Influential Neuroscientist Reviews Decades of Failure

"Psychiatry’s most fundamental characteristic is its ignorance," according to influential neuroscientist Raymond Dolan.

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In a new paper, Raymond Dolan—the second most influential neuroscientist in the world—reviews the three decades of failure of his profession.

“It remains difficult to refute a critique that psychiatry’s most fundamental characteristic is its ignorance, that it cannot successfully define the object of its attention, while its attempts to lay bare the etiology of its disorders have been a litany of failures,” he writes.

A man holds his head and screams. Behind him, a sheet of neuroimaging results. Photo collage.The paper, published in the journal Neuron, was coauthored by Matthew Nour and Yunzhe Liu, all at University College London.

The authors sum it up this way:

“Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making.”

They add that over the past 30 years, more than 16,000 neuroimaging articles have been published—meaning that billions of dollars and decades of researcher focus has been paid to this line of inquiry, with nothing to show for it:

“Casting a cold eye on the psychiatric neuroimaging literature invites a conclusion that despite 30 years of intense research and considerable technological advances, this enterprise has not delivered a neurobiological account (i.e., a mechanistic explanation) for any psychiatric disorder, nor has it provided a credible imaging-based biomarker of clinical utility.”

So what are some of the obstacles impeding the success of neurobiological research?

One issue is the unreliability of MRI data. Researchers have to make thousands of choices when deciding how to run the statistics. None of these choices are technically “right” or “wrong,” but each choice can mean the difference between finding a positive result or not. Previous studies have found that up to 70% of the time, MRI data can create the illusion of brain activity even when there is none—as in the infamous “dead salmon” experiment that “found” brain activity in a dead fish. Worse, researchers often conduct multiple tests—raising the likelihood of chance results—and only publish the ones that come back positive. Researchers have described neurobiological research as hindered by “data pollution.” Ultimately, this type of study takes a massive chaotic mess of data points, and attempts to find a signal in that noise, even when no true signal exists—the technological version of pareidolia.

A second issue is that even when slight correlations are found, the explanatory effect is minimal. For instance, a recent study found that a polygenic risk score predicted less than 1% of whether a person would get a diagnosis of schizophrenia. For comparison, about 17% was explained by socioeconomic, family dynamic, and relational factors. This can be reported as a “statistically significant correlation between genetics and schizophrenia”—but it’s clinically useless, providing no real information. (In large studies, researchers have also determined that this tiny correlation is likely just due to chance.)

Another issue cited by Dolan, Nour, and Liu: psychiatry’s diagnostic labels have terrible reliability and validity. As Kenneth Kendler wrote recently, it is “implausible” that psychiatric diagnoses are even “approximately true.” (Kendler, an expert on psychiatric genetics, was the second most influential researcher in psychiatry in the 1990s).

As then-NIMH head Thomas Insel wrote in a now-infamous blog post in 2013, psychiatric diagnoses are invalid in a way that would not be tolerated by any other subset of medicine:

“The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

After all this criticism, some researchers have argued that psychological research is “incompatible with hypothesis-driven science.” Others have suggested that psychological researchers rarely even adhere to the scientific method, instead using the veneer of “scientific” language to hide unscientific practices.

In the end, Dolan, Nour, and Liu suggest that the solution is to simply double down on neurobiological research. The brain, they argue, is essentially just a computer whose programming has been disrupted. They do not mention any potential impact of social, cultural, or interpersonal factors, including trauma, on human emotion or behavior. Instead, they write that the best way to understand human distress is as a malfunctioning computer program:

“We contend that neuroimaging research in psychiatry, more than ever, needs to embrace theoretical frameworks derived from basic and computational neuroscience. This includes addressing how high-dimensional neural activity supports cognition, coupled with formulating testable predictions as to behavioral and symptomatic consequences of disruptions to these processes. Arguably, an urgent necessity is to view symptoms through the lens of computational models of cognition, bridging a gap between knowledge articulated at different levels of analysis (from neural to behavioral) and in different species.”

