Saturday, January 17, 2015

A Problem with Brain-based Models

We are living in a time of obsession with the brain.  It is true that neuroscience is producing discoveries which are interesting an may be useful (time will tell), though humans will always amount to much more than what we carry in the cranium.  On a daily basis I see in my news feeds items like "Gene found responsible for chronic tardiness", or "CAT scan shows region involved in ADHD", or "Bipolar Disorder rise attributed to increase in brain abnormality".

A problem I have with research like this, and like so much that we consume, is that it does not appear to take into account developmental, contextual, and environmental factors. Because of this the dialog focuses on a reductionist and brain-based model as though the person-in-environment does not exist. This facilitates intrusive and authoritarian “treatments” and is often a dead end in improving human welfare. To say that diagnosis X is rising really does not tell us what we need to know, which is why or how. And that’s putting aside all the arguments involving inadequate support for diagnoses and the inter-rater reliability problems associated with them. Sometimes it seems as though the research paradigm is oriented toward simplistic goals for the purpose of developing efficient delivery of interventions, mainly drugs. And by efficient I mean not having to develop human relationships or spending much face time with people.

The "innovations" all seem to actually reduce time spent in human contact, thereby increasing the ROI in billing.

I am not an expert in the technicalities of diagnosing, though I think I do well in the formulation of human life problems.  I do know that our young adults are functioning in a context which is often pathogenic in and of itself. Here are some of the factors we see as relevant:

  • Stress related to global political and marketplace influences
  • Extremely poor sleep routines and hygiene
  • Arrhythmic lifestyles, or more simply put, chaos
  • Too much screen time, not enough play and exercise
  • A paucity of trusting, mutually satisfactory relationships, in any sphere
  • Racism and discrimination
  • Increased sense of threat and diminished opportunity for affiliation
  • Poverty
  • Alcohol and drug abuse
  • Poor nutrition
  • The inherent “volatility” of the late adolescent and young adult
  • The seasonal nature of the stresses in the academic environment
  • Corruption, or at least mutual and self-serving contamination, among our leaders including those involved in healthcare and the Pharma-Insurance conglomerate
  • Violence, rape, sexual assault, harassment
  • Environmental toxins and their suspected role in some diagnoses (see http://bit.ly/1kRI8Dw)
If I bathed your brain in even half of these factors, what would you look like?

I have personally worked with many young folks who “looked” Bipolar (or ADHD or Whatever 209.45), but who were really experiencing intense emotion which they could not articulate in language nor act to soothe. The intense emotion was, more often than not, a result of a pathogenic environment of people, places and things, some of which they created themselves.

This is not a new problem.  Some years back we hanged and drowned and burned some women in Salem, MA.  It wasn't even thought until the 1970s that there might have been a fungus in the rye they ate which caused some alarming behavior.  Never mind whatever proportion of them were being assaulted.  But they were killed, because it was easier to attribute behavior to the individual rather than her context.  This is still the case.

Please recall Seurat and his pointillism, the painting style consisting of a series of dots.  A diagnosis is a few dots.  You have to stand back from the painting to see the darn thing.  It is much the same with humans.

I am sure there are other views. This is mine, and it does not necessarily foreclose on the concept of serious illness.  But I submit the threshold for this is much higher than what many appear to believe, especially those with an investment in the "treatment" for the illness.