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A Black Hole Between Neuroscience and Mental Illness

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A snapshot of modern psychiatry: Major scientific breakthroughs, little relief from mental pain. Millions of homeless mentally ill, steady rise of suicide, mediocre success with depression or schizophrenia, and transparent impotence with addiction. Do we have a wall of darkness between science and mental illness? A black hole in the shadow of a mountain of progress in medicine. 

Thanks to scientific advances dramatic gains against ancient medical foes, such as diabetes, cancer, and heart disease have been accomplished. In essence, in medicine scientific approach has been crucial for relief. Not so in psychiatry.

The lives of people with mental pain have been witnessing a rising tide of misery. For progress from the patient's perspective is sensitively dependent on access to science. And, our societal laws and regulations constrain our neuroscientific growth and its direction. They define what is possible and what is impossible. As we have witnessed they can shape the lives of millions, as well as when their misery should end.

Why have we failed to see the black hole? Possibly because of three influences: The DSM (the diagnostic statistical manual of mental disorders), the classification of controlled substances and our flawed registration system of vital statistics. They'll share a single property:  Lack of scientific integrity. For instance the DSM confuses a disease with complications arising out from a disease and is incapable of detecting the most powerful influences of brain function that are not visible or easily observable to our sensory system. The confusing boundary of disease and disease complication is of profound significance for it is a major impediment for progress. As a consequence, more than a dozen of mental disorders, i.e. schizophrenia, addiction, or depression are considered primary diagnosis while they should be classified under complications of other diseases which have not been diagnosed or treated effectively. This would be akin to classifying blindness due to diabetic retinopathy as a primary disease without realizing that it is a complication of diabetes mellitus.

Consider our death reporting system. Regardless of any scientific validity - confirmed by laboratory or clinical input - any trace of a narcotic is recorded as the cause of death without taking into consideration other crucial causative factors (1). The end result of this is a false alarm of phantom epidemics of methadone and narcotic analgesic related deaths.

Our current classification of controlled substances that governs almost all aspects of neuroscientific research and treatment and in particular pain and mental illness is unscientific (2).

In the history of mankind people with mental illness have been both vilified and victimized. In our modern wars against mental illness our current systems are counterproductive.

There are many more challenges but not much progress is possible unless we adopt science based methods to lead psychiatry.

References:

1) Webster L., Dasgupta N. Obtaining Adequate Data to Determine Causes of Opioid Related Deaths, Pain Medicine 2011;  12: 586-592

2) Salerian AJ. Addictive Potency of a Substance. Medical Hypothesis 2009

 

http://www.salerianbrain.com

Alen J. Salerian, MD is a Washington, DC based physician, author, and historian who has been practicing psychiatry and psychopharmacology for 35 years. He is the former chief psychiatrist of the FBI's mobile psychiatric unit. He has authored (more...)
 

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While there certainly is a lot of evidence to supp... by Michael Germain on Monday, Sep 23, 2013 at 3:29:44 PM
... by Annec on Tuesday, Sep 24, 2013 at 12:21:25 PM