There was an article at Psyche.co called “Mental disorders are brain disorders“. The thesis is that thinking of mental disorders as a separate category from other physical disorders is hindering patient care. The author, Christian Jarrett, says that many people don’t think so because the causes of mental disorders are “outside the body.” Then, he gives an analogy with heart disease. Many, if not most, of the things that contribute to heart disease are outside the body. Think of diet, exercise, smoking, drinking, etc. Yet, no one considers heart disease anything other than heart disease. We need to focus on the organ or organ system that is damaged.
This thesis is likely to rub a lot of people the wrong way. That’s especially true since the debunking of the serotonin hypothesis. The reason it’s likely to bother people is because, those of us with mental illness, have been trained on talk therapy. It’s not that we don’t take medicines for mental illness. It’s that therapy is the first intervention, and usually continues with the medication. Jarrett counters this by explaining that talk therapy is a biological intervention. It changes structures in the brain, specifically the medial prefrontal cortex.
So, if both therapy and medication work on the brain, what does that mean? I think it means that Jarrett makes his case, mental disorders are brain disorders. However, I need some clarifications.
First, the mind/body problem has been around for centuries, and no one has been able to settle it one way or the other. People who debate it are extremely confident in their positions, but they can’t come up with an argument that convinces the other side. Now, I tend towards physicalism. That’s the idea that everything that exists is physical. It follows from that that the mind and body are identical. They aren’t two separate things. That leaves me predisposed to accept Jarrett’s argument. I want to know what someone who believes that mind and body are separate would react. I feel like they may have some good arguments that I haven’t thought of.
Second, just because both medication and talk therapy change the brain, is that what makes them effective treatments (when they are effective)? Every experience we have changes the brain. (Thank goodness there we no fMRI machines when the printing press was invented.) What makes these changes causal?
Third, as far as I know, doctors don’t know what the drugs do to the brain or how they work. They just know that medications do something and they’re an effective treatment about half the time. Of course, I take medication and it seems to work for me, but these kinds of numbers don’t instill confidence. Wouldn’t you think that they’d work in 80 or 90 percent of cases if they were truly affecting the brain in the right way?
Just because I’m asking for some clarification doesn’t mean I disagree with Jarrett. I do believe that mental disorders are brain disorders, and I believe that’s where the research should focus. But I have questions. I wonder if there are any neuroscientists or psychiatrists out there who could help.
