Neuroscience of little value in treating mental illness

This thought-provoking article at the ever-brilliant Aeon site – https://aeon.co/essays/why-can-t-we-treat-mental-illness-by-fixing-the-brain – unequivocally punctures the notion that neuroscience is solving, or will solve, all ills.

By assessing the progress in medical science relating to other organs compared to that of the brain, it’s easy to see just how far behind we are in understanding the brain. Neuroscience is barely scratching its wrinkly grey surface.

Really, we shouldn’t be surprised. This article reminds us of the way neurons work:

“Neurons work in a particular way: the brain is an electrochemical machine. Each neuron is activated by a chemical released from another neuron: this then initiates an electrical signal that passes down the neuron’s fibre and, in turn, releases another (or the same) chemical onto the next neuron. But this isn’t a simple chain: each neuron can communicate with about 10,000 others, meaning that the permutations are unbelievably huge. There are around 100 billion neurons in the human brain, and around 1,000 trillion possible connections.”

The further problem is that even if we begin to understand the brain at the neuronal level, how do we relate or equate this to the functions of the brain, let alone how those functions translate into feelings, actions, behaviour?

Half way through the article is the fascinating and disturbing insight (that made me wonder, ‘can this really be correct? And if so, why aren’t we all up in arms about it?’) that no-one seems to know if or why chemical treatments for depression work. I quote:

“Ask any psychiatrist what happens in the brain to make people depressed, and she will probably mention serotonin. Serotonin is one of the many chemicals that neurons release. The psychiatrist singles out this one because most of the drugs used to treat depression seem to work by altering its levels in the brain. Altering noradrenaline (a related neurotransmitter) is also effective.

“And yet, there is no evidence at all that the levels of serotonin or noradrenaline in the brains of depressed people are any different from normal. The logic is flawed: you cover a cut on your finger by a sticking plaster, which helps recovery; but the cut was not caused by a lack of sticking plasters. So altering serotonin can speed recovery in some people – and there are those who question even this – without telling us anything about what depression is or how it occurred in the first place.

“At present, a pathologist looking at the brain of a depressed person could not distinguish it from the brain of someone who was mentally well.”

For an amateur like me, this is astonishing. Does everyone who works in this field know this? Is this old news?

The article goes on to describe the shortcomings of trying to classify mental illnesses (in the ever-burgeoning DSM for example) but for most people, I presume that this argument is pushing at an open door.

This excellent article was, for me, let down only because it excluded other solutions to mental disorders. It concludes with ‘neuroscience has no credible experimental model of any psychiatric illness’, followed by a wish for psychiatry to one day be refined enough to deal with all of these problems, probably chemically. However, what the whole article seems to indicate to me is that mental illnesses and disorders have their root in systemic, developmental and existential factors – all places that this article resolutely refuses to go.

So rather than looking to change the brain chemically, how about we look at changing society, the way we raise children, the role of religion, understanding what makes a good and satisfying life. Why do we insist on tinkering with the symptoms rather than addressing the causes?

As a society, investing in building on our body of knowledge around child development (and disseminating this knowledge widely) and in providing therapy to adults will surely pay rich dividends? For those of us lucky enough to live comfortably without fear of war or famine, our challenges are existential. To ignore that because it’s too airy-fairy is to ignore its consequences: growing mental illness and unhappiness, further schisms in society, religious extremism, damaging jingoism. The fabric of society is already under tremendous strain. Let’s not let it be torn apart while we search for impossible quasi-solutions.

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