Neuroscience psychiatry’s future?
There are some psychiatrists who believe that neuroscience has no relevance in clinical settings, i.e. in the treatment of patients.
There are others who are ardent supporters of it and believe neuroscience is the future of psychiatry. This group hold firmly to the belief that the sole cause of all mental illness resides in the brain, with the job of neuroscience being to find the biomarkers to prove it. 1
Indeed if one follows the progress of neuroscience there are announcements after announcements of this and that discovery. It all seems very exciting and yet what has it produced for psychiatry?
Yet to produce a single benefit
“…I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness…”
Thomas Insel, former director of the National Institute of Mental Health. 2015
Billions have been spent on it, it is probably the highest-funded research activity in medicine or all of the humanities, ever.
Despite 30 years or so of ‘modern neuroscience’ it has yet to produce one thing that could help a mentally ill person, let alone cure them.
Thomas Insel, the former director of the National Institute of Mental Health which oversees United States research funding for mental health had this to say:
“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.”
Thomas Insel from E. Fuller Torrey, Wendy W. Simmons, Elizabeth Sinclair Hancq, John Snook. The Continuing Decline of Clinical Research on Serious Mental Illnesses at NIMH Psychiatry Online. 2021. 2
Nothing for the mind or mental illness
“Unfortunately, it is still not possible to cite a single neuroscience or genetic finding that has been of use to the practicing psychiatrist in managing these illnesses despite attempts to suggest the contrary.”
David Kingdon
While there has been some value in neuroscience in understanding and even helping treat biological conditions. The same cannot be said for the mind or mental illness.
David Kingdon is Emeritus Professor of Mental Health Care Delivery, University of Southampton, UK agrees that there has been a lot of activity, but little result:
“In contrast, the major mental illnesses psychosis, bipolar disorder, anxiety disorders, anorexia nervosa and depression have proved remarkably resistant to similar developments. Unfortunately, it is still not possible to cite a single neuroscience or genetic finding that has been of use to the practicing psychiatrist in managing these illnesses despite attempts to suggest the contrary.”
David Kingdon. Why hasn’t neuroscience delivered for psychiatry? 2021.3
Theory or fixed idea?
“Just where is the rational justification for ploughing the same furrow again and again?”
David Kingdon
In terms of psychiatry, neuroscience’s statement that the cause of mental illness and its solution solely lies within the brain is a hypothesis, a statement put forward as an explanation before research as to its validity. How long does it take to say ‘we given this one a good run, let’s call it a day and think of something else’?
Or like Galen’s 4 blood of ‘sooty vapours’ and ‘vital spirits’, are threatened ‘authority’ and reputations suppressing real advancement?
And to borrow from Professor Kingdon again:
“But does this not seem, after more than 30 years of failure, more akin to a religious or, albeit culturally influenced, persistent strong belief than one based on scientific grounds? Just where is the rational justification for ploughing the same furrow again and again?”
David Kingdon. Why hasn’t neuroscience delivered for psychiatry? 2021.5
Equipment not up to the job
For 25 years or so functional magnetic resonance imaging (fMRI) has been one of the primary tools for neuroscience. There have been around 40,000 published papers on the subject according to the medical journal PubMed. A very large study analysing FMRI results found astonishing false-positive results, as high as 70% affecting possibly 16,500 studies. 6
There is a famous example of this from 2009 where a dead salmon was tested in a MRI machine and the fish asked a series of questions as a human being would be. Although very dead, the salmon’s brain lit up in response. This example, not only highlights false positives but throws a cautionary note that these ‘flashes’ in the brain aren’t necessarily what neuroscientists think they are.
This area of false positives is also throwing a spanner into the works of one very important aspect and that is being able to duplicate experiments and so validate them. 7
A long, long way yet before assuming the label of a precision science.
Conclusion
There are some in psychiatry who are relying on neuroscience to lift them out of their precarious situation of having no cures for mental illness and only having, often brutal, treatments for symptoms. They shouldn’t hold their breath.
Machine learning failed to find biomarkers for Major Depressive Disorder
5. No psychiatry, you can’t take over the world
- Daniel Barron. Why Psychiatry Needs Neuroscience. 2017. Scientific American.
- E. Fuller Torrey, Wendy W. Simmons, Elizabeth Sinclair Hancq, John Snook. The Continuing Decline of Clinical Research on Serious Mental Illnesses at NIMH Psychiatry Online. 2021.
- David Kingdon. Why hasn’t neuroscience delivered for psychiatry? Cambridge University Press. 2021.
- Galen of Pergamon was a Greek physician and surgeon born in 129 AD. He was granted the status of being an authority on human anatomy for hundreds of years. When William Harvey challenged Galen’s theory on the circulation of blood in 1628, Harvey’s correct ideas were initially suppressed as Galen was an ‘authority’
- David Kingdon. Why hasn’t neuroscience delivered for psychiatry? Cambridge University Press. 2021.
- Anders Eklund, Thomas E. Nichols, and Hans Knutsson. Cluster failure: Why fMRI inferences for spatial extent have inflated false-positive rates. PNAS. 2016.
- Quartz. 2016. A deep flaw has been discovered in thousands of neuroscience studies. So why aren’t neuroscientists freaking out?