Recently a colleague passed along a really interesting
article about prevention, neuroscience, and mental illness. (Find it here: http://chronicle.umbmentoring.org/prevention-neurobiology-and-childrens-mental-health/).
This article highlights some really interesting
considerations when it comes to the role of brain science in treating mental
illness. Particularly, given the recent federal granting efforts around the Brain Initiative, it’s interesting
to think about the value placed on brain sciences, and how that has come to
eclipse many other forms of knowledge.
The article’s author quotes a recent article from the NewYork Times by Benjamin Fong, who writes about how psychology has come to
fully embrace cognitive neuroscience, and the potential pitfalls of such complacent
bedfellows. He highlights many of the arguments surrounding the pros and cons
of the Brain Initiative, and astutely reflects:
“The real trouble with the Brain Initiative is
not philosophical but practical. In short, the instrumental approach to the
treatment of physiological and psychological diseases tends to be at odds with
the traditional ways in which human beings have addressed their problems: that
is, by talking and working with one another to the end of greater personal
self-realization and social harmony.” (see full article here)
This got me thinking.
Isn’t it weird that we’ve gotten to a
point in history where “fixing the brain” is perceived as the easiest way to
treat mental illness?
It wasn’t always this way.
Historically, and even as recently as 20-30 years ago, the brain was viewed as
an enigma, a black box that could not be understood. And it was early
neuroscientists who, to their credit, started pushing the limits of what we
knew about the brain and advanced the field by leaps and bounds to the point
where we as a society have come to place high value on understanding the role
of the brain in our lives – arguably to a fault.
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Historically, humans used to rely on each
other or home remedies to treat mental and physical illnesses. Trusted
home-remedies, and medicinal traditions were passed on through generations of
humans.
Care was kept within community.
And yes, with scientific discoveries
and medical advancements, we found out that a lot of the things we’d been doing
were just plain wrong. Some of the traditional methods of treatment were doing
more harm than good. Anyone who’s been to a museum display medical history can
attest to this.
Scientific progress has brought
humanity crucial advancements that have saved lives. There’s no doubt about
that. But when applying science to the human psyche, things get a little trickier.
Traditional reductionist methods of
scientific inquiry do not fit well when trying to examine human psychology. Our
lives, and our understanding of them, are determined not just by our genetic
makeup, but by the interactions with our surrounding environments. Those environments
have the power to shape the expression of genetics and physical biology.
It’s nature and nurture in a
never-ending tango. Each taking the lead from time to time, in somewhat
unpredictable ways.
The problem with psychology embracing
cognitive neuroscience so fully and completely is that traditional,
reductionist perspectives on how the world works don’t fit well for psychology
because of its inherent complexity and unpredictability.
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Unfortunately, recent scientific priorities
have pushed us to favor quick fixes to change the brain, because the brain is
easy. It’s an organ. It can be reduced to classic scientific fields of biology
and chemistry; scientific fields that are easy (or easier anyway) to understand
and manipulate in ways that science can predict.
And this is where Benjamin Fong’s point
is well taken. There is a complete lack of practicality of the Brain Initiative
for treating psychological problems. Understanding how the brain works is
great, but humans, despite being made up of chemicals, are not just chemicals. Humans are social beings
who rely on trust and relationships with one another to survive. Without that
social structure, relationships, and community, humans cease to thrive. Chemical
treatments to fix deep psychological wounds created by the pain of broken
communities and shattered relationships just won’t cut it. Those broken
communities and shattered relationships will continue to do damage until the
factors contributing to that brokenness are addressed.
This brings to mind a book called GhostMap, which is lauded in public health circles as a true triumph of human
ingenuity and the scientific method to stop a massive cholera epidemic in London, England. Instead of using a solely medical model approach to find an effective treatment
for cholera for everyone who was sick, and then accepting fact that cholera would continue
to be an epidemic the whole of London, the emphasis was placed on figuring out
WHY cholera was spreading in the first place. What was it that people were
doing that was contributing to the spread of illness?
And wouldn’t you know it, it was a
lifestyle thing. Choices that humans were making about where to deposit bodily
waste where it was too near the local water supply, thus spreading the bacteria
that causes cholera.
Because of this discovery, people who
were living in community with one another, to promote their own health, changed
where they deposited waste, and subsequently stopped the epidemic. Instead of
sinking resources and money into treating everyone who had the illness with medicine,
one environmental change prevented the spread of the disease, halting the
epidemic in its tracks.
They could have treated cholera with
medicine alone – treating the illness.
But they wouldn’t have saved as many
lives as they did by changing the behaviors and systems that were causing the
epidemic in the first place.
Now I’m not saying that some of our
most pervasive and complicated societal problems like poverty, violence and
racism, are as easily solved as figuring out where to deposit waste. Nor am I
saying that all mental illness is attributable to only environmental factors.
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What I’m saying is that the answers to
the bigger problems with mental illness do not lie in the human brain alone. That
the Brain Initiative, for all of its strengths and laudable endeavors, is not
the silver bullet to end mental illness.
Because when it comes down to it, we
can treat the symptoms of mental illness by altering brain chemistry all we
want, but until we grapple with some of the bigger factors that contribute to
mental illness, we’re only putting Band-Aids over the gaping wound.
Fixing the brain is easy.
“Talking and working with one another
to the end of greater personal self-realization and social harmony” as Benjamin
Fong suggests?
That’s hard, but it’s what needs to be
done.
