Critical mental health has a brain problem

A common critical refrain in mental health is that explaining mental health problems in terms of a ‘brain disorder’ strips meaning from the experience, humanity from the individual, and is potentially demeaning.

But this only holds true if you actually believe that having a brain disorder is somehow dehumanising and this constant attempt to distance people with ‘mental health problems’ from those with ‘brain disorders’ reveals an implicit and disquieting prejudice.

It’s perhaps worth noting that there are soft and hard versions of this argument.

The soft version just highlights a correlation and says that neurobiological explanations of mental health problems are associated with seeing people in less humane ways. In fact, there is good evidence for this in that biomedical explanations of mental health problems have been reliably associated with slightly to moderately more stigmatising attitudes.

This doesn’t imply that neurobiological explanations are necessarily wrong, nor suggests that they should be avoided, because fighting stigma, regardless of the source, is central to mental health. This just means we have work to do.

This work is necessary because all experience, thought and behaviour must involve the biology of the body and brain, and mental health problems are no different. Contrary to how it is sometimes portrayed, this approach doesn’t exclude social, interpersonal, life history or behavioural explanations. In fact, we can think of every type of explanation as a tool for understanding ourselves, rather than a mutually exclusive explanation of which only one must be true.

On the other hand, the strong version of this critical argument says that there is ‘no evidence’ that mental health problems are biological and that saying that someone has ‘something wrong with their brain’ is demeaning or dehumanising in some way.

For example:

“such approaches, by introducing the language of ‘disorder’, undermine a humane response by implying that these experiences indicate an underlying defect.”

“The idea of schizophrenia as a brain disorder might offer further comfort by distancing ‘normal’ from disturbing people. It may do this by placing disturbing people in a separate category and by suggesting uncommon process to account for their behaviour…”

“The fifth category… consists people suffering from conditions of definitely physical origin… where psychiatric symptoms turn out to be indications of an underlying organic disease… medical science has very little to offer most victims of head injury or dementia, since there is no known cure…”

“To be sure, these brain diseases significantly affect mental status, causing depression, psychosis, and dementia, particularly in the latter stages of the illness. But Andreasen asks us to believe that these neurological disorders are “mental illnesses” in the same way that anxiety, depression, bipolar disorder, and schizophrenia­ are mental illnesses. This kind of thinking starts us sliding down a slippery slope, blurring distinctions that must be maintained if we are to learn more about why people are anxious, depressed, have severe mood swings, and lose contact with reality.”

There are many more examples but they almost all involve, as above, making a sharp distinction between mental health difficulties and ‘biological’ disorders, presumably based on the belief that being associated with the latter would be dehumanising in some way. But who is doing the dehumanising here?

These critical approaches suggest that common mental health problems are best understood in terms of life history and meaning but those that occur alongside neurological disorders are irrelevant to these concerns.

Ironically, this line of reasoning implies that people without clearly diagnosable neurological problems can’t be reduced to their biology, but people with these difficulties clearly can be, to the point where they are excluded from any arguments about the nature of mental health.

Another common critical claim is that there is ‘no evidence’ for the causal role of biology in mental health problems but this relies on a conceptual sleight of hand.

There is indeed no evidence for consistent causal factors – conceptualised in either social, psychological or biological terms – that would explain all mental health problems of a certain type, or more narrowly, all cases of people diagnosed with say, schizophrenia or bipolar disorder.

But this does not mean that if you take any particular change conceptualised at the neurobiological level that it won’t reliably lead to mental health problems, and this is true whether you have faith in the psychiatric diagnostic categories or not.

For example, Huntingdon’s disease, dementia, 22q11.2 deletion syndrome, Parkinson’s disease, brain injury, high and chronic doses of certain drugs, certain types of epilepsy, thyroid problems, stroke and many others will all either reliably lead to mental health problems or massively raise the risk of developing them.

Critical mental health advocates typically deal with these examples by excluding them from what they consider under their umbrella of relevant concerns.

The British Psychological Society’s report Understanding Psychosis simply doesn’t discuss anyone who might have psychosis associated with brain injury, epilepsy, dementia or any other alteration to the brain as if they don’t exist – despite the fact we know these neurological changes can be a clear causal factor in developing psychotic experiences. In fact, dementia is likely to be the single biggest cause of psychosis.

In a recent critical mental health manifesto, the first statement is “Mental health problems are fundamentally social and psychological issues”.

