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IHR Podcast #8: Doubling down on the brain-based model of mental illness

NOEL HUNTER & WILLIAM SCHULTZ
NOEL HUNTER & WILLIAM SCHULTZ

In this episode of the Integral Health Resources Podcast, I discuss an important paper by Noel Hunter and William Schultz called A Response to the Hyper-focus on Brain-based Research and “Disease”.

Here are some other media resources that may be helpful/relevant to this discussion:

Here are the quotes from the white paper that I cited throughout this podcast:

The brain-based initiatives for clinical research rely on a disease model that is based on erroneous logic, a faulty reductionistic view of human nature, and a contradiction of the most robust research findings within the mental health field. The brain research conducted thus far actually appears to indicate that most of the conditions referred to as “mental illnesses” are likely otherwise healthy adaptive processes in response to extreme environmental experiences. So while it appears that such adaptive processes often do correlate with changes within the brain, and that they may lead to certain long-term problems for the individual, these changes do not necessarily signify biological disease. Furthermore, brain research has ironically reinforced the benefits of certain psychosocial interventions, such as yoga, meditation, and psychotherapy, thereby negating the assumption that the resolution of such distressing conditions requires psychopharmological or other related biological interventions.

But, is it really necessary to have “evidence” from brain scans to know that mediation, exercise, and eating healthily have beneficial effects on one’s wellbeing? The only thing this research really seems to show is how much the brain is constantly adapting to its environment. In fact, one could even interpret the findings of many of the brain differences in traumatized and distressed individuals as signs of adaptive functioning— the complete opposite of disease!

Three prominent negative consequences of focusing on biological, brain-based etiologies of “mental illness” are that it results in skewed research funding, biased treatment preferences, and clinically harmful impacts.

Many of the biological anomalies that one finds with chronic sufferers of “mental illness” are directly caused by the very biological interventions thought necessary to decrease distress.

So not only are brain-based etiologies of psychological distress unsupported by the evidence and related to the excessive use of dangerous medications, they also have powerful psychological impacts that can adversely influence treatment.

The resources available for mental health research and care are limited, and that every dollar and person-hour spent pursuing brain-based solutions to psychological distress comes at a direct cost to those resources available for psychosocial research and support.

When we consider the vast disparity between the predominant research and interventions within the mental health field on one hand, and the actual needs of distressed human beings on the other hand, we recognize that our mental health field is in dire need of a radical paradigm shift—from trying to make sense of psychological distress from a biologically reductionistic framework to one that is more humanistic and needs-based. This essentially involves shifting the general stance within the mental health field from “diagnosis and treatment” to one of “assessing needs and offering support.” This would mean focusing our resources on providing psychosocial support for individuals, families, and communities and working towards a social system in which meaningful and rewarding activity, education, and work is accessible to everyone.

Even in those cases in which the specific needs or other causal factors are unable to be identified, the evidence suggests that when a person’s basic needs are addressed, such conditions of psychological distress still naturally recede over time. And in those rare cases where such factors are unable to be identified and addressed, and in which the condition does not naturally recede over time, some psychoactive drug support may be beneficial, as long as it is used in minimal dosage for minimal duration and only with the individual’s fully informed consent.

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IHR Podcast #1: Precision Psychiatry

In this –the inaugural episode of the Integral Health Resources Podcast– I flounder about trying to figure out what on earth I’m doing. Topics include:

  • “Precision psychiatry”
  • NIMH Director Thomas Insel
  • Integral/Biopsychosocial models of health

Summary:

    In the May issue of Science, Dr. Thomas Insel (Director of the National Institute of Mental Health) makes his case that so-called “mental disorders” should be re-conceived as “brain circuit disorders,” and that by focusing ever more on neuroscience we will finally get to a place where the practice of psychiatry makes a lick of sense. I agree with Allen Frances (who was chair of the DSM-IV task force) that Insel’s conclusions here are “ridiculously premature,” but, more than that, I think that his “precision medicine for psychiatry” project is a step “precisely” in the wrong direction.

    I blogged about Insel’s new agenda for psychiatry a couple of years ago, HERE.

Here are some other media resources that may be helpful/relevant to this discussion:

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Meet the new boss, same as the old boss: The NIMH rejects DSM categories, but continues to give short shrift to psychosocial perspectives

NIMH-color-logo-300x217The National Institute of Mental Health will reportedly discourage the use of DSM categories for its future research projects. NIMH Director Thomas Insel is promoting a new approach, the Research Domain Criteria (RDoC), which is based on three guiding principles: 1) Pathology is conceived in terms of dimensions ranging from normal to abnormal; 2) Classification of disorders will be generated from basic behavioral neuroscience, not current DSM categories; 3) Multiple units of analysis (i.e. physiological activity, behavior, self-reports of symptoms) will be used in defining constructs for study. In a recent article by Maia Szalavitz, Insel is quoted as saying:

I look at the data and I’m concerned. I don’t see a reduction in the rate of suicide or prevalence or mental illness or any measure of morbidity. I see it in other areas of medicine and I don’t see it for mental illness.

As I understand it, the basic idea behind RDoC is that researchers will likely be more successful in understanding the neurological and genetic underpinnings of psychiatric disorders if they focus on specific symptoms, which may occur across multiple disorders, rather than continue to focus on disease categories based on complex groupings of various symptoms. This makes sense to me as a better way to approach the biological dimensions of mental health, but it also implies that the NIMH, like the American Psychiatric Association, is content to downplay the subjective, interpersonal, and sociocultural dimensions of mental health and distress, at least when it comes to research funding. As Benjamin Wachs puts it:

The NIMH isn’t offering a real alternative to the DSM:  rather, they’re doubling down on the fallacy that the DSM was pursuing in the first place.  That the mind is best understood as a computer, and when your computer breaks you don’t talk to it or ask it how it feels.  In fact, you don’t even let the computer decide whether it’s broken or not.  If it’s not behaving according to spec, you get it fixed.

DSM-IV Chair Allen Frances said the following his recent analysis of the topic:

APA and NIMH are both on the sidelines, doing nothing to help restore humane and effective care for those who most need it. DSM-5 introduces frivolous new diagnosis that will distract attention and resources from the real psychiatric problems currently being neglected. NIMH has turned itself almost exclusively into a high power brain research institute that feels almost no responsibility for how patients are treated or mistreated in the here and now.

There seems to be two major viewpoints in the mental health field these days. The first, typified by highly influential organizations like the APA and NIMH, sees mental health as primarily a matter of brain functioning. Lip service is often paid to “cultural factors,” but the subjective, intersubjective, and sociocultural dimensions of humanity are given short shrift in terms of emphasis and resource allocation. The second major trend in mental health is the integrative or integral view, which insists that every dimension of humanity must be fully taken into account in all mental health theory, research and practice. The NIMH’s new research direction will hopefully bear fruit, but it will miss the big picture if the narrow focus on neuroscience is not placed within a broader biopsychosocial context.