On an article...

hey - jus writing down some of my musings abt this topic in response to an article i read recently... the reference, for anyone who's interested is:
Fuchs T (2004). Neurobiology and psychotherapy: an emerging dialogue. Curr Opin Psychiatry 17:479-485

firstly, i'm hardly in a position to challenge the expert opinion of an associate professor at a major european uni... so what i'm saying, to go in the face of some things implied by the article, is probably somewhat foolish!!! but i jus thought i'd say it anyway... i guess what i'm saying doesn't really argue against anything that he says, but rather jus puts a different light on the findings described in the article... - i'll quit rambling, here goes:

fuchs' article outlines some exciting, recent developments that link, by correlation, psychotherapy and neurobiology, which are two traditionally separate scientific fields... neurobiologists probably see their field as far more "scientific", but as psychotherapy is increasingly pressured to join the bandwagon of evidence-based therapies in order to survive in mainstream psychiatry, studies are being carried out looking at brain changes brought about thru psychotherapy and comparing them to brain changes brought about thru pharmacological intervention... - neuroimaging has gone a long way to making this possible... some very interesting findings have come to light - these include the similar neuroimaging findings across the two modalities of therapy, the temporal dimension of change brought about by the two modalities, and the circuits involved in mediating the long-term brain morphological effects of psychotherapy...

i'll begin with a brief overview of psychotherapy - a modality of treatment consisting of courses of sessions with a psychotherapist (psychologist or psychiatrist, usually) that finds its origins in the psychoanalytic theories of freud... the image that comes to mind is one of the patient on the couch, and the psychiatrist in a chair, a cozy room, and the patient divulging intimate details about past lives to a psychiatrist with an ulterior motive!!! of course, there is in truth much structure to psychotherapy, and more recent incarnations of psychotherapy are short courses of 10-20 separate hour-long sessions in which certain themes in the patient's history are explored using sophisticated, controlled techniques in which the psychiatrist not only seeks to understand the patient, but his or her own reaction to the patient's story also... the current vogue is cognitive-behavioural therapy (CBT), which is a form of psychotherapy in which the patient is encouraged to exercise thought-pattern and behavioural changes slowly and consistently to overcome his or her problems, often employing goal-forming and distraction techniques to achieve these changes...

CBT has been found to achieve very similar brain changes on neuroimaging to pharmacotherapy for certain conditions, such as obsessive-compulsive disorder... this is an encouraging finding, since although both had some level of evidence that they worked, the neuroimaging findings support the view that a disturbance in the architecture of the brain (distinguishable at an anatomical level) is associated with the disorder itself, and not merely a confounder... on the other hand, different changes were observed between the two types of therapy when applied to depression...

the temporal aspects alluded to earlier were ones of a more top-down progression of change associated with psychotherapy, and a more bottom-up progression associated with pharmacotherapy... the implication here is that psychotherapy recruits the active involvement of the cortex, and reorganisation thereof causes secondary changes in associated circuits in lower centres, while pharmacotherapy primarily targets the lower centres... this makes sense as well, with pharmacotherapy being more targeted at different neurotransmitter pathways, which are usually localised in lower centres, while psychotherapy's involvement of the conscious mind implies the involvement of the higher centres (cortex), which has traditionally been described as the part of the brain responsible for consciousness, and "what makes us human"...

i guess this is the point that i find contentious... the point of view put forward commonly in scientific papers such as this one tends to ignore or exclude the existence of a mind that transcends the physical world... as a dualist (as in, one believing in an extraphysical mind), i tend to look upon conscious humanity as being an entity additional to, rather than emergent from, the physical brain... now what relevance does this have to the article?!? - the existence of mind-brain correlates, as found by neuroimaging following intervention, should not be interpreted to imply that the brain is therefore responsible for the mind-state... the brain, to me, is simply reflective of the mindstate, and certainly exerts influence over the mind as much as the mind exerts influence over it... the fact that psychotherapy, as every interpersonal relationship, is going to involve connection between minds, does not mean that psychotherapy implicitly will have no effect on the brain, since the mind and brain are very closely related units...

take memory for example... ppl talk about implicit and explicit memory, and different circuits in the brain being involved in each... yet these structures have been shown to be associated with memory formation, but no area has been proved to be associated with memory storage as such... - does this mean that memory isn't stored in the brain?!? - i don't think it's a wise thing to extrapolate and say that it definitely isn't, but i think that the distinct possibility that memory may be stored in a mind additional to the brain should not be discounted... brain changes related to learning also should not automatically be attributed to storage - since there are changes in the memory formation apparatus (refinements) that may well result from the process of learning...

memory is a really interesting concept - i can look at a scene, and take it in, and remember in great detail so many aspects of the scene... we can all do this, with remarkable success, through processes that are unconscious as well as conscious ones... an interesting question, though, would be whether the rich sensory information that is able to be remodelled with recall can be stored in some compressed, compact format in the brain itself... such a complex system of memory storage would be an amazing feat of association (between all five senses, previous experiences, and completely novel constructs with each experience), and an amazing metabolic accomplishment, since remodelling is constantly necessary to live a well-adjusted life... not only does memory cover perceptual experience, but also conceptual experience, whereby the mind forms or encounters abstract constructs in order to help make sense of the world... this, in effect, is imagination... anyhow, to think that such amazing things are possible with the brain in isolation, given the physical limitations of the brain organ, is quite mind-boggling... to me, it seems to make more sense that the mind allows us to transcend these limitations...

i can come up with counter-arguments to myself tho... what of the monkeys?!? do they also have minds?!? after all, they seem to have a fairly strong sense of declaritive and procedural memory too... it's a hard topic... i really don't know... but i'm always finding this interesting, and hoping to find out more...

anywayz, have been rambling long enough... ;p shall return to reality once more... ah, the responsibilities of being a member of human society...