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Another blow to mind-body dualism
Aug. 15th, 2001 10:39 pmWESTPORT, CT (Reuters Health) - Antidepressants and psychotherapy, when used to treat major depressive disorder, appear to affect brain activity in similar ways, according to the findings of two studies reported in the July issue of the Archives of General Psychiatry.
In one study, Dr. Arthur L. Brody, from the University of California at Los Angeles, and colleagues used positron emission tomography to assess metabolic changes in the brains of 24 patients with major depressive disorder who were treated with paroxetine or interpersonal psychotherapy. Sixteen normal subjects were scanned for comparison.
Prior to treatment, patients had higher activity in the prefrontal cortex and lower activity in the temporal lobe than control subjects. With treatment, however, these metabolic changes tended to normalize. Depression scores improved more in the paroxetine-treated group than in the psychotherapy group, but both groups experienced similar changes in metabolic activity.
In another study, Dr. Stephen D. Martin, from the Cherry Knowle Hospital, Sunderland, UK, and colleagues used single photon emission computed tomography to evaluate brain blood flow changes in 28 patients with major depressive disorder who were treated with venlafaxine hydrochloride or interpersonal psychotherapy.
Both treatment groups experienced a substantial improvement in their depression scores compared with baseline values, the authors note. Both groups demonstrated increased basal ganglia blood flow, while only the psychotherapy group showed increased limbic blood flow.
In an editorial, Dr. Harold A. Sackeim, from the New York State Psychiatric Institute in New York City, comments that "despite the specifics of the regional changes that were identified, both studies found that the changes in functional brain activity following pharmacotherapy and psychotherapy were remarkably similar."
Dr. Sackeim states that "it is conceivable that a unitary pathway or set of pathways is involved in the relief of depressive symptomatology."
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Ha. I am so pleased. I remember seeing similar results presented when I was in college, involving PET scans of people with OCD receiving either psychotherapy or medication. I should dig those articles out, along with these, so I can prosyletize.
On the one hand, you have the folks who have been as well-educated by the pharmaceutical industry and the National Alliance for the Mentally Ill as those organizations could possibly ask. "Depression is a disease" - (No, depression is not a disease. Depression is a syndrome. Diseases have known pathological processes. It drives me crazy to be, apparently, one of the few people in the world who understands this distinction.) - "like any other. You wouldn't ask a diabetic to do without insulin, and try to make changes just by talking about them."
On the other hand, you have the Dr. Peter Breggins of the world, frothing about the conspiracy to medicate us all into complicity with an unjust evil system, and convinced that if we only had enough freedom and compassion no one would ever have symptoms of mental illness.
Depression is not like diabetes, because insulin and glucose are not thoughts. There is no difference between thoughts and speech and ideas on the one hand, and neurochemical and neuroelectrical events on the other. If a diabetic could adjust insulin and glucose by an act of will, or with the assistance of another's will, we would ask them to make changes just by talking about it - or at least, we'd place that strategy before them as an option. Psychotherapy is no different. Contrariwise, to deny that neurochemical processes underlie complex human mental activity is equally absurd - and if you accept it, you either have to accept the validity of chemical intervention in adjusting mental processes, or you have to make the tenuous argument that only indirect intervention is morally or philosophically acceptable.
I confess, mind-body dualism is hard to uproot - even for a committed believer in monism. There seems to be something profoundly natural about making a division between the realms of thought and the realms of, well, meat. Even as I sneer at Descartes' assertion that the soul and body are separate spheres, intersecting at the pineal gland, I find myself making much more subtle variations on dualistic errors. But these studies thrill me. I hope it's only the beginning of an entire body of research aimed at understanding how thoughts and chemistry run in parallel, without trying to force one or the other into supremacy.
In one study, Dr. Arthur L. Brody, from the University of California at Los Angeles, and colleagues used positron emission tomography to assess metabolic changes in the brains of 24 patients with major depressive disorder who were treated with paroxetine or interpersonal psychotherapy. Sixteen normal subjects were scanned for comparison.
Prior to treatment, patients had higher activity in the prefrontal cortex and lower activity in the temporal lobe than control subjects. With treatment, however, these metabolic changes tended to normalize. Depression scores improved more in the paroxetine-treated group than in the psychotherapy group, but both groups experienced similar changes in metabolic activity.
In another study, Dr. Stephen D. Martin, from the Cherry Knowle Hospital, Sunderland, UK, and colleagues used single photon emission computed tomography to evaluate brain blood flow changes in 28 patients with major depressive disorder who were treated with venlafaxine hydrochloride or interpersonal psychotherapy.
Both treatment groups experienced a substantial improvement in their depression scores compared with baseline values, the authors note. Both groups demonstrated increased basal ganglia blood flow, while only the psychotherapy group showed increased limbic blood flow.
In an editorial, Dr. Harold A. Sackeim, from the New York State Psychiatric Institute in New York City, comments that "despite the specifics of the regional changes that were identified, both studies found that the changes in functional brain activity following pharmacotherapy and psychotherapy were remarkably similar."
Dr. Sackeim states that "it is conceivable that a unitary pathway or set of pathways is involved in the relief of depressive symptomatology."
----------
Ha. I am so pleased. I remember seeing similar results presented when I was in college, involving PET scans of people with OCD receiving either psychotherapy or medication. I should dig those articles out, along with these, so I can prosyletize.
On the one hand, you have the folks who have been as well-educated by the pharmaceutical industry and the National Alliance for the Mentally Ill as those organizations could possibly ask. "Depression is a disease" - (No, depression is not a disease. Depression is a syndrome. Diseases have known pathological processes. It drives me crazy to be, apparently, one of the few people in the world who understands this distinction.) - "like any other. You wouldn't ask a diabetic to do without insulin, and try to make changes just by talking about them."
On the other hand, you have the Dr. Peter Breggins of the world, frothing about the conspiracy to medicate us all into complicity with an unjust evil system, and convinced that if we only had enough freedom and compassion no one would ever have symptoms of mental illness.
Depression is not like diabetes, because insulin and glucose are not thoughts. There is no difference between thoughts and speech and ideas on the one hand, and neurochemical and neuroelectrical events on the other. If a diabetic could adjust insulin and glucose by an act of will, or with the assistance of another's will, we would ask them to make changes just by talking about it - or at least, we'd place that strategy before them as an option. Psychotherapy is no different. Contrariwise, to deny that neurochemical processes underlie complex human mental activity is equally absurd - and if you accept it, you either have to accept the validity of chemical intervention in adjusting mental processes, or you have to make the tenuous argument that only indirect intervention is morally or philosophically acceptable.
I confess, mind-body dualism is hard to uproot - even for a committed believer in monism. There seems to be something profoundly natural about making a division between the realms of thought and the realms of, well, meat. Even as I sneer at Descartes' assertion that the soul and body are separate spheres, intersecting at the pineal gland, I find myself making much more subtle variations on dualistic errors. But these studies thrill me. I hope it's only the beginning of an entire body of research aimed at understanding how thoughts and chemistry run in parallel, without trying to force one or the other into supremacy.
