Monitor on Psychology - June 2012 - (Page 33)

mental illnesses are likely to have multiple causes, including genetic, biological and environmental factors. Of course, that’s true for many chronic diseases, heart disease and diabetes included. But for mental illnesses, we’re a particularly long way from understanding the interplay among those factors. That complexity is one reason that experts such as Jerome Wakefield, PhD, DSW, a professor of social work and psychiatry at New York University, believe that too much emphasis is being placed on the biology of mental illness at this point in our understanding of the brain. Decades of effort to understand the biology of mental disorders have uncovered clues, but those clues haven’t translated to improvements in diagnosis or treatment, he believes. “We’ve thrown tens of billions of dollars into trying to identify biomarkers and biological substrates for mental disorders,” Wakefield says. “The fact is we’ve gotten very little out of all of that.” To be sure, Wakefield says, some psychological disorders are likely due to brain dysfunction. Others, however, may stem from a chance combination of normal personality traits. “In the unusual case where normal traits come together in a certain configuration, you may be maladapted to society,” he says. “Call it a mental disorder if you want, but there’s no smoking-gun malfunction in your brain.” You can think of the brain as a computer, he adds. The brain circuitry is equivalent to the hardware. But we also have the human equivalent of software. “Namely, we have mental processing of mental representations, meanings, conditioning, a whole level of processing that has to do with these psychological capacities,” he says. Just as software bugs are often the cause of our computer problems, our mental motherboards can be done in by our psychological processing, even when the underlying circuitry is working as designed. “If we focus only at the brain level, we are likely to miss a lot of what’s going on in mental disorders,” he says. The danger in placing too much attention on the biological is that important environmental, behavioral and social factors that contribute to mental illness may be overlooked. “By overfocusing on the biological, we are doing patients a disservice,” Wakefield says. He sees a red flag in a study by Steven Marcus, PhD, and Mark Olfson, MD, that found the percentage of patients who receive psychotherapy for depression declined from 53.6 percent in 1998 to 43.1 percent in 2007, while rates of antidepressant use stayed roughly the same (Archives of General Psychiatry, 2010). A nuanced view The emerging area of epigenetics, meanwhile, could help provide a link between the biological and other causes of mental illness. Epigenetics research examines the ways in which environmental factors change the way genes express themselves. “Certain genes are turned on or turned off, expressed or not JUNE 2012 • MONITOR ON PSYCHOLOGY expressed, depending on environmental inputs,” McNally says. One of the first classic epigenetics experiments, by researchers at McGill University, found that pups of negligent rat mothers were more sensitive to stress in adulthood than pups that had been raised by doting mothers (Nature Neuroscience, 2004). The differences could be traced to epigenetic markers, chemical tags that attach to strands of DNA and, in the process, turn various genes on and off. Those tags don’t just affect individuals during their lifetime, however; like DNA, epigenetic markers can be passed from generation to generation. More recently, the McGill team studied the brains of people who committed suicide, and found those who had been abused in childhood had unique patterns of epigenetic tags in their brains (Nature Neuroscience, 2009). “Stress gets under the skin, so to speak,” McNally says. In McNally’s view, there’s little danger that mental health professionals will forget the importance of environmental factors to the development of mental illness. “I think what’s happening is not a battle between biological and non-biological approaches, but an increasingly nuanced and sophisticated appreciation for the multiple perspectives that can illuminate the etiology of these conditions,” he says. Still, translating that nuanced view to improvements in diagnosis and treatment will take time. Despite decades of research on the causes and treatments of mental illness, patients are still suffering. “Suicide rates haven’t come down. The rate of prevalence for many of these disorders, if anything, has gone up, not down. That tells you that whatever we’ve been doing is probably not adequate,” Insel says. But, he adds, there’s good reason to hold out hope. “I think, increasingly, we’ll understand behavior at many levels, and one of those will be physiological,” Insel says. “That may take longer to translate into new therapies and new opportunities for patients, but it’s coming.” In the meantime, according to Insel and Kandel, patients themselves are clamoring for better biological descriptions of mental disorders. Describing mental illnesses as brain malfunctions helps minimize the shame often associated with them, Kandel says. “Schizophrenia is a disease like pneumonia. Seeing it as a brain disorder destigmatizes it immediately.” Certainly, Kandel adds, social and environmental factors are undeniably important to understanding mental health. “But they do not act in a vacuum,” he says. “They act in the brain.” It’s too soon to say whether we’ll someday have a blood test for schizophrenia or a brain scanning technique that identifies depression without any doubt. But scientists and patients agree: The more we understand about our brain and behavior, the better. “We have a good beginning of understanding of the brain,” says Kandel, “but boy, have we got a long way to go.” n Kirsten Weir is a freelance writer in Minneapolis. 33

Table of Contents for the Digital Edition of Monitor on Psychology - June 2012

Monitor on Psychology - June 2012
Letters
President’s column
Contents
From the CEO
Give an Hour founder is one of Time magazine’s ‘most influential’
APA treatment guidelines panels are being formed
APA supports ‘Speak Up For Kids’
In Brief
Time Capsule
Random Sample
Judicial Notebook
Questionaire
APA honors Howell
Science Watch
Science Directions
What you should know about online education
Speaking of Education
Psychologist Profile
Redefining masculinity
Miscarriage and loss
Something for everyone
Candidates weigh in
Division Spotlight
American Psychological Foundation
Personalities

Monitor on Psychology - June 2012