Neuroscience: Psychotherapy’s Executioner?




Psychiatry and Psychology CategoryWithin the field of psychology more and more research is based on the functioning of the brain. Even in fields such as social psychology, which traditionally was opposed to looking at the relationship between brain and behavior, is neuroscience growing. More and more psychological disorders are being explained in relation to neurological function or dysfunction. Depression is caused by too few or too many neurotransmitters. Schizophrenia is caused by a “mis-wired” brain. Anxiety is caused by a hyper-reactive sympathetic nervous system (and possibly an abnormal amygdala). We are overweight because of hypothalamic problems and can’t sleep because our reticular activating systems are out of whack.

All psychopathology is now being described in neurological terms. Many believe this implies that all psychopathology is now treatable and curable by medication because all psychopathology has a biological basis. Cartesian dualism is alive and well; in fact, it’s never been stronger.

Does this spell out impending doom for psychotherapy? Can we simply medicate our problems away?

Bust of Rene DescartesLet’s return to philosophy to find out. The increasing emphasis on the brain is leading to a blurring between what is mind and what is body. Perhaps, Descartes’ philosophy isn’t as strong today as we thought. If body and mind are not separate entities then we no longer have a dualism but rather a monism. This implies that psychopathology is, at its core, nothing more than pathological brain function or structure. For example, according to the philosophy that underlies the neuroscience of psychopathology, depression is nothing more than a perhaps smaller cingulated gyrus and basal forebrain with abnormally low production or abnormally high re-uptake of serotonin and norepinephrine. This does not, however, imply that behavioral or cognitive therapies are not necessary and that all psychopathology is ultimately treatable by medication or electrode implants or neurogenesis or whatever the next neuroscience fad is.

Having no distinction between mind and body or brain and behavior (a monism opposed to a dualism) implies that affecting either mind or body affects both because they really are the same. As confusing as that sounds, it’s an important concept. It means that psychotherapy is not threatened with extinction by neuroscience or pharmaceuticals. Treating the mind (behavior) changes the body (brain). Conversely, treating the body (brain) changes the mind (behavior). There is room for both biological and psychological therapies. There are people who seek a purely biological cure and those who eschew biology for psychology. However, the ultimate solution lies in moderation — a balance between the two.

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  • I was relieved to see that you close this piece with a sound conclusion, but dismayed that you lead with some of the most pervasive, unfounded cliches of what has been called “neuromythology.” For instance the biobabble myth that: depression is caused by lack or excess of neurotransmitters.

    As I’m sure you are aware: There is absolutely no evidence to support the idea that depression is “caused” by too few or too many of any particular neurotransmitter. Depression is correlated with these states. But there is scant understanding about the nature of the relationship between the two. A causal relationship has never been established.

    Any psychiatrist will tell you that we have no idea what the mechanism is makes these drugs work (when they do better than placebo).

    As you rightly point out treating the mind affects the body and vice versa. You explicitly address this in your piece, I just wish you hadn’t loaded the misconceptions in the first paragraph, the only one that many people read.

  • The solution lies in the integration offered by a bigger picture. That is a person with physical and spiritual/psychological dimensions.

    Disentangling cause and correlation is indeed tricky.

    Thanks for a great post on a very important topic.

  • Though most scientists would say that brain and mind are the same thing (i.e., monism), that is not all that helpful. We need to distinguish three kinds of mind: unconscious, subconscious, and conscious. Conscious mind is especially significant because it is the teacher of the subconscious. Though conscious mind emanates from brain function, it is unique. Some researchers say that it is an observer of the output of subconscious processes and can veto subconscious impulses and decisions. Others (I among them) say that it also is the primary teacher of the subconscious mind, controlling what sensory and cognitive experiences are presented to the subconscious. See my new, inexpensive e-book on “Core Ideas in Neuroscience” (neurosciideas.com). I also operate a blog on what science reveals for improving everyday memory (thankyoubrain.blogspot.com).

    .

  • I was relieved to see that you close this piece with a sound conclusion, but dismayed that you lead with some of the most pervasive, unfounded cliches of what has been called “neuromythology.” For instance the biobabble myth that: depression is caused by lack or excess of neurotransmitters.

    Thanks for pointing that out. I know I oversimplified the biology of depression (and the other disorders). I did so for the sake of brevity at the expense of accuracy. Depression is also correlated with abnormalities of the frontal lobes.

  • Maunik

    As someone with a background in neuroscience that also has aspirations to become a psychotherapist I do not necessarily see the two as irreconcilable. I think that those that put too much emphasis on the biology over the psychology underestimate the power of neuroplasticity. I believe that while most behavior and by extension mental disease may be explainable in terms of biology we must acknowledge that our brains our constantly changing in response to the environment. The subjective experience of the psyche plays an important role in how neurobiology changes. The future of both of these fields will be one in which they are compatible rather than competitive.

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  • An excellent article! As a former psychiatrist, with a neuroscience PhD, now working as an executive performance coach, I am delighted to see this kind of thinking brought to the fore. Of course there are details around depression correlating to decrease receptor sensitivity that have to be simplified to engage a wider audience, but the overall message is important and delivered very well – thank you. PS antidepressants work by up-regulating serotonin (plus noradrenaline) receptor sensitivity in the frontal lobes but psychological therapy can also do this as can physical exercise. These therapies are not mutually exclusive and it would be sad if anyone took them to be so 🙂

Jared Tanner, PhD

Jared Tanner has a Ph.D. in clinical psychology with an emphasis in neuropsychology. His interests are mainly neuroimaging and neuroanatomy. He spends his research time looking at the structure of gray and white matter in the brains of people with Alzheimer's disease and Parkinson's disease. With a focus on neuropsychology, he is also interested in how normal and abnormal brain structure relates to cognitive and behavioral functioning.
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