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Separating the Wheat From the Chaff

Separating the Wheat From the Chaff

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From the Editor

We’re usually so busy trying to keep up with all the advances in our field and our own professional education needs that it’s hard to know what kind of information, other than the most egregious examples, the general public is receiving about psychiatry. This summer, in the June 28th health issue of the New York Times Magazine, there was a lengthy series of articles on psychiatric issues that illustrated for a general readership some of the most important and exciting advances. In addition to personal reminiscences from several prominent writers, the articles give a snapshot of both state-of-the-art scientific advances and personal experiences with treatment, and how our understanding of mental processes can be applied in ways that might seem unusual but may turn out to be very important.

Since the 1993 Time magazine cover that asked, “Is Freud Dead?”1 the public has been inundated with articles both proclaiming the lack of validity of Freud’s theories about mental development and the uselessness of psychoanalysis and related psychodynamic psychotherapies (and by extension all psychotherapies) for treatment. It was refreshing, therefore, to see the positive approach taken in the New York Times article “Tell It About Your Mother: Can Brain-Scanning Save Freudian Psychoanalysis.”2 This article presented, in an easily understandable way, how modern neuroscience research is providing support not only for some of Freud’s basic theories about mental functioning but also for how positive clinical improvement can be correlated with identifiable changes in brain functioning.

Of course, psychiatrists know that researchers have been working to illuminate these matters for over 4 decades. As long ago as the early 1980s, Eric Kandel, the Nobel prize–winning psychiatrist, was asserting that if psychotherapy works, it produces changes in brain micro-anatomical organization and functioning. He said that someday our ability to observe the brain’s functioning would be good enough to see evidence of those changes.

Psychiatrists know that day came over a decade ago, but these findings are little known to the public. This lack of awareness has made it easier for those who wish to disparage psychotherapeutic treatment or fail to support reimbursement for psychotherapy. Political discussions about climate change and old commercials about “better living through chemistry” notwithstanding, most Americans have a healthy regard for science and are able to understand scientific advances and to see how those advances can translate into better health. As both a psychoanalyst and a cognitive neuroscience researcher, I was glad to see a sophisticated and easily understandable article on psychoanalysis and the neuroscientific research that supports it.

On the other end of the spectrum, a very balanced presentation about the benefits and risks of one of the most dramatic pharmacotherapeutic advances in modern psychiatry—the FDA approval of lithium carbonate to treat bipolar illness—was found in “I Don’t Believe in God But I Believe in Lithium.”3 (I still remember exactly where I was in 1970—in my medical school’s preclinical study room—when I first heard about the FDA approval of lithium and its “almost magical” impact on the disease’s symptoms.)

Too often, the public media is filled with sensationalistic antipharmaceutical and antipsychiatry stories about the dangers and abuses of psychotropic medications. The primary aim of these stories has been not to educate but to frighten. The impact has been to increase stigma about psychiatric treatments and to induce even more hesitancy than would ordinarily exist in seeking treatment by those in need. The New York Times story, on the other hand, is a first-person account of the amazing beneficial effect of lithium on bipolar disorder as well as an appropriately cautionary discussion of the risks. My kudos and thanks go to the author, whose courage and thoughtfulness provided a report useful to patients with bipolar disorder, their families, and the general public as well as being supported by many in the psychiatric community.

You’d have to have been incommunicado for the past several years to be unaware of all the news reports about the increasingly important study of the role of our own micro-biome, especially our gut bacterial flora, in illness and health. The latest wave of interest has been the role of our intestinal flora in problems such obesity and autoimmune disorders such as Crohn disease and lupus.


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