This must ring hollow to someone who has developed, for example, psychosis in the context of 22q11.2 deletion syndrome (25% of people affected) or depression after brain injury (40% of people affected).

It’s important to note that these problems are also clearly social and psychological, but to say mental health problems are ‘fundamentally’ social and psychological, immediately excludes people who either clearly have changes to the brain that even critical mental health advocates would accept as causal, or who feel that neurobiology is also a useful way of understanding their difficulties.

All mental health problems are important. Why segregate people on the basis of their brain state?

The ‘not interested in mental health problems associated with brain changes’ approach tells us who critical mental health advocates exclude from their zone of concern: people with acquired neurological problems, people with intellectual disabilities, older adults with dementia, children with neurodevelopmental problems, and people with genetic disorders, among many others.

I’ve spent a lot of time working with people with brain injury, epilepsy, degenerative brain disorders, and related conditions.

Humanity is not defined by a normal brain scan or EEG.

Mental health problems in people with neurological diagnoses are just as personally meaningful.

Social and psychological approaches can be just as valuable.

If your approach to ‘destigmatising’ mental health problems involves an attempt to distance one set of people from another, I want no part of it.

What a more inclusive approach shows, is that there are many causal pathways to mental health problems. In some people, the causal pathway may be more weighted to problems understood in social and emotional terms – trauma, disadvantage, unhelpful coping – in others, the best understanding may more strongly involve neurobiological changes – brain pathology, drug use, rare genetic changes. For many, both are important and intertwine.

Unfortunately, much of this debate has been sidetracked by years of pharmaceutical-funded attempts to convince people with mental health difficulties that they have a ‘brain disease’ – which often feels like adding insult to injury to people who may have suffered years of abuse and exclusion.

But what’s under-appreciated is the over-simplified ‘brain disease’ framework also rarely helps people with recognisable brain changes. Their mental health difficulties reflect and incorporate their life history, hopes and emotional response to the world – as it would with any of us.

So let’s work for a more inclusive approach to mental health that accepts and supports everyone regardless of their measurable brain state, and that aims for a scientific understanding that recognises there are many pathways to mental health difficulties, and many pathways to a better future.

Genetics is rarely just about genes

If you want a crystal clear introduction to the role genetics can play in human nature, you can’t do much better than an article in The Guardian’s Sifting the Evidence blog by epidemiologist Marcus Munafo.

It’s been giving a slightly distracting title – but ignore that – and just read the main text.

Are we shaped more by our genes or our environment – the age-old question of nature and nurture? This is really a false dichotomy; few, if any, scientists working in the area of human behaviour would adhere to either an extreme nature or extreme nurture position. But what do we mean when we say that our behaviours are influenced by genetic factors? And how do we know?

It will be one of the most useful 20 minutes you’ll spend this week.
 

Link to excellent introduction to genetics and human behaviour.

The death of the soul has been greatly exaggerated

CC Licensed Image from Wikipedia. Click for source.I’ve got a piece in today’s Observer looking back on 20 years since novelist Tom Wolfe wrote a landmark article that threw open the doors on how the new science of cognitive neuroscience was challenging the notion of the self.

Exactly 20 years ago, Tom Wolfe wrote one of the most influential articles in neuroscience. Titled Sorry, But Your Soul Just Died, the 1996 article explores how ideas from brain science were beginning to transform our understanding of human nature and extend the horizons of our scientific imagination. It was published in a mainstream magazine, written by an outsider, and seemed to throw open the doors to an exhilarating revolution in science and self-understanding. Looking at the state of neuroscience and society two decades later, Wolfe turned out to be an insightful but uneven prophet to the brain’s future.

Wolfe’s article has been cited widely by both neuroscientists and the popular press.

It’s not entirely clear whether it shaped our popular understanding of brain science or whether it just predicted a future trend but it’s notable that before 1996 most press articles on fMRI were focused on technical details but subsequently they tended to be much more about ‘the brain reason for’ some aspect of human thought or behaviour.

Either way, it was clearly an important moment for neuroscience and my piece in The Observer looks back on Wolfe’s take on our changing view of human nature with the benefit of 20 years of brain science behind us.

And just to say, I occasionally have a bit of a grumble about the headlines written for my articles but hats off to however came up with “Neuroscience and the premature death of the soul” for this piece.
 

Link to ‘Neuroscience and the premature death of the soul’ in The Observer
Link to Tom Wolfe’s epic ‘Sorry, But Your Soul Just Died’.

