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.

Whose decision?

Yesterday the dual carriageway I was travelling on was closed because a teenage girl jumped from a bridge to her death.

A couple of months ago the House of Commons voted against an Assisted Dying Bill. A blunt summary might be to wonder whether being fully able-bodied is the only qualification you need to take your own life.

The Assisted Dying Bill has many opponents. Their arguments are by and large very reasonable, and it’s easy to see that insufficient safeguards could result in terrible situations of people being pressured, coerced and choosing a death they weren’t ready for. There’s a generation that is so selfless and would do anything for others – especially their children – at their own expense that it’s not beyond the realms of possibility that with little left to live for, they would make the ultimate sacrifice.

However, for me, choosing to die is a right everyone has as a human being. The problem with this position, though, is how to define and guarantee autonomy and influence-free decision making.

The young girl who took her life obviously chose to. However, there is every chance she was mentally unwell. At what point can we, society, take that decision out of her hands? If she could be cured, or at least made to feel a little better through treatment, shouldn’t we be obliged to prevent her making such a terminal choice before she had the opportunity to get better? Could she really have been classed as autonomous and making decisions freely?

What if she were not mentally ill by any clinical measure but had thought the matter through deeply and could see no value in living. Should we still prevent her? If not, why not – are we prejudiced against mentally ill people, or young people, or females? Does she have to pass an IQ test?

Would we fight with the same verve to prevent an 85-year old in great pain committing suicide? Probably not. We might conclude they’d had a good innings but the young girl’s life was all ahead of her. But maybe the 85-year old hadn’t had a good life and perhaps they should have had one more shot at redemption. And maybe the girl would go on to a life of pain and distress not only to herself but to others. Which is the right decision? And who should make it? And when deciding all this, who are the moral arbiters and by what principles do they act?

Teach philosophy in schools

13.8.15

This BBC website article – http://www.bbc.co.uk/news/education-33464258 – suggests that teaching philosophy in primary schools improves test results. Good. I’m sure this research is right. Get young people thinking for themselves early, not straitjacketed into formulaic ways of thinking. Help them realise there aren’t always easy answers, sometimes ‘I don’t know’ is ok, and other people can have opinions different to yours. Make them realise they don’t have to accept what they’re told and should feel free to question anything.

Leave it too late and people become part of their family and society’s model and lose the ability to disagree, to challenge. Every child must know that there are more ways of seeing the world than the ways that they’re presented with as a fait accompli. Now, more than ever, this is critical.

And if it boosts test results too, then great. But really, it’s about creating better human beings and better societies.