

The New Science of Mind - amerika_blog
http://www.nytimes.com/2013/09/08/opinion/sunday/the-new-science-of-mind.html?smid=re-share&_r=0&pagewanted=all

======
thelettere
"Mental illnesses are disorders of the brain that disrupt a person’s thinking,
feeling, moods, and ability to relate to others. Just as diabetes is a
disorder of the pancreas, mental illnesses are brain disorders... [They] are
not a result of personal weakness, lack of character, or poor upbringing."

That's from a 2000 pamphlet written by the National Alliance for the Mentally
Ill. Kandal's claim that this is new is BS - it's an old idea, and one not
demonstrated by the research he cites. It's simply more evidence that mental
illnesses are mediated by biological processes - something we've known for
years.

The claim that mental illnesses are "caused" by biology is just as false now
as it was then, and these experiments make no suggestion in either direction.

Clearly, neither study permits inferences about cause. Again, just because
biological processes are involved does not mean that it is triggered by it.
This is the same idea that's been pushed by over-zealous neuro-scientists for
years. It's based on the belief that if we just drill down far enough in
biology and genetics, we will explain most of the variance in behaviors.

If you don't cherry-pick the evidence, the whole picture suggests the same
story that we've known for quite a while - but some in the psych/mental
illness field aren't satisfied with it because the truth doesn't fit with
their cravings for prestige - with our cultural obsession with the biological
being more "real" than the social. Not to mention the financial aspects - one
of the reasons we know so little about the social etiology of mental illness
is because there's so little funding available for it.

The evidence suggests that environmental factors are just as involved - and in
many cases is the primary cause, which plays on biological vulnerabilities
that determine how the illness is expressed and through which it becomes self-
perpetuating, not only for the individual, but on down through the family
through cultural transmission and epigenetics.

Why does this even matter though? Because our perceptions of mental illness
influences its outcome - how we view mental illness determines in large part
what it is and how it expresses itself. If we believe it's fundamentally a
fixed genetic and biological disorder that the individual themselves is
helpless to do anything about, then through the nocebo effect it becomes a
self fulfilling prophesy. That is one reason why outcomes for schizophrenia
are better in sub-saharan Africa than they are in the US.

Sources

On Epigenetics: Masterpasqua, F. (2009). Psychology and epigenetics. Review of
General Psychology, 13(3), 194.
[http://pzacad.pitzer.edu/~dmoore/2009_Masterpasqua_Psych&Epi...](http://pzacad.pitzer.edu/~dmoore/2009_Masterpasqua_Psych&Epi_Rev%20Gen%20Psych.pdf)

On Biological and Environmental Etiology: Bentall, R. (2009). Doctoring the
mind: Is our current treatment of mental illness really any good?. NYU Press.
[http://www.power2u.org/downloads/Richard-Bentall-Broken-
Brai...](http://www.power2u.org/downloads/Richard-Bentall-Broken-Brain-
Critique.pdf)

Scheid, T. L., & Brown, T. N. (Eds.). (2009). A handbook for the study of
mental health: social contexts, theories, and systems. Cambridge University
Press.[http://hmid.basijmed.ir/public/hmid/books/mental%20health/A_...](http://hmid.basijmed.ir/public/hmid/books/mental%20health/A_Handbook_for_the_Study_of_Mental_Health__Social_Contexts__Theories__and_Systems___2nd_edition.pdf#page=28\(pg).
104 to end of chapter provides a good overview)

Whitaker, R. (2011). Anatomy of an epidemic: Magic bullets, psychiatric drugs,
and the astonishing rise of mental illness in America. Random House Digital,
Inc..

On social Expectancy: Burns, J. K. The Social Determinants of Schizophrenia:
An African Journey in Social Epidemiology. Public Health Reviews, 34(2).
[http://www.publichealthreviews.eu/upload/pdf_files/12/00_Bur...](http://www.publichealthreviews.eu/upload/pdf_files/12/00_Burns.pdf)

Whittaker, R., Kemp, S., & House, A. (2007). Illness perceptions and outcome
in mild head injury: a longitudinal study. Journal of Neurology, Neurosurgery
& Psychiatry, 78(6), 644-646
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077969/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077969/)

~~~
pekk
Everything is mediated by biological processes, we are organisms.

What illness has nothing to do with "biology" \- robot illnesses?

The idea that there is exactly one cause for any event is ridiculous, this
isn't specific to illnesses.

~~~
thelettere
For a long time it was thought that mind and brain were not synonymous.

I do not argue it either way though - my point was that Kandel's claim that
mental illnesses are fundamentally biological, that people are not at all
responsible and that our brains "control our actions" is not supported by his
examples or the evidence.

------
TelmoMenezes
I tend to think of fMRI based neuroscience as analogous to trying to reverse-
engineer how a computer works by measuring the electric fields it generates. A
lot could be learned, but only to a degree. Except that there was no
evolutionary pressure for understandability on the brain, so it's quite
probably a convoluted kludge. This complexity cuts across levels of
abstraction, with interplay between the genetic, neural and environmental
levels. I suspect the entire thing is too complex for us to understand --
without better mathematical and computational tools. Anti-depressants work for
some cases for some reasons, but we might need some paradigm leap to
eventually understand why.

The current hypothesis of neurotransmitter imbalance always sounded childish
to me. A bit like trying to fix a software bug by improving the conductivity
of the circuits, or something like that.

