better outcomes.
The whole article can be read at:
http://blog.stevenreidbordmd.com/?p=899&cpage=1#comment-214158
Thoughts & reflections on psychiatry
Psychiatric uncertainty and the neurobiological buzzword
by Steven P Reidbord MD
April 17th, 2014
A few years ago I wrote that uncertainty
is inevitable in psychiatry. We literally don’t know the pathogenesis
of any psychiatric disorder. Historically, when the etiology of
abnormal behavior became known, the disease was no longer considered
psychiatric. Thus, neurosyphilis and myxedema went to internal
medicine; seizures, multiple sclerosis, Parkinson’s, and many other
formerly psychiatric conditions went to neurology; brain tumors and
hemorrhages went to neurosurgery; and so forth. This leaves psychiatry
with the remainder: all the behavioral conditions of unknown etiology.
Looking to the future, my fervent hope that researchers will soon
discover causes and definitive cures for schizophrenia, bipolar
disorder, and other psychiatric disorders comes with the expectation
that these conditions will then leave psychiatry for other specialties.
We will always deal with what is left. At minimum we psychiatrists
should accept this reality about our chosen field. After all, there
appears to be no alternative. Some of us go beyond this to embrace
uncertainty as intellectually attractive. We like that the field is
unsettled, in flux, alive.
Yet many of us clutch at illusory certainty. Decades ago, psychoanalysis purportedly held the keys to unlock the mysteries of the mind. It later lost favor when many conditions, particularly the most severe, were unaffected by this lengthy, expensive treatment. Now the buzzword is that psychiatric disorders are “neurobiological.” This is said in a tone that implies we know more than we do, that we understand psychiatric etiology. It’s a bluff.
Patients are told they suffer a “chemical imbalance” in the brain, when none has ever been shown. Rapid advances in brain imaging and genetics have yielded an avalanche of findings that may well bring us closer to understanding the causes of mental disorders. But they haven’t done so yet — a sad fact obscured by popular and professional rhetoric. In particular, functional brain imaging (e.g., fMRI) fascinates brain scientists and the public alike. We can now see, in dramatic three-dimensional colorful computer graphics, how different regions of the living brain “light up,” that is, vary in metabolic activity. Population studies reveal systematic differences in patients with specific psychiatric disorders as compared to normals. Don’t such images prove that psychiatric disorders are neurobiological brain diseases?
Yet many of us clutch at illusory certainty. Decades ago, psychoanalysis purportedly held the keys to unlock the mysteries of the mind. It later lost favor when many conditions, particularly the most severe, were unaffected by this lengthy, expensive treatment. Now the buzzword is that psychiatric disorders are “neurobiological.” This is said in a tone that implies we know more than we do, that we understand psychiatric etiology. It’s a bluff.
Patients are told they suffer a “chemical imbalance” in the brain, when none has ever been shown. Rapid advances in brain imaging and genetics have yielded an avalanche of findings that may well bring us closer to understanding the causes of mental disorders. But they haven’t done so yet — a sad fact obscured by popular and professional rhetoric. In particular, functional brain imaging (e.g., fMRI) fascinates brain scientists and the public alike. We can now see, in dramatic three-dimensional colorful computer graphics, how different regions of the living brain “light up,” that is, vary in metabolic activity. Population studies reveal systematic differences in patients with specific psychiatric disorders as compared to normals. Don’t such images prove that psychiatric disorders are neurobiological brain diseases?
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