[sciborg2]

The lure of ‘cool’ brain research is stifling psychotherapy

Allen Frances

The more we learn about genetics and the brain, the more impossibly complicated both reveal themselves to be. We have picked no low-hanging fruit after three decades and $50 billion because there simply is no low-hanging fruit to pick. The human brain has around 86 billion neurons, each communicating with thousands of others via hundreds of chemical modulators, leading to trillions of potential connections. No wonder it reveals its secrets only very gradually and in piecemeal fashion.

Genetics offers the same baffling complexity. For instance, variation in more than 100 genes contributes to vulnerability to schizophrenia, with each gene contributing just the tiniest bit, and interacting in the most impossibly complicated ways with other genes, and also with the physical and social environment. Even more discouraging, the same genes are often implicated in vulnerability to multiple mental disorders – defeating any effort to establish specificity. The almost endless permutations will defeat any easy genetic answers, no matter how many decades and billions we invest.

The NIMH has boxed itself into a badly unbalanced research portfolio. Playing with ‘cool’ brain and gene research toys trumps the much harder and less intellectually rewarding task of helping real people.

Contrast this current NIMH failure with a great success story from NIMH’s distant past...

[H]

From the article:

Having treated many thousands of psychiatric patients in my career, and having worked on the American Psychiatric Association’s efforts to classify psychiatric symptoms (published as the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV and DSM-5), I can affirm confidently that there are no neat answers in psychiatry. The best we can do is embrace an ecumenical four-dimensional model that includes all possible contributors to human functioning: the biological, the psychological, the social, and the spiritual. Reducing people to just one element – their brain functioning, or their psychological tendencies, or their social context, or their struggle for meaning – results in a flat, distorted image that leaves out more than it can capture.

I cannot think of anything I have ever read in my entire life that I could agree with more than this.

[TaoHorror]

From the article:

Having treated many thousands of psychiatric patients in my career, and having worked on the American Psychiatric Association’s efforts to classify psychiatric symptoms (published as the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV and DSM-5), I can affirm confidently that there are no neat answers in psychiatry. The best we can do is embrace an ecumenical four-dimensional model that includes all possible contributors to human functioning: the biological, the psychological, the social, and the spiritual. Reducing people to just one element – their brain functioning, or their psychological tendencies, or their social context, or their struggle for meaning – results in a flat, distorted image that leaves out more than it can capture.

I cannot think of anything I have ever read in my entire life that I could agree with more than this.

It's possible we currently can't count that high and eventually when we do we can map this stuff. Otherwise mental disorders couldn't be categorized, they would vary too much. Each afflicted person has a unique experience, yes, but they're similar enough that there likely is/are cause(s) even if factors outside genetics are a part of it.

[H]

It's possible we currently can't count that high and eventually when we do we can map this stuff. Otherwise mental disorders couldn't be categorized, they would vary too much. Each afflicted person has a unique experience, yes, but they're similar enough that there likely is/are cause(s) even if factors outside genetics are a part of it.

Hmm, I'm not sure, but it seems like I might have come across as somehow being against DSM there.  That really wasn't my intent.  I don't think there is anything, specifically, wrong with DSM, at least, as long as people aren't treating it as somehow "gospel."

What I was agreeing with, though, was this part: "The best we can do is embrace an ecumenical four-dimensional model that includes all possible contributors to human functioning: the biological, the psychological, the social, and the spiritual. Reducing people to just one element – their brain functioning, or their psychological tendencies, or their social context, or their struggle for meaning – results in a flat, distorted image that leaves out more than it can capture."

That is, if we take a "one-dimensional" look, we are apt to miss something.  And probably a lot of somethings.

[BeardFisher-King]

From the article:

Having treated many thousands of psychiatric patients in my career, and having worked on the American Psychiatric Association’s efforts to classify psychiatric symptoms (published as the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV and DSM-5), I can affirm confidently that there are no neat answers in psychiatry. The best we can do is embrace an ecumenical four-dimensional model that includes all possible contributors to human functioning: the biological, the psychological, the social, and the spiritual. Reducing people to just one element – their brain functioning, or their psychological tendencies, or their social context, or their struggle for meaning – results in a flat, distorted image that leaves out more than it can capture.

I cannot think of anything I have ever read in my entire life that I could agree with more than this.

Agreed, H. This is a great, single-paragraph recommendation of how to "do" psychiatry.