It’s a lot like watching a reality television show, only without Simon Cowell providing amusing commentary. But the essential ingredients are all there: shifting alliances, suspicions, competition for resources, and perhaps even frenemies. Yes, watching neuroscience interact with clinical psychology might be entertaining if the consequences didn’t directly affect millions living with mental illness.
Neuroscience and clinical psychology should, in theory, be on the same team. They share similar goals in addressing mental health issues. However, the history of their relationship has been marked by heated debates over research funding and personal suspicions held by both camps. An alliance formed between them when neuroscience promised to legitimize mental illness as real, biological illness. However, changing rhetoric in the neuroscience world, as advocated by a recently-published paper, now threatens to end the fragile truce.
There was a time when I would have thought a reality television metaphor went too far, until I had to survive for three months under one roof with both camps. I worked as an intern at a European institute that housed both a therapy clinic and a neuroscience laboratory. The personal disdain that neuroscientists and clinicians often hold for one another’s work surfaced quickly. Not two weeks into my time there, someone in the lab offered to “get me out of” working in the clinic. Clinical work, he observed quietly, was a waste of time for a budding scientist. Not long after, a clinician cornered me and gave me an unsolicited lecture on why he thought neuroscience would never help a real patient. These sister disciplines, housed on two floors one right on top of the other, ostensibly sharing the same goals, were seemingly worlds apart.
This drama played out in America at the same time, only not in the whispered tones of internal corridors, and with much higher stakes. The National Institutes of Mental Health (NIMH), the body primarily responsible for funding scientific research on mental illness, has come under serious fire over the last decade for supporting neuroscience and other basic research. Patient advocacy groups have long argued that NIMH should only fund studies that directly examine mental illness. And NIMH has listened, shifting funding priorities away from neuroscience and other basic research that is perceived to not have any immediate benefit to people living with mental illness (Holden, 2004). However, many neuroscientists have seen their budgets cut just as their findings were coming to fruition in terms of helping clinicians. There remains a great deal to be learned about basic cognition and behavior, these researchers contend, before more complex phenomena such as mental illness can be fully understood.
Arguments over funding and research prioritization remain heated and unresolved. However, despite philosophical differences and institutional infighting, the public face of the relationship between clinicians and neuroscience researchers has been much friendlier. In fact, much of the clinical world has come to actively market neuroscience research.
In some ways, neuroscience research has been manna from heaven. It legitimized mental illness as illness in public opinion. If the average American believes that depression is a lazy person’s response to regular life difficulties, well then, that person should just buck up and get over it. This heavy stigma cast a long shadow over the progress of mental health treatment for decades. However, when newly armed with brightly-colored blobs on brain scans showing that depression might have something to do with biology, patient advocacy groups had more success in changing public opinion. If schizophrenia is a “brain disease” and depression is a “chemical imbalance,” then it’s game over for anyone who believed that mental illness wasn’t real or worth the devotion of public funds and support. No one can argue with biology.
And so we come to the latest twist of the story, which may threaten the already-precarious relationship between clinical psychology and neuroscience. A recent article published in Perspectives on Psychological Science essentially bursts the biological bubble, the darling of clinicians and neuroscientists alike (Miller, 2010). Although it is satisfying to believe that there is a “gene for” schizophrenia, or chemical problems “underlying” depression, these assumptions are both wrong and damaging. Biology does not underlie or explain mental illness, and indeed will never be able to do so.
The arguments could perhaps best be understood as follows: If I were to ask you what the Internet was, your answer would probably not be “a bunch of computers.” We know that the Internet requires computers, but the Internet also requires a lot of human input and interaction between human input and the computer. The Internet is also an environment in which many things transpire. If you are watching a rerun of American Idol on YouTube, you would understand that this activity is the product of many things: hardware, software, networks, actions of other users, etc. In short, you could easily recognize that computers are necessary, but not sufficient, to explain the Internet.
Mental illness can be thought of in the same way. There is little doubt that genes and neural networks are necessary for the development of mental illnesses, but they are by no means sufficient to explain them. Just as hardware can alter the actions of software, software can alter the actions of hardware, or of networks, or of users. Mental illness is equally multidirectional. Biological interventions might affect psychology (e.g. a person’s mood state), but psychological interventions such as therapy have also been shown to affect biology (Baxter et al, 1992). The Perspectives article argues that it is naïve and irresponsible to try and reduce mental illness to biology, no matter how socially convenient it is to do so.
So what will happen next? If the clinical world perceives that neuroscience no longer has a direct ability to explain mental illness, will the fragile truce between clinicians and neuroscientists be broken? How will NIMH and other funding agencies react, and what will the ramifications be for the advancement of neuroscience?
Stay tuned for the next season, folks. It’s going to be a live one.
Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, Alazraki A, Selin CE, Ferng HK, & Munford P (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of general psychiatry, 49 (9), 681-9 PMID: 1514872
Holden, C. (2004). BEHAVIORAL SCIENCE: NIMH Takes a New Tack, Upsetting Behavioral Researchers Science, 306 (5696), 602-602 DOI: 10.1126/science.306.5696.602
Gregory A. Miller (2010). Mistreating Psychology in the Decades of the Brain Perspectives on Psychological Science, 5, 716-743 : 10.1177/1745691610388774