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Hot Topics of 2016: In and Around Psychiatry: Page 3 of 3

Hot Topics of 2016: In and Around Psychiatry: Page 3 of 3

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To me, the important take-home message of this campaign has less to do with evaluating the fitness of the candidates, but more what the election’s outcome tells us yet again about the role of empathy in politics. Whichever side you were on in the election, what’s clear is that decisions were made by many people not on their thoughts about the candidates. Nor did voters choose based on the strength of intellectual arguments. Their decisions in most cases, I believe, were based on their feelings about themselves and their own lives. The frustration, fear, and rage we saw, which led to an outpouring of votes for Donald Trump, was not invented by either Donald Trump or Bernie Sanders; it was already there. And like an empathic listening psychotherapist, the candidates who empathized with those feelings in the electorate, whether actual or feigned empathy, formed an alliance that led to lots and lots of votes and an electoral college victory (although at the time that I wrote this, Hillary Clinton was leading the popular vote).

Good psychotherapy does not primarily produce change through intellectual discourse but through engaging the emotional valance for certain cognitions in our patients—in my book, this is what won the election. Being a CNN and MSNBC addict (though I haven’t had much trouble going through withdrawal), I rarely heard any reference to those affects from the Democrats. The Republicans, at least since Nixon, have been masters at this, as is, for better or worse, the new President-elect.

There are lots of reasons anyone wins an election, including this one, but I think the politico-therapeutic alliance is a major factor that rarely gets much attention until the election postmortems. And then, the lessons are often forgotten. No one has to be well versed in Maslow’s hierarchy of needs pyramid to know that economic security, which supplies food and shelter, and safety/security for self and family are the most basic and primal. Bill Clinton, he of “I feel your pain,” and James Carville, he of “It’s the economy, stupid” (his exhortation to the campaign staff), and just last month, Donald Trump, are textbook examples. No one paying attention to this issue should have been surprised that Trump won, which in my view was due in large part to his bonding with voters around their affects stemming from economic insecurity (no job, no food or shelter, which leads to fear and insecurity about safety, which then often leads to rage).

One very important difference between therapy and politics, however, is that psychotherapists are well aware of the power of affects and their potentially harmful impact on the individual’s thinking and behavior. Because of this, we do our best to be exquisitely sensitive about modulating our interactions with our patients so that the individual is not overwhelmed and therefore maladaptive responses are kept in check. When political candidates for national office (this year we saw this at both the presidential and congressional level) not only empathize with strong dysphoric affects, but also mirror those intense affects in their own words and affects, what can be easily understood as fostering loss of usual constraints on maladaptive actions, it can unleash extremely worrisome consequences. And, to our great dismay, we have seen, both during the election campaign and its aftermath, the alarming rise in reported incidents of hateful speech and actions, often but not only by adolescents and young adults, directed against women and members of minority ethnic and racial groups.

And just a bit more

I can’t end this list of important issues from 2016 talking about politics, so just let me mention 2 other topics from the research world that made my own list. From Science magazine last February comes a report highlighting the role that maternal immune activation (as in Zika but other infections too) influences fetal brain development.17 This has been known for a long time, but has not been much of a subject for psychiatric research outside of decades-old explorations of a link between schizophrenia (or more recently autism) and maternal infection. Understanding the pathophysiology of this effect has tremendous implications for understanding the potential impact of prenatal maternal immune activation on many psychiatric illnesses.

Finally, I have to highlight the explosion of interest in the gut microbiome and its role in both physical and psychiatric disorders such as depression. While this field of research is really in its infancy, it has been known for ages that there are intimate connections between the gut and the brain. Now we are wondering what role our gut bacteria play in these processes. It is really like beginning to explore a whole new galaxy, and I’ll bet there is a great deal that pertains to mental functioning and psychiatric disorders awaiting discovery.

Well, it’s been an exhausting year, and if you’re still reading, this column has probably taxed your attention a bit, too. I hope everyone enjoys the holiday season, has time for at least a short break, and has a safe, healthy, productive and, more importantly, peaceful year.

Pages

References

1. Darby MM, Yolken RH, Sabunciyan S. Consistently altered expression of gene sets in postmortem brains of individuals with major psychiatric disorders. Transl Psychiatry. September 2016. http://www.nature.com/tp/journal/v6/n9/full/tp2016173a.html. Accessed November 10, 2016.

2. Sekar A, Bialas AR, de Rivera H, et al. Schizophrenia risk from complex variation of complement component 4. Nature. 2016;530:177-183.

3. Mukherjee S. Runs in the family. New Yorker. March 2016. http://www.newyorker.com/magazine/2016/03/28/the-genetics-of-schizophrenia. Accessed November 10, 2016.

4. Hamami C, Holtzheimer P, Lozano AM, Mayberg H, eds. Neuromodulation in Psychiatry. 1st ed. London, UK: Wiley-Blackwell; 2016.

5. Siegel DJ. Mind: A Journey to the Heart of Being Human. 1st ed. New York: WW Norton; 2016.

6. Sokhadze EM, El-Baz A, Tasman A, et al. Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: an exploratory study. Appl Psychophysiol Biofeedback. 2014;39:3-4.

7. Hillard B, El-Baz A, Sears L, et al. Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application. Clin EEG Neurosci. 2013;44:193-202.

8. Glasser MF, Coalson TS, Robinson EC, et al. A multi-modal parcellation of human cerebral cortex. Nature. 2016;536:171-178.

9. Goldstein-Piekarski AN, Korgaonkar MS, Green E, et al. Human amygdala engagement moderated by early life stress exposure is a biobehavioral target for predicting recovery on antidepressants. Proc Natl Acad Sci. 2016;113:11955-11960.

10. Tasman A. At last . . . I hope. Psychiatric Times. May 2016. http://www.psychiatrictimes.com/psychopharmacology/last-i-hope. Accessed November 10, 2016.

11. Volkow ND, McLellan T. Opioid abuse in chronic pain: misconceptions and mitigation strategies. N Engl J Med. 2016;374:1253-1263.

12. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain: United States, 2016. http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. Accessed November 10, 2016.

13. Pies RW. Physician-assisted dying for adolescents with intractable mental illness? Psychiatric Times. May 2016. http://www.psychiatrictimes.com/blogs/physician-assisted-dying-adolescents-intractable-mental-illness. Accessed November 10, 2016.

14. Barnard A. How Omran Daqneesh, 5, became a symbol of Aleppo’s suffering. August 2016. http://www.nytimes.com/2016/08/19/world/middleeast/omran-daqneesh-syria-aleppo.html. Accessed November 10, 2016.

15. US Department of Health and Human Services. Mental Health and Substance Use Disorder Parity Task Force: Final Report. http://www.hhs.gov/about/agencies/advisory-committees/parity/index.html#report. Accessed November 10, 2016.

16. Tasman A. Whistle while you work, Stevenson’s a jerk. Psychiatric Times. September 2016. http://www.psychiatrictimes.com/cultural-psychiatry/whistle-while-you-work-stevensons-jerk. Accessed November 10, 2016.

17. Estes MK, McAllister AK. Maternal Th17 cells take a toll on baby’s brain. Science. 2016;351:919-920.

 
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