 

 

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Nour, M. M., Liu, Y., & Dolan, R. J. (2022). Functional neuroimaging in psychiatry and the case for failing better. Neuron, 110, 2524-2544. https://doi.org/10.1016/j.neuron.2022.07.005 (Full text)

25 COMMENTS

  1. In Psychiatry’s failure is success for this industry- after all it is a Business. Psychiatric patients long term are destabilized, misdiagnosed, mistreated, deprived of their humanity and through “never ending ongoing treatment” WITHOUT IMPROVED OUTCOMES” get on this roller coaster merry-go-round “treatment” that guarantees that that patient will only get worse and the more services and more aggressive treatments are needed!

    There are NO medical reversals in Psychiatry as there are for say cardiology that recently reversed recommendations for daily 81mg of aspirin since it increased brain bleeds. No they are pushing psychedelics and medical devices from the brain! Bad outcomes are great for psychiatry since it is a business where you always need them and go back to “treatment” forever until the music stops and there are no chairs to sit down on.

      • Thx for this important article.

        Allow me to respectfully disagree regarding “medical reversals”.

        These guys couldn’t throw their ‘evidence-based’ principles’ and ‘lifelong diagnosis’ overboard fast enough, in my case.
        I wrote the APA, wondering why they weren’t trumpeting the medical breakthru!!…ANAPHYLAXIS CURED BIPOLAR DISORDER!!!
        They seemed un-amused.

        I received a “medical reversal” because the clinic director was ultimately responsible for his NP plunging me into anaphylaxis…after my documented report of a first ADR. He continued the drug, leaving me in a terrible position; stop it myself and deal with the ALREADY frightening side effect(s), or continue, knowing exactly what anaphylaxis could bring.

        I stopped for a few days, still suffering from the FIRST ADR. I was ‘decomp-ing’ dramatically. I took one for relief and woke up with my head the size of a basketball & my eyes protruding from their sockets.

        Uh oh. ER run. Mega Cortisone injected, oral for weeks…AND my hospital records.

        Ultimately, a ‘Come to Jesus’ meeting resulted in the director’s (& CEO’s approved) capitulation to my quiet terms (after 9 years of horror)…doctor-guided withdrawal of all drugs (took 2.5 harrowing years) AND vacation, IN WRITING of the B.S. bipolar label.

        There was a ‘more important’ event in the works ‘offstage’…the director was poised to ascend to the CMO/VP downtown office (and DID). He/they needed me to be quiet, no lawyers, no exposure….it was the smart play.

        Anaphylaxis could not be dismissed in the usual way…as a ‘worsening of ‘my’ mental illness’….
        A problem for the recipients of the second largest MH management budget in the U.S. at the time. Lotsa money.

        And his career arc. Mo’ money.

        I got everything I requested…(AND 19 seizures for the following three years…a subcortical focal lesion.)

        I worked hard to recover, with no help; It’s done & life is terrific. But I carry my paperwork in my phone…just in case.

        I keep telling this story as I want folks to know how fragile the industry’s own commitment to their ‘science’ ideology really is…I never threatened a lawsuit (it was implied, in their minds) but if it had happened, it would have been a minor settlement with non-disclosure clauses, in a secondary demographic market.

        ‘Just don’t rock the boat, Ms. Hartmann, we’ll get you out…..CAREERS are at stake!’

        I walked behind the curtain, saw who they really were, took back my life….& believe in a certain kind of ‘justice’.
        I’ve been patient.
        It’s coming quickly now….with a modest but documented shove in the back by me.

  2. How many “decades of failure” must we put up with, prior to apologies being made, and there is a changing from psychiatry’s “ignorant” ways, instead?

    “They do not mention any potential impact of social, cultural, or interpersonal factors, including trauma, on human emotion or behavior. Instead, they write that the best way to understand human distress is as a malfunctioning computer program.”

    The stupidity and insanity never ends. Distressing events cause distress, duh. And why and when did distress become a disease anyway? Distress is NOT a disease, it’s a normal human reaction to a distressing event, or a group of distressing events.

