Are psychiatric disorders actually brain diseases? | Steven Reidbord, MD | January 7, 2016
a long list of medical and surgical diseases include psychiatric features: stroke, anoxic brain injury, meningitis, lupus, diabetic ketoacidosis, and febrile delirium to name a few.
One important job of the psychiatrist is to recognize such problems, treat the psychiatric manifestations when appropriate, and refer the case to one’s colleague — neurologist, internist, surgeon — for treatment of the underlying problem
Of the conditions deemed inherently psychiatric, some seem rooted in biological brain dysfunction.
Schizophrenia, autism, bipolar disorder, and severe forms of obsessive compulsive disorder and melancholic depression are often cited.
Lately, however, some big names in psychiatry have taken a more ideological stance, declaring that psychiatric disorders, in general, are brain diseases — right now, no further proof needed. Dr. Charles Nemeroff, widely published professor and chairman of psychiatry at the University of Miami Miller School of Medicine, writes:
In the past two decades, we have learned much about the causes of depression. We now know from brain imaging studies that depression, like Parkinson’s disease and stroke, is a brain disease.
Dr. Thomas Insel, recent director of the National Institute of Mental Health (NIMH) wrote:
Mental disorders are biological disorders involving brain circuits…
Psychiatrist and Nobel laureate Dr. Eric Kandel says: All mental processes are brain processes, and, therefore, all disorders of mental functioning are biological diseases
These claims by prominent psychiatrists agitate critics. No biomarker for any psychiatric disorder has yet been identified
Functional brain imaging reveals biological correlates of mental impairment, not etiology, and no such imaging can diagnose a specific psychiatric condition.
Our best account for most mental disorders remains a complex interaction of innate vulnerability and environmental stress, the “diathesis-stress model.”
How can they call psychiatric disorders brain diseases without scientific proof?
The brain mediates all mental activity, normal or not. Consequently, any psychiatric intervention — or influential life experience — acts upon the brain. This is not a new discovery.
No modern studies of brain tissue, no genetic testing, no advanced brain imaging were needed for the father of psychoanalysis to posit that mental activity arises from biology.
Psychiatric “brain disease” is neither an exaggeration nor a lie. It does not require scientific proof — and brain imaging has neither strengthened nor weakened the case
In theory, all psychology can be reduced to electrochemical events in brain cells. All psychopathology can be reduced to aberrant electrochemical events, i.e., brain disease.
Calling psychiatric disorders brain diseases serves no clinical or research purpose, it only serves political ends: bringing psychiatry into the fold as a “real” medical specialty, impressing Congress and other funding sources, perhaps allaying stigma.
As a tactic it smacks of insecurity and self-aggrandizement, wholly unbefitting a serious medical specialty.
A reductionistic account of this sort, festooned with pseudoscientific verbiage, has no practical significance.
Brain research is a young field. It should be vigorously pursued for what will surely be learned.
Stumping for psychiatry as clinical neurobiology will be justified when basic research in this area affects clinical practice. Until then, “brain disease” is only a philosophical technicality, a spin, to give our clinical work and the institution of psychiatry an air of scientific credibility.