In contrast to downstream sensationalised portrayal of of human advancement in psychiatry by the media, there is actually deep, honest, thoughtful and humble reflection upstream. Armand Nicholi provides one such humble reflection. Below is an excerpt from ‘How Does the World View of the Scientist & the Clinician Influence Their Work?’
Research on Mind & Brain
New knowledge in psychiatry comes from a variety of sources including the following.
(1) Recent clinical and laboratory research and new technology that facilitates this research such as the vastly improved brain scanning methods of computed tomography (CT), positron emission tomography (PET), and magnetic resource imaging (MRI); from the advances in molecular biology prompting the search for a specific gene in the transmission of schizophrenia and other of the major psychiatric disorders; computer brain electrical activity mapping (BEAM), and new biomedical techniques for assessing enzymes, metabolites and neurotransmitters in human tissues.
(2) The emergence of diseases such as Acquired Immune Deficiency Syndrome, or AIDS, whose first and sometimes only manifestation may be severe psychiatric symptoms.
(3) The increased incidence of disorders such as bulimia, and the recent intensive investigation of others such as Alzheimer’s Disease and obsessive compulsive disorder.
(4) Environmental and cultural changes that result from or contribute to psychiatric disorder such as the current changes in family structure, the rapid rise in psychoactive drug use, and the epidemic in adolescent suicide.
Progress in psychiatry continues in many directions. More rigorously controlled studies have replaced the relatively unsophisticated research of the past. Investigations have focused on establishing the neurological substrates of psychiatric disorders; that is, on ascertaining the specific parts of the brain associated with disturbed thinking, feeling, and behavior of these disorders. A great deal of research today continues to search for metabolic and physiological abnormalities that may be clues to the cause and to the cure of particular illnesses. New discoveries have come from explorations both within cells, to find the gene or genes involved in genetic transmission of a disorder, and between cells, especially at “synaptic clefts,” the name given to those spaces that exist between each of the billions of brain cells. We have focused a great deal of attention on these spaces because we have found that drugs that alleviate psychiatric symptoms, such as the neuroleptic drugs as well as drugs that imitate psychiatric symptoms like the amphetamines, act at the level of neurotransmitters–chemicals that carry impulses across these spaces. Although we have made great strides in the biochemistry and neurophysiology of the brain and an understanding of the neural basis and the localization of certain feelings and certain thought processes in the brain, we have as yet failed to find any metabolic or physiological abnormality consistently present in any of the major psychiatric illnesses. Even when and if we find this magic abnormal metabolite we will be only halfway home–for we still won’t know whether the abnormality causes or results from the disorder.
Paradoxically, the more we learn about the mind the more we realize that we can never reduce human thought, feeling, or behavior to a biochemical reaction. Our knowledge of biology by no means rules out the significance of psychological factors, nor our knowledge of genetics the significance of environmental factors. The more we know about one area, the more significant the other area seems to become in explaining the whole picture. The more we develop and use psychopharmacologic drugs, the more we realize that these drugs usually must be combined with psychotherapy to be most effective. Perhaps once we discover the elusive abnormal metabolite, we may find it influenced by a combination of genetic, environmental, biological, and psychological factors. The integration of these factors certainly constitutes psychiatry’s greatest challenge.1 One thing we can say for sure: All of the modern research and new technology has not altered significantly the statement by the famous neurosurgeon Penfield when he wrote in 1975, after a life’s work of research on the brain, “In the end I conclude there is no good evidence in spite of new methods – that the brain alone can carry out the work that the mind does. I conclude that it is easier to rationalize man’s being on the basis of two elements than on the basis of one.”2 Though we have accumulated new and significant evidence of how the mind influences the body and the body the mind, we must still agree with Penfield that brain and mind are two distinct entities. We cannot reduce the mind of man to neurochemistry and neurophysiology.
What we can conclude is that new knowledge of the mind reveals not only its paradoxical nature but also its enormous complexity. Recent scientific research leaves us with an acute awareness of how little we really know. It reminds us of the statement by Dr. Lewis Thomas in the New England Journal of Medicine: “The only solid piece of scientific truth about which I feel totally competent is that we are profoundly ignorant about nature. Indeed, I regard this as the major discovery of the past one hundred years of biology . . . it is this sudden confrontation with the depth and scope of ignorance that represents the most noteworthy contribution of 20th century science to the human intellect.”3 New knowledge, if kept in proper perspective, increases not our arrogance but our humility–perhaps because as our island of knowledge increases, so does our shoreline of ignorance.