  3. “They do not mention any potential impact of social, cultural, or interpersonal factors, including trauma, on human emotion or behavior. Instead, they write that the best way to understand human distress is as a malfunctioning computer program”

    Understandably, they make no mention of it because it’s not in their domain of knowledge to do so. The question we are not asking, even in the MIA community is this: to what degree does capitalism, our socio-economic and political forces have adverse effects on our emotional well being and our innate potential for self realization? How can we possibly assume that the society in which we live in is a difference that makes no difference? In Dr. Dennis, Kingsley’s book “Breaking the Spell: An Exploration of Human Perception, he says

    “Human consciousness manifests in our daily lives through the cultural lens of our cognitive systems. And these systems are a result of specific, often localized, conditioning. They are often the result of our upbringing, our education, our regional legal systems and cultural ‘realities’. Our beliefs too form a part of our cognitive matrix, infused through various faith and/or dogmatic teachings. It is now accepted by modern research that the general person thinks in patterns that become reinforced over the years. After some time a person finds it difficult to adjust to a different cognitive reality, or point of view. Yet everything changes, is subject to change, and must develop (or devolve). In the end, it is all a question of how we perceive the external world internally . That is, how matter becomes a part of our mind”

    In Joost Merloo’s book “The Rape of the Mind: The Psychology of Thought Control, Menticide, and Brainwashing” he said

    “The mechanization of modern life has already influenced man to become more passive and to adjust himself to ready-made conformity. No longer does man think in personal values, following more his own conscience and ethical evaluations; he thinks more and more in the values brought to him by mass media. Headlines in the morning paper give him his temporary political outlook, the radio blasts suggestions into his ears, television keeps him in continual awe and passive fixation. Consciously he may protest against these anonymous voices, but nevertheless their suggestions ooze into his system”

    Elsewhere he said

    “The continual intrusion into our minds of the hammering noises of arguments and propaganda can lead to two kinds of reactions. It may lead to apathy and indifference, the I-don’t-care reaction, or to a more intensified desire to study and to understand. Unfortunately, the first reaction is the more popular one. The flight from study and awareness is much too common in a world that throws too many confusing pictures to the individual. For the sake of our democracy, based on freedom and individualism, we have to bring ourselves back to study again and again. Otherwise, we can become easy victims of a well-planned verbal attack on our minds and consciences. We cannot be enough aware of the continual coercion of our senses and minds, the continual suggestive attacks which may pass through the intellectual barriers of insight. Repetition and Pavlovian conditioning exhaust the individual and may seduce him ultimately to accept a truth he himself initially defied and scorned”

    Lastly, in Dr. Robert Firestone’s book “Psychological Defenses in Everyday Life” He says

    “Our society actually exists as a kind of negative afterimage. We all live in a crazy, backward world, often unaware of the lies and double messages we are given. If we could be free for a moment to catch a glimpse of our true situation, if we could view our society as a visitor from another planet, we would be stunned at the nightmare in which we live. The things we are expected to believe about ourselves and about society are frequently the very opposite of the way things really are. Unhappily, the individual and all the members of our society are often unconsciously working together to maintain a largely defensive and dishonest way of living”

    Maybe I’m beside the truth, but the vast majority of people believe they are normal but there is no such thing as being normal since we have not yet achieved self realization. We are unwittingly in a state of collective arrested development masquerading as normal that contributes to all manner of mental illnesses and far more than we realize. To make matters worse, our sick society also impairs that which I believe we should be striving for: the emotional, psychological, and spiritual evolution of humanity. No amount of science is going to save us from all this. It’s time we stop putting the onus solely on the individual for mental illnesses and call out the sick society in which we live and those in power -political and corporate- who perpetuate it as they have no regard for the future of humanity.

  4. Ok geniuses, tell me what a thought is. How much it weighs, how fast it travels through the ether. Then we can talk about abnormal thoughts. Can’t do it? Surprise. But thoughts are still real and abnormal thoughts cause real pain. Speaking of pain, tell me if nobody knew you felt it and it left no trace in your hypocampus, would it still exist?

    • A “thought” is usually a recorded mental image revivified by the being we know as the personality. Once revivified, it can result almost immediately in a body response, without further analytical filtering. Such a body response would then be considered “reactive.”

      Thoughts weigh basically nothing. They don’t travel, but they can be shared telepathically or by other more mechanical forms of communication.

