A recent issue of Science, Technology, & Human Values explores emerging biological technologies and their relationship to psychiatry. The editors call for more research into these technologies from a perspective that critically examines the personal and social effects of these interventions, rather than taking the “disordered brain” for granted and failing to consider how these new technologies will affect those experiencing mental distress.
“Today, it is widely held that the future of psychiatry and clinical psychology will entail the integration of genetic and neurobiological forms of knowledge. Although biographical and environmental conditions are considered significant factors contributing to psychological distress, various influential actors in this field conceptualize mental disorders as brain diseases, in other words as disorders of neurotransmitter chemistry or neural network activity,” write social scientists Dr. Jonas Ruppel and Dr. Torsten H. Voigt.
There is a long history of psychiatrists and other medical professionals attempting to locate “mental illness” in the brains of individual patients, even though attempts to discover reliable biomarkers for mental illness have thus far failed. Some professionals have argued that this entire approach is in error.
Still, the search continues, as the National Institute of Mental Health has initiated a new research paradigm called the Research Domain Criteria (RDoC) focused on providing psychiatry with a solid neurobiological foundation. This paradigm aims to change the way that psychiatrists and psychologists currently diagnose mental illness, based on the narratives of their patients and other methods such as questionnaires and inventories.
Scholars in fields such as the sociology and anthropology of medicine have argued that this new approach, attempting a more personalized analysis based in genetics and neuroimaging, may result in new forms of social control. They also argue that this approach cannot begin to understand mental distress without taking the broader context of social, economic, and other factors into account.
“Using novel imaging technologies that became available in the 1980s, such as fMRI, PET, and MEG, psychiatrists and (clinical) psychologists have intensified efforts to visualize the “disordered brain,” Ruppel and Voigt write.
“The former president of the United States, George H. W. Bush, prominently articulated the promise that neuroscience may lead to new and more effective treatments of various neurological and psychiatric disorders. Accordingly, he established an enormous funding initiative for neuroscientific research and proclaimed the 1990s to be the ‘decade of the brain’.”
Ruppel and Voigt argue that these new biotechnologies may have unanticipated effects on how people understand themselves, as well as contribute to new forms of social domination. The authors are concerned that people are increasingly coming to understand themselves as “neurochemical selves.” Additionally, they are interested in issues of power, such as how these technologies will affect clinical patients and whose interests are being served by these developments.
Although the emphasis on the brain is not new, the authors argue that these new technological developments may lead to a “molecularization” of psychiatric interventions. Rather than simplistically focusing on the brain, or relying on patient reports, the stated goal of research programs like RDoC is that these technologies become more fine-grained, exploring neurotransmitter chemistry and neural network activity in greater diagnostic detail. The authors claim that this is hailed by many to be the future of the psychiatric establishment.
Research has discovered evidence that people treated with antidepressants come to understand themselves and their struggles in terms of malfunctioning biological processes. Additionally, clinicians often interpret conditions such as “manic depression” as a brain disorder. The authors state, on the other hand, that people still respond to and understand manic depression in different ways, so the idea of a single “disorder” is not an accurate picture. Furthermore, clinicians tend to rely on a variety of different frameworks for understanding mental illness. Psychiatry, then, has so far not managed to capture all of the psychological disciplines under its new directive.
The authors claim that this new direction has not revolutionized mental health care, in spite of its ongoing mission. They argue that the “medical gaze” of the “clinic,” as discussed by the French philosopher Michel Foucault, is alive and well. In other words, people are still being subjected to attempts to normalize their differences and rehabilitate them as functioning, productive members of society. Emerging biotechnologies are simply the latest in a long line of tools utilized toward this end, although they do present new methods and new challenges for those who are critical of psychiatry.
The authors conclude by calling for increased scholarship into these issues. To track the contemporary problems of social control and domination by the “medical gaze,” they argue that further research in the social studies of medicine is necessary. The rest of the journal’s special issue, titled “Emerging Biotechnologies and the Reconfiguration of Mental Health,” commits to exploring these questions.
Rüppel, J., & Voigt, T. H. (2019). The death of the clinic? Emerging biotechnologies and the reconfiguration of mental health. Science, Technology, & Human Values, 44(4), 567–580. (Link)