Psychiatry and neuroscience: Don't sacrifice proven emergence at the altar of unproven reductionism

John Markowitz who is a clinical psychiatrist at the NIH has a cogent column in the New York Times in which he argues that an excessive focus on neuroscience translational research is stifling useful and proven research in psychiatry. His main point is that the neuroscience research is unproven and long term, and while it may promise attractive dividends, there are many patients who need good psychiatric treatment now, patients who cannot work along the timelines promised by cutting edge neuroscience work.

I think in general he's right. Neuroscience seeks to find out the basic mechanisms governing neural health and disease by way of genes, receptors and small molecule drugs. Psychiatry and especially psychotherapy takes a more empirical and holistic approach, trying various combinations of talk therapy and drugs to treat mental illness. Even psychiatry itself has suffered from the kind of crisis that the author talks about. For instance, it is now increasingly clear that talk therapy (especially CBT) works at least as well as psychiatric drugs like antidepressants.

To me, at least part of the debate seems to be about a topic that I have often explored on this blog: emergence vs reductionism. Generally speaking, the goals of neuroscience are reductionist, seeking to modulate mental processes in health and disease by understanding and engineering interactions between genes, proteins and drugs at the molecular and network levels. The goals of psychiatry are emergent and empirical. Psychiatry does not care about the underlying molecular mechanisms of mental health; instead its goal is to work at a higher and more holistic level, empirically trying out different approaches until a particular combination of methods seems to show efficacy. It is not surprising that drugs like antidepressants which aim to interact with specific protein receptors in the brain are often found wanting because they target only part of a much larger system.

This philosophical difference between neuroscience and psychotherapy also strikes me as being a bit similar to the philosophical difference between chemistry and physics which I have often talked about here. Physics may want to find out how the world works by tracing the interactions between elementary particles like quarks, but chemists have little use for this information, benefiting tremendously instead by understanding semi-empirical concepts like hydrogen bonds and hydrophobic effects. The time discrepancy that the author points out regarding the fruits of neuroscience research and psychiatry also applies to physics and chemistry; if chemists waited long enough to be able to use physics and understand every complex molecular system from first principles, we would still be living in the age of alchemy.

The NYT article ends by appealing to the NIH to not sacrifice proven empirical psychiatry research at the altar of long-term translational research in neuroscience, and this underscores yet another one of the more general problems with translational research that I and others have pointed out. It is why the much celebrated and publicized Brain Initiative troubles me; I fear that it will detract from more mundane but effective psychiatric research. Far flung reductionist research may well promise and eventually bring great insights, but it should not be pursued at the cost of immediately workable emergent research whose very lack of precision makes it so useful.