      “Abnormal thoughts” are not the point. We are concerned about self-defeating behaviors. To the extent that thoughts bridge over into behaviors, they can inform the cause of those behaviors, but are not the primary causes. Mental mechanisms (or machines) are the prime cause of irrational behaviors.

      Pain, as one potential reactive response, may or may not leave any measurable trace on the hippocampus or any other human organ. Neuroscience, in the service of psychic healing, is worse than useless.

  5. “Ultimately, this type of study takes a massive chaotic mess of data points, and attempts to find a signal in that noise, even when no true signal exists—the technological version of pareidolia” –

    I love the above statement. It describes exactly what mainstream psychiatry is trying to do in yet another effort to be taken seriously. And the last quoted paragraph is a good example of its wilting pseudoscientific word salad:

    “We contend that neuroimaging research in psychiatry, more than ever, needs to embrace theoretical frameworks derived from basic and computational neuroscience.”

    “…more than ever”? Really? But haven’t they heard? Wishful thinking isn’t science, no matter how much they believe in the Tooth Fairy. But apparently no one’s taught them that the human brain-mind-psyche-soul-spirit can’t be reduced to a mathematical equation, no matter how good holding that notion makes them feel about themselves as researchers.

    “This includes addressing how high-dimensional neural activity supports cognition, coupled with formulating testable predictions as to behavioral and symptomatic consequences of disruptions to these processes.”

    Wow…high dimensional neural activity… but wait a minute — haven’t they heard of Pavlov’s despicable dog experiments? To which they’ll undoubtedly respond with something along the lines of, “What we’re doing is much more sophisticated!”. Oh yeah. “Sophisticated”. Well, I’ve said it before, and I’ll say it again — phrenology’s phrenology, even if it is high tech. Capiche???

    “Arguably, an urgent necessity is to view symptoms through the lens of computational models of cognition, bridging a gap between knowledge articulated at different levels of analysis (from neural to behavioral) and in different species.”

    (Didn’t I just mention Pavlov’s dog experiments?) And as for “urgent necessity” — WHO’S “urgent necessity”? This statement reveals their ever urgent quest to be taken seriously as a medical science. Well good luck with that. Too bad they can’t see statements like this just scream desperation, and how addicted they are to believing in certainty, which, btw, is a telltale sign of their cultish mindset.

    Why don’t these people do themselves and everyone else a favor and just stick to computer science? The next time they get the urge to spout off more of their pseudoscientific nonsense, they oughta to look up the word “pareidolia”. That’ll tell ‘em all they need to know.

    • Too bad some people don’t know the difference between neuro-science and neuro-nonsense. Then maybe they’d see all they’re doing is making high tech Rorschach tests.

      Which leads to the conclusion that some people don’t know the difference between intellect and wisdom.

    • Why can’t these “scientists” see that their efforts to digitally explain “human cognition” is like trying to defy the laws of gravity?

      But sometimes it’s best to leave people to their digital navel-gazing.

      And what is naval gazing?
      Self indulgent or excessive contemplation of oneself or a single issue, at the expense if a wider view

      And yet, for all their overheated efforts to digitally explain human cognition, I can’t help but wonder if they know the difference between consciousness and conscience, never mind “cognition”. But something tells me that even if they do, it wouldn’t make any difference –

  6. And still the general public is completely clueless about all of this. People will still talk about someone who is mentally ill and doing some horrible thing because they’re off their meds. Psychiatry will always get away with what they’ve always gotten away with because the overwhelming majority of people are in general either too stupid or have too much riding on the idea that any of this is real, or both. Nothing will ever change, and no one who hasn’t been through it will ever understand what it’s like to be the target of psychiatric abuse.

    My mother and I don’t speak. She’s dying. The last phone conversation we ever had, she found it necessary to remind me that I was “mentally ill”.

  7. I was wondering, when I read the headline, if the authors would simply circle back and assert that neuroscience, as failed as it is in resolving the problems of “mental illness” and its healing, must still be the path to an answer.

    In this assertion they prove themselves to be little more than pompous asses.

