impressed with the above doctors and find their recommendations very helpful in achieving better health and well being. He advocates for exercise to help the brain as most experts do.

    Here is a link to Dr. David Perlmutter’s book:

    http://www.amazon.com/dp/031623480X/ref=rdr_ext_tmb

    Another favorite of mine for the neuroplasticity of the brain when changing bad habits is:

    You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life Paperback by Jeffrey M. Schwartz (Author) , Rebecca Gladding MD (Author).

    You may know that Dr. Schwartz is a psychiatrist and I especially like and admire him because he has great faith that we can change our brains by understanding self defeating thoughts and mind sets that cause “OCD,” addictions and bad habits in general while not being a big fan of drugs and stigma. He also has web sites and articles on the web and has written other books I admire as well such as Dear Patrick.

    Here’s a link to Dr. Schwartz’ book:

    http://www.amazon.com/You-Are-Not-Your-Brain/dp/1583334831/ref=sr_1_1?s=books&ie=UTF8&qid=1394679278&sr=1-1&keywords=you+are+not+your+brain+the+4-step+solution+for+changing+bad+habits

    In keeping with our last exchange of comments, I am glad you reminded me of the articles you wrote about Is It All In Your Head? and Thoughts On the Meaning of Neuroscience you cited above. I thought these articles were great when I initially read them and I especially liked the latter article and the issues you raised about relationships and other factors being so important. You were right that you have been giving considerable and very worthwhile, encouraging attention to a wide range of factors and issues that are “outside of the box” of the rigid biopsychiatry stigmatizing and drugging agenda alone.

    The last time we exchanged comments, you had a pretty full reading agenda, but if you get the chance I recommend the top two books and/or at least checking them out on Amazon and other web sources along with reviews to get a better idea about them and how they might enhance brain function, thinking and well being in general.

    By the way, I just read an article in a science publication that if you took an extra minute when making decisions, you will make better decisions because you will be more focused and less distracted by other competing agenda. I thought of your being so impressed with Thinking Fast And Slow and this seems to fit into that concept. Would you agree?

    Have a nice night. Hope you get these comments and I look forward to hearing your thoughts.

    P.S. Looks like Dr. Nardo is doing some great things in his practice that are “outside the box” of just stigmatizing and drugging too, which made me quite pleased (especially when he “mentioned” three times that bipolar is greatly overdiagnosed and made my day!).

    Report comment

    • Hi Donna,
      I am still scanning the comments. thanks for reading and commenting. I am familiar with some of this. I think it was on your recommendation that I bought Hyman’s book.
      I am interested in food and its effects on us and have been really for most of my life.
      I sometimes worry that these food books may overstate our current knowledge base but I encourage people to try their own self experiments – cut something out, see how it goes, etc. I am also following the work of Bonnie Kaplan and Julia Rucklidge and others in their study of micronutrients.
      There is a book coming out this spring on the gut biome that I am looking forward to reading. IT is an incredibly complex topic since there are some many organisms living in and on our bodies and science does not handle this level of complexity all that well so this will be unfolding over many years. the challenge is how to stay somewhat current without jumping on to bandwagons. I do not have an answer for that.
      I am not familiar with Dr. Schwartz but it sounds like he write fro a CBT perspective which I agree can be very helpful.

      Report comment

  12. Hi Sandy,

    Thanks for your response. I knew from your past comments that you are very interested in food and its effects with one of your most influential favorites Michael Pollan. I would certainly be interested in hearing from you about the types of recommendations about food you make regarding intertwined emotional and physical health in future posts. I was also aware and honored that you bought Hyman’s book and you said it convinced you to cut out more sugar. I liked the fact that Hyman included many parts to his program including spirituality that might not have been appealing to you though it can be crucial to others, especially the lonely you wrote about. Dr. Fuhrman below may be more your type. See, “I’m listening,” as Frasier Crane would say. Speaking of Frasier, I think humor and laughter can be one of the best medicines too.

    I agree with you that diet needs can be personal in that some people suffer more from allergies to things like gluten and milk products like me, but many experts are exposing these and other products can effect all people in negative ways. Sugar and especially high fructose corn syrup are getting much attention for being toxic poison for one and all as you’ve pointed out.

    I agree with you that it is important not to jump on bandwagons too quickly and our food diet is a great example given that there is often so much conflicting advice. That’s why I am careful to consider many different views and reviews of authoritative experts and “take what I need and leave the rest.” Like you, I try to keep my mind open to new evidence as it comes out.

    Is the book on the gut biome you cited a really technical book? I would appreciate it if you could share the title if you get a chance. Actually, my favorite food expert is Dr. Joel Fuhrman who is highly recommended by doctors for not only achieving a healthy weight, but also health in general:

    http://www.amazon.com/Eat-Live-Amazing-Nutrient-Rich-Sustained/dp/031612091X/ref=sr_1_1?s=books&ie=UTF8&qid=1394722586&sr=1-1&keywords=joel+fuhrman+eat+to+live

    My son and I became walking ads for this approach when we both lost lots of weight/got in shape and everyone wanted to know the “secret.” Our doctors had a high regard for this approach too. I learned the hard way from those like Fuhrman that it isn’t just a matter of eating less and exercising more if one’s diet was filled with sugar and junk food in general causing “toxic hunger and food addiction” per those like Fuhrman and Hyman. .

    Here’s a great book researched by a journalist exposing the truth about the fallacy of mere moderation in all things and the delusion that all calories are equal:

    http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462/ref=sr_1_1?s=books&ie=UTF8&qid=1394722867&sr=1-1&keywords=taubes+good+calories+bad+calories

    Finally, my favorite posts from you are those that focus on thinking outside the box. It dawned on me that I was an English major with a life long love of books while subjects like chemistry and geometry were often torture for me in my youth because I found them very boring. I arrived at the conclusion that there are literary/fine arts types versus science/engineering types in a sense, so that could be why some of us have trouble communicating. When I see really technical articles that also involve junk science, my eyes glaze over, but articles that deal with the human side of life and their emotions/psychology are fascinating to me.

    Anyway, I forced myself to get a master’s degree in business administration in addition to my humanities and other more technical degree to prove to myself that I could “master” such courses as quantitative methods and managerial economics, but I’ll take Shakespeare as one of the greatest psychologists of all time any day. It strikes me that Dr. Philip Thomas may be of the latter category too. That’s why I enjoyed your article on neuroscience you cited above. Do you think that this could be part of the problem on why people have trouble communicating in such areas as human psychology, emotional distress, etc.? I think that is the case with me anyway.

    We all appreciate having you here and I admire your willingness and courage to tough out these challenging issues with us.

    Report comment

LEAVE A REPLY