Why hasn't neuroscience delivered for psychiatry? - David Kingdon

ME/CFS Skeptic

ME/CFS Skeptic

Senior Member (Voting Rights)
Abstract
Biological research has produced major advances in our understanding of our bodies and, where systems go wrong, is producing remedies to address these, but it has yet to do the same for the mind. This is because no causative biological evidence has been found for the major mental disorders in contrast to the wealth of psychosocial findings. This disparity in regard and resource needs to be addressed.

Link to paper: https://www.cambridge.org/core/jour...r-psychiatry/2EB9F2202E61BCC98A5D1E5F5F825607
 
Not exactly a recommendation. The authors asks: "isn’t listening to patients perceptions of causation more likely to provide insights rather than looking down a microscope?"

The main question - "Why do we not have evidence of biological malfunctioning for severe mental disorders?" - is interesting but the authors solution (stop looking) less so.
 
"David Kingdon is Emeritus Professor of Mental Health Care Delivery at the University of Southampton, UK and formerly psychiatrist and manager with Southern Health NHS Trust. His research interests are in cognitive therapy of severe mental health conditions and mental health service development. He currently chairs or is a member of a number of TSC and DMECs. He lectures, holds workshops and edits/writes publications including new editions of Cognitive Therapy of Severe Mental Illness (APPI) and Seminars in General Adult Psychiatry (CUP)."

https://www.southampton.ac.uk/people/5wzknh/emeritus-professor-david-kingdon

A CBT true believer by the look of it.
 
ME/CFS Skeptic said:
The main question - "Why do we not have evidence of biological malfunctioning for severe mental disorders?" - is interesting but the authors solution (stop looking) less so.
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One need only look at how things like POTS are psychologized to understand at least a part of the why (an assumption is made that the malfunction must be in the mind/brain).

Another part is presumably that the diagnostic system is based on certain assumptions, many of which could be wrong. And they can't question that because it's a too big to fail situation.

I also suspect a good portion of presumed mental illness (the milder end) doesn't have a biological cause, but is just how stress of poverty, lack of housing, stability, low well being, etc. can manifest.
 
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There is also the possibility that current psychiatric diagnoses do not correspond to real world categories. For example with ME/CFS the BPS, in their formulation of CFS, seek to lump people with diverse aetiologies together, which along with their obsession with the non specific symptom of fatigue and their failure to take seriously the symptom of PEM may have delayed any understanding of its biological underpinnings.

Potentially depression, as a symptom, may similarly be non specific, appearing in a range of distinct pathologies.
 
ME/CFS Skeptic said:
"isn’t listening to patients perceptions of causation more likely to provide insights rather than looking down a microscope?"
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The answer is clearly "no". The microscope provides quantitative data, while questionnaires provide qualitative opinions/beliefs.

"Qualitative research, on the other hand, collects non-numerical data such as words, images, and sounds. The focus is on exploring subjective experiences, opinions, and attitudes, often through observation and interviews.

Quantitative data is information about quantities, and therefore numbers, and qualitative data is descriptive, and regards phenomenon which can be observed but not measured, such as language."

What comes to my mind is how in the 70's (?) educators tried to replace actually teaching a subject with some "touchy-feely, new-age self-directed" philosophy. Is there any quantitative data on how well students under that philosophy learned math, language skills, etc, vs the traditional methods?

"Interest in qualitative data came about as the result of the dissatisfaction of some psychologists (e.g., Carl Rogers) with the scientific study of psychologists such as behaviorists (e.g., Skinner )."
Maybe that can be interpreted as: "They were failing to provide impressive results using quantitative methods, so they decided to switch to a method that made even utter nonsense look impressive and was almost impossible to prove invalid."

The quotes are from https://www.simplypsychology.org/qualitative-quantitative.html I found it quite amusing, and a good example of biased perceptions. Since it's in a psychology journal, the author and editors must perceive the content as supportive of psychology's reliance on qualitative data. From my perspective, the article accomplishes the opposite, showing the weaknesses of the approach and the self-serving nature of it.

Hmmm, psychology has one major success: it saw the weaknesses in human reasoning and used psychological manipulation techniques to make psychology look better than it actually is. If you can't show statistical evidence of success, convince people that statistical evidence should not be applied to psychology (just apply appropriate bafflegab and handwavium).
 
Hoopoe said:
Another part is presumably that the diagnostic system is based on certain assumptions, many of which could be wrong.
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The main assumption being that medicine knows all there is to know about basic physiology, and there is nothing important left to discover, so there is no need to keep looking.
Peter Trewhitt said:
There is also the possibility that current psychiatric diagnoses do not correspond to real world categories.
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"....we cannot succeed if we use DSM categories as the “gold standard.” The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category."

Thomas Insel, Director of NIMH (2002-15), in 2013.

https://thehealthcareblog.com/blog/2013/05/03/transforming-diagnosis/
 
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Further on "gold standards": it's been my recent experience that one gold standard relied on as such, is not as advertised, an absolute gold standard.

However, practitioners with limited knowledge and skills have taken this so-called "gold standard" as the be all and end all, to the detriment of patients.

More in-depth research, understanding, and indeed, input from a patient, or patients, changes the weight, influence and effect of this relied on testing in decision making re diagnosis and treatment.

Reliance on testing and diagnostic categories "written in stone", as the DSM appears to be, do not necessarily keep up with emerging research data, as the quote above by Thomas Insel indicated.
 
My bolding

ME/CFS Skeptic said:
Biological research has produced major advances in our understanding of our bodies and, where systems go wrong, is producing remedies to address these, but it has yet to do the same for the mind. This is because no causative biological evidence has been found for the major mental disorders in contrast to the wealth of psychosocial findings. This disparity in regard and resource needs to be addressed.
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The bit in bold isn't true. I suspect that schizophrenia is classified as one of the "major mental disorders", and its symptoms have been found to reduce if nutritional deficiencies are treated. This makes me wonder if nutritional deficiencies in the mother can increase the risk of schizophrenia developing in the child in the womb.

A web search for "vitamin deficiencies in schizophrenia" returns lots of results.

Title : B vitamins reduce schizophrenia symptoms, study finds

Link : https://www.manchester.ac.uk/discover/news/b-vitamins-reduce-schizophrenia-symptoms-study-finds/

.

Title : The psychotropic effect of vitamin D supplementation on schizophrenia symptoms

Link : https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03308-w

.

Another common condition which is associated with the risk of psychiatric disorders is iron deficiency anaemia.

Title : Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis

Link : https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02621-0

Iron deficiency is known to be most common in women, and so is depression and anxiety.

I am aware that mentioning vitamin deficiencies is often viewed as being a sign that someone believes in "woo" and who can therefore be ignored. But having said that, I still believe that someone with disease X will feel worse with low levels of nutrients, whatever X is.
 
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