Spike activity 12-02-2016

Quick links from the past week in mind and brain news:

Don’t tase me bro! Because it’ll cause short term cognitive impairment which may affect my ability to respond correctly under police interview. Important research from Drexel.

Mosaic has an interesting piece on hacking the placebo response and associative learning to improve medical treatments.

Your Next New Best Friend Might Be a Robot. Might be already for all I know. Nautilus on social robotics.

Science reports that sleep deprivation markedly increases false confessions.

The microcephaly brain changes apparently linked to the Zika virus are puzzling science. Good piece from NBC News.

The Atlantic covers the bitter fight over the benefits of bilingualism.

Good sceptical Gary Marcus talk on the current state of artificial intelligence and a useful tonic to those who think deep learning will lead to strong AI.

The Economist has an excellent in-depth article on the social effects of legalising cannabis.

There’s an excellent interview with pioneering neuroengineer Ed Boyden in Edge. Really, go read it.

Science News reports that the rise of human civilization was tied to belief in punitive gods. And also reality TV, you’ll notice.

A quartet of complementary brain books

Last night I taught a two hour class called ‘Navigating Neuroscience’ for the Guardian Masterclass series and I had the interesting challenge of coming up with a two hour course on some key concepts to help people make better sense of brain science, how it’s discussed, and its changing place in society.

As part of that, I recommended some books to give interested non-specialists a good critical introduction. I added a book after hearing some of the questions and I’ve included the list below.

I’ve mentioned some of them before on Mind Hacks in their own right, but I thought they’re worth mentioning as a set.

The books have been chosen to complement each other and the idea is that if you read all four, you should have a solid grounding in modern cognitive neuroscience and beyond. In no particular order:

Brainwashed: The Seductive Appeal of Mindless Neuroscience
by Sally Satel and Scott O. Lilienfeld

This is a great book for understanding common fallacies in conclusions drawn from cognitive neuroscience studies and what conclusions can reasonably be drawn from this evidence. It tackles several areas as examples of where these fallacies are having a significant effect: neuromarketing, neurolaw, lie detection, addiction and the brain-disease fallacy.

50 Ideas You Really Need to Know About the Human Brain
by Moheb Costandi

It’s a book of 50 small chapters each of which contains an essential idea on which the foundation of modern neuroscience rests. It’s very accessibly and accurately written and gets across some key subtleties that many academic textbooks miss. The great thing about this book is that it’s not just a ‘nuts and bolts’ guide to the brain and isn’t afraid to go into quite technical areas (‘Default Mode’, ‘Prediction Error’) while making sure they’re described in straight-forward language.

Great Myths of the Brain
by Christian Jarrett

This is especially good for listing and dispelling commonly cited but erroneous brain ‘facts’. It starts with some historical ones (‘Drilling a Hole in the Head Releases Evil Spirits’), move on to more obvious contemporary myths (‘We Only Use Ten Percent of Our Brains’) but then includes a range of common myths that may be well understood by neuroscientists but which pervade popular discourse and the media (‘Mirror Neurons Make Us Human’, ‘The Brain Receives Information from Five Senses’).

Neuro: The New Brain Sciences and the Management of the Mind
by Nikolas Rose and Joelle M. Abi-Rachedneuro

This is a great book for understanding how neuroscience is understood and used in society. It’s actually an academic book and Rose and Abi-Rached are sociologists but it’s technically accurate without being densely written. I genuinely think it’s one of the most important neuroscience books of the last decade. It is a brilliant analysis of how brain science and the practice of brain science have become associated with changing ideas of what it means to be human and their reciprocal relationship between politics and social influence in the world.

Spike activity 22-01-2016

Quick links from the past week in mind and brain news:

The New Yorker covers the shifting sands of autism in light of recent books that have rethought the history of the condition.

Brian Resnick at Vox asked twenty psych researchers: What do you hate about science journalism? Lots of good stuff.

Science reports big and welcome news: the Montreal Neurological Institute, one of the world’s leading brain research centres, is going entirely open science.

Why does the brain use so much energy? asks Wired UK.

The Independent has a piece on the history of the drug amyl nitrate, sold widely as ‘poppers’, and its place in gay culture, clubbing and sex.

I get interviewed by the Spanish-language blog Neuromexico – text in Spanish but audio largely in English.

The New York Times has a subtle first-person piece on prison psychotherapy.

A brief history of decapitation. Over at Inverse.