------
skunkworks
A welcome article to read after this:
[https://news.ycombinator.com/item?id=6346567](https://news.ycombinator.com/item?id=6346567)

I hope one day we'll have a complete model for understanding depression, but
for now, it's encouraging enough to know that there are different kinds that
are more/less responsive to different treatments.

Also, nice to see CBT get some props. It's really effective. And as someone
who often proselytizes about the wonders of therapy, I'd like to get rid of
the quacks who practice "black magic" therapy i.e. a non-evidence-based mish-
mash approach. They are not helping the bias against mental health services in
the US.

~~~
thelettere
“Psychotherapy is an undefined technique applied to unspecified problems with
unpredictable outcome. For this technique we recommend rigorous training.”
-Horowitz

All therapy is "black magic" in the sense that no-one quite understands
exactly how it works. CBT gets props because it's one of the few therapies
that has a manual and can actually be studied scientifically.

I'm sorry but I prefer to speak with a therapist who doesn't have to consult a
manual for every response he/she makes. Therapy is ultimately a human
relationship, and just as messy and unpredictable as any other relationship -
and subject to all the contingencies thereofe.

Just because something cannot be studied scientifically does not mean it is
not effective. Evidence for the limited long term effectiveness (high relapse
rates, ect) of shallow and manualized interventions like CBT is growing by the
day. Compare that with more messy therapies that dig deeper (like
psychodynamic) whose outcomes actually improve the longer the subjects are
tracked.

The vast majority of the effectiveness of therapy is due to hope (placebo
effect) and the relationship. Focusing on the "technique" is distracting and
leads to a view of therapy as something that is done to you, as opposed to
something that is done with you. Lasting change comes from taking personal
responsibility, not from having special "scientific" techniques done to you.

That para-professionals with 2 weeks of training have outcomes as good or
sometimes better than those with Ph.d's in clinical psychology is all one
needs to know when deciding whether or not to categorize psychotherapy as a
science.

~~~
skunkworks
CBT gets props because its empirical results have shown to be more effective
than the traditional talk therapy approach. It's been around for a long time,
has been studied enough for us to be confident that it makes a real
difference, and I consider it as medicine for thoughts. Of course there's no
way for us to quantify its precise method of action, so it's not that
different than making the observation that the bark of a certain tree seems to
reduce pain and inflammation, but if the burden of proof is to show direct
causation from our thoughts and CBT to a better outlook on life, we might as
well be asking about the nature of human consciousness.

CBT is a framework more than it is a manual, and not nearly as robotic as
you've described. All therapy requires a human relationship to be successful.
You have to trust your therapist to believe in the things they say, and that
belief is a prerequisite for putting in the effort to reshape your thoughts
and attitudes, but what's so robotic about a therapist asking you to explore
the origin of a preconceived notion? About them asking you to be mindful of
those type of thoughts? On coaching you to intercept those negative thought
patterns and replace them with improved ones?

I think chalking up the efficacy of therapy to hope and placebo is a bit
disingenuous. Yes, belief in change is a precursor to real change -- no
therapist can help someone who isn't willing to believe or even want to change
-- and in a way, the therapist's role is to guide you in your own endogenous
healing process. However, there needs to be some rigor in the way they guide
you to break bad patterns and replace them with better ones.

In a way, the therapist's challenge is like inception: how can I plant
something in someone else's head but make them feel like they came up with it
themselves? I think most of us could look at someone with low self esteem and
negative thoughts and tell them what's wrong and what they should say or do or
believe instead. However, that process needs rigor, and one of the best tools
in the toolbox is to increase someone's mindfulness, and one of the best ways
to do that is CBT.

I think overall you're a bit dismissive of it as a shallow, robotic approach
when really it's a simple, repeatable, controllable frontline intervention.
It's not going to work for deep-seated issues, but I think of it as almost
being a prerequisite before those deeper issues can be tackled. I am of course
speaking from personal experience, in both myself and what I've observed with
others.

~~~
thelettere
That hope and the relationship make up a much larger percentage of what causes
change than technique is not my personal opinion. It's the result of a trans-
theoretical analysis that was done a few years ago.

I don't recall the name of the study, but it's described in detail in "The
Heart and Soul of Change".

------
JackFr
I realize that this is aimed at a popular audience, but describing brain
structure and function with imprecise words like 'circuits', 'controls',
'connected to' and 'involved in' without being clear as to a specific
physical, biologic mechanism completely undermines his point.

Additionally, appealing to one studies which have not been independently
reproduced, which are not double blind does little to dissuade me that the
bulk of neuroscience is an exercise in confirmation bias.

------
Patryk
But it is important to note, once again, that correlation does not imply
causation -- no matter how fancy a scientific tool you are using, either fMRI
or genetics.

The best data Kandel cites in support of his argument is the improved
treatment outcomes that could be "predicted" due to genetics. However, it
would not be too surprising if some behavioral or cognitive measure did just
as well at predicting the improved outcome.

~~~
has2k1
Genetics are more fundamental than behavior or cognition. The prediction of a
biological outcome using genetics tends to be more damning than if the
predictor were something else. Genetics carry a lot of weight, you cannot
teach them away, nor think them away and still in 2013 you cannot replace
them. You are damned by them.

Plus, you cannot genuinely critique a revelation based on an article aimed at
the general audience. That is a cheap shot with the potential to mislead self.

~~~
tokenadult
Take a look at a Hacker News comment

[https://news.ycombinator.com/item?id=6078734](https://news.ycombinator.com/item?id=6078734)

from a month or so ago with lots of links to full text articles about human
behavior genetics from leading researchers on the subject. Genetics is a more
complicated topic than most people suppose.