    They embrace the concept of “computational models of cognition.” The book I read in 1981, written in 1950, also compared the mind to a computer, with memory banks and analyzers and circuits. The hope was to find a way to “clear” (reset) the computer so that it could begin to function properly. The problem, then, is not in our “models of cognition.” The problem is looking in the brain seeking cognition. Any shaman or reiki master knows that is not where cognition occurs. It is not more modern to look in the brain; it is less modern!

    Can these people ever learn to look at the workable data that is all around them and then change their own minds about this? What would happen to them if they did? Could they even tolerate psychiatry or psychology becoming successful and regularly curing people?

    • Yes, the conclusion to the article is wrong; the error is thinking the brain is the source of mind – these guys give cognitive science a bad name. The majority of cognitive scientists have long discarded the reductionist fallacy of equating mind with brain. There’s even a word for this – the mereological fallacy. Dan Hutto, the guru of radical enactivism, once wittingly said that enactivists are no longer the barbarians at the gates of cognitive science, but now occupy its cafes and wine bars. Read Alva Noë’s ‘Out of our heads: Why you are not your brain, and other lessons from the biology of consciousness’ for an introduction to this way of thinking, if you are unfamiliar with it.

      • I am glad to hear someone in academia has crossed that bridge.

        Most of the books I read are considered by most people to be propaganda tools, so I got out of the habit of recommending that others read them. I could also recommend a website, but I figure if someone is really interested, they will figure it out for themselves.

        But I did look up Alva Noë and watched a talk he gave at Google. What gives his ideas an appeal to “ordinary” people like software engineers is that he stays within the realm of biology. The people I study don’t do that.

        The problem with staying in the realm of biology is that we cannot escape the drug scene that is “modern mental health.” And we need to escape that scene. When one pays attention to the data that indicate that consciousness is a property of personality which is separable from the body, one does accomplish that escape.

        • I don’t think the problem is staying within the realm of biology; it is to reunite biology and mind, which enactivism does. Descartes is largely responsible for splitting the two apart, and set the wheels in motion for the subsequent development of separate disciplines, which find a pseudo-unity in psychiatry. Gregory Bateson brought the two together again with his ‘Mind & Nature: A necessary unity’. Enactivism takes us further in this reunification.

          Practically what does it portend for the future. Seikkula refers to his approach (Open Dialogue – which has been so successful with psychosis) as not really a method but a “way of life” – it’s an applied philosophy more than it sits in the traditional “psy” disciplines. As a way of life, or philosophy, suggests that being with people is more important than doing something to them. Milton Erickson, the great hypnotist and healer, remarked toward the end of his career that it took him a long time to learn not to direct “patients”; instead “…let things develop and make use of things as they develop… You let the subject grow”. [The language is pretty dated but we can forgive Erickson for this.] I think that enactivism makes for a “relational self”, and as this develops it has an influence on other people.

          • Well, if this theory results in a rigorous technology for improving mental health, let us all know on this website.

            But the theory I’ve studied led to such a technology around 60 years ago, and that technology is quite robust and still in use today.

            I can’t make anyone believe this data. But I can mention it so that readers know that it exists and is being used. The finding is that Spirit created biology, and that Spirit is the essence of personality and thus is the factor or entity to be addressed if one wishes to resolve mental health difficulties.

            Make of this what you will. But we are in a time when we are long on theories and short on workable answers. Find the workable answers! We can figure out exactly why they work later. Primitive man did not wait for the science of Mechanics to start using wheels and other simple machines. We need, more than anything, effective healing technologies.

  8. It wouldn’t even matter if “neuroscience” found a way to distinguish one from the other.

    The fact would remain that they would have to keep defining and redefining someone’s idea of “normal”.

    Psychiatry remains what always has been, for groups of people to assign onto other persons, slandering labels. To convince the public that differences in people are disorders.

    That will never go away.

    I am glad that each person has no more than 70 years on earth to do damage and the end result looks very similar in a neuroscientific manner….the bones underground, of a shrink (and whoever else slanders people) and their victims.

    But they had to make a living, while alive, even if to try and use their 80 years to defend lies. Psychiatry is an illegal scheme, well supported by our governments. It’s a lazy government.

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