translating speculations…

Posted on Sunday 21 April 2013

Last week, we watched in awe as the authorities were able to mobilize technology to solve a pretty sticky problem – finding the Boston bombers. By the third day, there was enough mass video assembled to identify them on national media [upper right]. I was personally impressed by that top shot from an iPhone [suspect far left]. When the search was underway, they showed the middle image from Bing that identified the suspect’s boat hiding place. I looked it up on my Google Earth, and the picture showed the boat trailer [obviously from a different flyover]. Then they were watching the suspect and measuring the amount of gas in the boat’s tank using a combat-tested infrared camera from a helicopter. By bed-time of the fourth day, there was a picture of the suspect getting out of his hiding place, after a robot arm pulled back the cover. Techno-sleuthing was on parade. The tools were there, they fit the problem to a tee, and you could just feel that they knew what they were doing..

In between the happenings in Boston, I was reading Neuroskeptic’s post about some difficulties analyzing fMRI data [fMRI: More Voxels, More Problems?]. His post was out of my league, but it set me thinking about the ubiquitous topic of neuroimaging [as I watched the mass videography poring out of Boston] and I thought about our love affair techno-anything.  Back in the 1980s, the early neoKraepelinians couldn’t stop talking about neuroimaging [then, it was PET scans] and it’s still right on the tip of their tongues [now it’s fMRI scans or the Human Connectome Project]. The allure of seeing the brain in action and the brain’s circuitry is a Siren’s song we yearn to follow:

But is something clinically useful just around the bend? just around the decade? or even way on down the road? In 2002, the DSM-5 Task Force aimed for just around the corner, and it didn’t work out. Can the NIMH RDoC run that same line again and justify these postulates?
  • First, mental illnesses are presumed to be disorders of brain circuits.
  • Secondly, it is assumed that the tools of clinical neuroscience, including functional neuroimaging, electrophysiology, and new methods for measuring neural connections can be used to identify dysfunction in neural circuits.
  • Third, the RDoC approach presumes that data from genetics research and clinical neuroscience will yield biosignatures that will augment clinical signs and symptoms for the purposes of clinical intervention and management…
or saying this:
    … a fundamental flaw: it says nothing about the biological underpinnings of mental disorders. In the past, that shortcoming reflected the science. For most of the DSM‘s history, investigators have not had a detailed understanding of what causes mental illness. That excuse is no longer valid. Neuroscientists now understand some of the ways that brain circuits for memory, emotion and attention malfunction in various mental disorders…
This kind of rhetoric has an all too familiar ring. I call it future·think but the Disney metaphors like fantasy·land or tomorrow·land work just as well. The postulate, mental illnesses are presumed to be disorders of brain circuits, is not that far off away from the previous chemical imbalance theories, perhaps even more speculative. It’s similar in that what-we-are-currently-able-to-measure is the target du jour. It’s the available technology that generates the hypothesis, rather than technology being engaged to solve a problem [like in the FBI’s approach to the Boston bombing]. We heard this brain circuitry hypothesis being moved to the front burner by Dr. Insel not long after the DSM-5 Task Force had bailed out on their plan for a biological manual, and PHARMA was moving on from CNS drug development:

The field of mental health is on the cusp of a revolution, which is set to transform the diagnosis and treatment of mental illness and reverse the lack of major progress made in curbing associated ill health and death over the past 100 years, the director of the US National Institute of Mental Health, has claimed… The seismic shift had been driven by what he described as three “revolutionary changes” in thinking, the first of which was that mental illness was increasingly being recognised as a disorder of brain circuitry, rather than as a chemical imbalance, thanks to neuroimaging techniques and the discovery of some key biomarkers…
And in a recent presentation by Dr. Dennis Charney, this whole line of thinking was elaborated in much greater detail [A Roadmap for Innovation in Psychiatry][see also some time back…].
 
In irrational exuberance…, I was talking about feeling gamed by all of this, like there’s some line that’s being doled out from multiple sources – the APA, the DSM-5 Task Force, the NIMH, the RDoC, and academic psychiatry. I suspect that the "cusp of a revolution" and the "seismic shift" are driven more by the petering out of the chemical imbalance paradigms and by the disillusionment in the psychopharmacology it generated than because of any tangible scientific advances. The leadership in all of these organizations have grown up together, have spent the last twenty-five years in a climate promoting a stream of me-too medications now run dry together, and seem to be struggling to maintain their place at the helm. I don’t see much on that slide that’s likely to keep them there – just a lot of speculation, reframing, and future·think. They seem to be racing en masse to their cherished translation phase prior to having any basic understanding to translate – translating speculations
  1.  
    April 21, 2013 | 3:07 PM
     

    Yeah, and how are those monoamine treatments working out to remodel diseased brain circuitry?

    “mental illness was increasingly being recognised as a disorder of brain circuitry, rather than as a chemical imbalance” — this is because new jargon was required as “chemical imbalance” was getting embarrassing. “Disorder of brain circuitry” still doesn’t mean anything, but sounds so much more current.

  2.  
    wiley
    April 21, 2013 | 4:44 PM
     

    Psychiatry has its own Rorschach test now.

  3.  
    April 21, 2013 | 6:26 PM
     

    “Disorder of brain circuitry”, wasn’t that the cause of Frankenstein’s Monster?

    Just sayin’…

  4.  
    wiley
    April 21, 2013 | 11:26 PM
     

    What can observing the brain activity of SUBJECTS being observed tell us? It can tell us how objective the observers are, I guess, but shouldn’t that be THEIR problem?

  5.  
    April 22, 2013 | 6:27 PM
     

    Could the idea of disordered brain circuitry be an example of disordered brain circuitry? Just sayin’.

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