Brain confusion: Why it’s so difficult to find cures for mental disorders

Last fall, a paper in Nature on the largest genetic study ever conducted on schizophrenia generated a lot of excitement. The numbers alone were impressive: more than 300 scientists conducted a genome-wide association study (GWAS) on 37,000 people who had the disease and 113,000 who didn’t, and found 128 genetic variants (including but not limited to mutations) that showed up more often in schizophrenia than in non-schizophrenics.

“This finding lays to rest any argument that genetics plays no role,” noted Scientific American. Knowing the genetic underpinnings of a disease would help us understand how it develops. Just reverse the effects of whatever a variant is doing, and you have a cure, right?

That would be nice for schizophrenia, the treatments for which haven’t progressed much in 50 years, since drugs were discovered that could inhibit dopamine, one key chemical player in the disease. But schizophrenia, which affects 1 percent of Americans, is a complex disease (128 variants would be a clue to that complexity). And, like a lot of mental disorders, its evasiveness from modern treatment and medical research may indicate our shortcomings of how we try to understand the brain, and the mind.

Skewed perceptions

Just how badly our perceptions and understanding of the world can go wrong can be seen in understanding the symptoms of schizophrenia. They include hallucinations, delusions, and disorganized behavior, while other symptoms are emotional apathy and flatness of mood. While modern medicine strives for a treatment for all these symptoms, the disease might well exemplify a problem we have with studying mental illness—how can the brain study itself, and how do we know we’re right?

We don’t and we can’t, said Robert Burton, former chief of neurology at UC San Francisco and now an author of books on neuroscience. “A number of mental states that feel like conscious thought are actually involuntary mental sensations,” he told Salon. This is because, while the brain can study the brain—neurotransmitters, synaptic networks, genes and glucose metabolism—it’s not so adept at studying the mind.

And what is the mind? Nobody’s come up with a solid definition, but Burton suggests that “it exists in two separate dimensions—the subjective experience of what goes on inside our heads, and as an abstract concept.” So an MRI may show us an anomaly in our brain, and a GWAS may show what genes may shape schizophrenia, our impressions of schizophrenia may be just as delusional as a hallucination.

And just as schizophrenia has eluded effective treatment, so have a number of disorders of mood, empathy and emotion—autism, depression, and bipolar mood disorders have all presented significant challenges to medical treatments, to say the least.

Certainly, this elusiveness is not due to a lack of trying. Scientists worldwide have spent the last century trying to understand how these disorders arise, while simultaneously looking into how the brain works, in sickness and in health. Anatomy, genetics, fMRI, cognitive studies, molecular mapping of synaptic networks, all and more have been used to determine what makes our brain unique. And the mind that goes with it.

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But we still don’t have a grasp of the subjective part of us that makes up the mind. Moods, desires, empathy, apathy, and feelings are all subjective, an important part of us as social beings, and are things that can go very wrong in a large number of mental disorders. As seen in this illustrative fictional conversation between medical students in an American Journal of Psychiatry paper, this argument has been going on for decades, even in the age of molecular biology:

Student A: People don’t feel a dysfunctional serotonin receptor. They have conflicts, wishes, and fears. How can molecules and receptors have wishes or conflicts?”

Student B: Are you seriously claiming that there are aspects of mental functioning that cannot be due to brain processes? How else do you think we have thoughts or wishes or conflicts? These are all the result of synaptic firings in different parts of our brains.

Where the solutions are — if only we could see them

As scientists continue to map, measure, and quiz research subjects, others have had more dramatic solutions.

The psychiatrist Thomas Szasz didn’t exactly win any converts from his colleagues when he suggested that labeling disease was the source of the problem with resolving mental disorders, and therefore, mental disorders should not exist. Not that the suffering isn’t there, but that calling them a disease was a scientific fraud of sorts, because diseases had to have physical lesions. And since he firmly believed that the mind was not at all physical, it cannot be diseased. In an altered state, yes. But not diseased. This is something like the “wave” theory of matter in quantum mechanics, where physicists believed that on a subatomic scale, matter existed in waves and could not be felt.

This was, however, a direct affront to brain scientists looking for changes in structure and function. For the purposes of metaphor, these scientists might be compared to “particle” theory physicists who believed that matter on a very small scale was something tangible, and rather static.

Help wanted: A new Einstein for the mind

Of course, Albert Einstein and other quantum physicists put these together; matter is both a wave and a particle. The only problem is, matter changes its character from wave to particle, depending on how you are looking at it. Much like how we’re looking at the mind and the brain, perhaps.

Robert Burton the neurologist calls for a new “quantum theory” of sorts for our study of the mind. In his view, the brain scientists, psychologists looking at the mind, and even the rare Szasz follower are failing to see an overall structure and function that perhaps, like quantum physics, goes beyond structure and function. And, like in quantum mechanics, the first step is knowing that you have no idea what you’re looking at.

Andrew Porterfield is a writer, editor and communications consultant for academic institutions, companies and non-profits in the life sciences. He is based in Camarillo, California. Follow @AMPorterfield on Twitter.

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