A few weeks ago, I was commenting on an article in JAMA:Psychiatry by three Residency Training Directors [yellow brick roads…] who were advocating a curriculum for psychiatry residents in neuroscience [The Future of Psychiatry as Clinical Neuroscience: Why Not Now?]. The gist of the article had to do with preparing future psychiatrists for the expected breakthroughs coming in neuroscience. Going so far as to say…
The overarching goal is that residents will incorporate a modern neuroscience perspective as a core component of every formulation and treatment plan and bring the bench to the bedside.
…which I thought sounded like something the USSR of old might have come up with back in the days before the walls fell down. I recalled a graphic I came up with four years ago about Tom Insel’s campaign for clinical neuroscience. I made it from an old Red Army poster from the days of the Russian Revolution, so I guess that I’ve thought of that analogy before. The constant hype about Neuroscience has been like the seven decades of Russian Communism, hope was always in the future [a future that ever came]. Note also the allusion to the Translational Medicine metaphor – another NIMH favorite [moving research findings rapidly from "the bench to the bedside"]. Best I can tell, we’ve established a network of Translational Centers all decked out for service, but there’s been nothing of note to translate.
I suggested that a neuroscience track ought to aim at arming the residents with the tools to evaluate emerging technologies:
Rather than being "ready to embrace new findings as they emerge", tomorrow’s psychiatrist needs to know how to critically evaluate new findings as they emerge.
Psycritic has a new post up on this topic that takes a somewhat different tack than mine [Psychiatry as a Clinical Neuroscience, Why Not?] – a deeper look on the place of neuroscience in psychiatry in general though equally cautious. He mentions this example…
I remember being taught as a resident about Broadmann Area 25 being critical in the pathogenesis of depression, based on exciting initial deep brain stimulation results from Dr. Helen Mayberg. This was almost treated as an established fact, despite the very preliminary nature of the research. Well, what happened when they tried to do a larger clinical trial? Neurocritic reported that the trial was halted before its planned endpoint in December 2013, and last month it was revealed that the medical device company conducting the trial [St. Jude] stopped it due to perceived study futility.
…and that’s what bothers me about the constant focus on the brain studies – as if they are the harbingers of something just around around the corner. Tentative signals get treated as "known facts," and it feels as if there’s a real pressure to put them into action [like for example the injunction to "incorporate a modern neuroscience perspective as a core component of every formulation and treatment plan"]. I can’t imagine how one might do that. It is, in fact, the very point that our critics legitimately hammer on – psychiatry forcing everything into an biomedical framework where much of it doesn’t fit. Psycritic goes on to reflect on his college Neuroscience Professor who gave the students a broad view of brain function:
"All of the neurons together in one brain form more connections with each other than there are stars and planets in the galaxy." The professor ended his lecture by giving us some practical tips based on his knowledge of neuroscience. Time and repetition, he told us, is what will help us succeed in the class, because that is how neuronal circuits are programmed and how processes in the brain ranging from retrieving facts from memory to riding a bicycle become automatic. I use the same advice almost daily with my patients when I emphasize to them the importance of practicing new behaviors or ways of dealing with difficult thoughts and emotions. Similarly, based on my reading of research on the effects of sleep, exercise, and social interactions on the brain, I share with my patients the importance of getting enough of each.
… as opposed to the narrow view:
… the narrow view tends to emphasize things like genetics, neurotransmitters, biomarkers, and circuits.
[Being an old man, I still have permission to call that broad view "the mind" if I want to]. I’ll leave it for Psycritic to relate his Professor’s story about Hemingway’s shortest story – one worth way more than the price of admission…
Also: I would recommend reading Philosophy Professor Anderson Brown’s blog on the "Mereological Fallacy"…
Effectiveness of repetition is long-standing learning theory. Plus — “Similarly, based on my reading of research on the effects of sleep, exercise, and social interactions on the brain, I share with my patients the importance of getting enough of each.” — isn’t this just basic common sense and humaneness? Sad to see it’s now an innovative approach to “brain function.”
We’re all suffering from jargon overload.
Respectfully disagree, Alto.
First, knowing that a thing is so is very different from knowing why it is so. The “why” is what lends the urgency and specificity to the repetition, and gives it greater power. It’s the difference between meditation and simply sitting in a corner with your eyes closed repeating the same word over and over again.
Second, it’s a bit of a game-changer to realize that man’s designs do not mirror nature’s. (As Stafford notes per Psycritic, a toaster doesn’t follow the same laws of form and function as the brain.) The idea that man’s artifacts somehow inherently follow the same structural logic as everything else in the universe is as old as the idea that man/woman is made in the image of God.
Love the way the four posts work together– Dr. Nardo’s, Brown’s, Psycritic’s and Stafford’s. Very elegant.