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Newtown and Neuroscience

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Newtown and Neuroscience

By Alen J. Salerian, MD

December 27, 2012

   At a time of national pain should we consider how to prevent future nightmares? Should we ask, "what does science say about Newtown 12/14/2012?"

   Science says: you cannot be a mass killer without a dysfunctional prefrontal cortex (the frontal end of the brain that regulates emotion and self-control). How come? Most likely, because a dysfunctional prefrontal cortex is no longer capable of rational thought in order to contain primal urges or animal instincts.

   Yes, science says you can't be a mass killer unless you suffer from a dysfunctional brain with structural and functional abnormalities. Study after study of neuroscientific maps show images of faulty wiring in intercellular communication in the prefrontal cortex of people with serious neuropsychiatric disorders. A fascinating recent study by Drs. Bansal, Stald, Laine, Hao, Xu, Liu, Weissmann and Peterson from Columbia and Yale has offered compelling evidence that brain imaging alone can accurately diagnose neuropsychiatric illnesses.

   One would wonder as to why the disasters strike us without any advance warning. Is it the nature of the beast, or is it us? One possible answer is perhaps that the dynamic complexities of neuropsychiatric disorders are inaccessible to current diagnostic systems. Or simply put, our tools are too naive to effectively detect, diagnose and treat brain dysfunction.

   Numbers speak well. The 10 deadliest US shootings have killed several hundred people (Table A). Often, a single shooter with an impaired brain kills innocent victims, then himself. Most of the tragedies have been homicides-suicides. This is a point worthy of emphasis. Once a person decides to end his life nothing seems to matter anymore. Absolutely nothing. In essence, homicides are complications of suicides. In order to solve the homicides we must solve the suicides. In order to solve the suicides we must solve the underlying psychiatric problems and that is where two latest neuroscientific discoveries can be of help:

A.    Most psychiatric disorders are associated with dysfunctions in specific brain regions often in the prefrontal cortex (1).

B.    Our diagnostic tools are grossly in adequate to detect psychiatric disorders (2).

C.    There are now reliable high-tech methods to diagnose psychiatric disorders and brain abnormalities (3).

   Should we question the crash of a jumbo jet had it occurred soon after a mechanical workup? Common sense suggests an effective system should forecast trouble. Yet psychiatry is notorious for its feeble accuracy of detecting trouble in advance. A tragic example: Jeffrey Dahmer, the worst serial killer in US history. In fact, before mutilating and murdering dozens of people Dahmer spent some time in an alcohol treatment center.

   Neuroscience has made major advances to accurately diagnose and monitor brain disorders. Sadly the latest neuroscientific advances are unavailable in routine practice. There is a huge gap between neuroscience and the real world. During the Jeffrey Dahmer era we did not have SPECT or FMRI, the latest neuroimaging advances to confidently declare that Jeffrey Dahmer's brain was abnormally wired.

   Sadly it is too late for many lost lives. In essence we need to urgently upgrade our psychiatric diagnostic systems to incorporate neuroscientific advances into daily practice to prevent future combustible brains killing others. And that is the take home message from neuroscience.

Table 1: Ten Worst Homicides in US


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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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