Whenever a mental health authority is interviewed in the media it’s nearly inevitable that this person is a medical doctor, usually a psychiatrist. This individual typically isn’t a practicing therapist; they may only be able to speak of clinical diagnoses and/or the prescription of psychopharmaceuticals. I mention this because when this authoritative psychiatrist is interviewed in the media I end up listening to a depiction of the massively complex human interrelational landscape I see around me every day, as both a writer and psychotherapist, reduced to a chemical imbalance in someone’s brain. It’s like ascribing a boxer’s loss of a title match solely to the width of their biceps.
The gold standard for looking at mental health is through what’s called a biopsychosocial lens, a flexible model that allows professionals to consider the biomedical (for example, thyroid issues, dementia), the psychological (traumatic experiences, abusive relationships), and socio-economic factors (unemployment, impoverished environment) that might be at play in the mental health profile of any given individual, even if it ends up a combination of one or more parts. In North America there is unfortunately a sacred primacy around the biomedical approach to mental health, with the psychological and socio-economic as (at best) secondary considerations at the table of funding and education. At this moment there are medical doctors losing sleep wondering how to beat the shame of knowing there is a patient in their care whose condition might be psychogenic (meaning, whose pathology is not, strictly speaking, a biomedical end product).
In the public consciousness there is no seemingly greater authority than a medical doctor. This might have as much to do with social prestige and class structure as a doctor’s expertise and exhaustive training. I’ve long been struck by a line in Bessel van der Kolk’s influential The Body Keeps the Score where he talks about being part of a generation of psychiatrists wielding psychopharmaceuticals in the 70s, as the medical community wrested power from the enigmas of Freud and Jung, whose influence on psychiatry seemed more philosophical (and thus empirically overstated) than demonstrable. With these drugs, v.d. Kolk writes, “many psychiatrists were relieved and delighted to become ‘real scientists,’ just like their med school classmates who had laboratories, animal experiments, [and] expensive equipment.” So, while the doctor is the public face of authority, the secret kingmaker is the lab cloak and microscope of the scientist. At this point in the evolution of understanding human behaviour the psyche gave way to an evolving list of chemical imbalance theories which researchers intimated lay behind mental health issues such as depression and anxiety. We have since been inculcated with the pairing of the words “illness” and “disease” when it comes to mental health.
The medical doctor who wishes to be a “real scientist” must therefore put the brain on a pedestal. This is a problem when it comes to the ubiquity of the “it depends” (or situational) nature of individual behaviour, which brings us back to the psychological and socio-economic forces that can affect us. For many a scientist, when you have hundreds of years of elegant theories describing both the movement of planets and the nearly (but not) magical behaviour of subatomic particles, the situational (and inconsistently replicable) complexity of human psychology creates more than a little discomfort. Let’s not get started on emotions, you know those pesky things that you and I and everyone on the planet use to communicate our situation. I sometimes feel that if researchers could strip emotions from human test subjects — better still, replace emotions with impersonal numbers — they would’ve done so across society already in an effort to bring some blessed consistency and predictability to our world. You know, the way life — sorry, scientific experiments — should be.
The brain, that organ sloshing around in our skull, rather than the soul or the psyche, has become the perfect representation of the mind as well as the terra firma of our consciousness. It has also become a battleground. Which brings us to Casting Light on the Dark Side of Brain Imaging, a wonderfully engaging collection of essays and research-based opinions edited by McGill University’s Amir Raz and Robert T. Thibault that attempts to speak frankly about the many ways neuroimaging — in this age of the brain — is being fundamentally misused and misrepresented, some ways more disturbing than others. Each author is an expert in their field, and each essay, barring one or two that cannot help themselves from using more technical terminology, is surprisingly approachable to novice readers who may not have a specialized background.
Full credit to the editors for assembling such a comprehensive selection of contributions from the fields of psychology, philosophy, psychiatry, law, and, of course, neuroscience. As someone whose interests straddle science, arts, and humanities, publications like this are a rarity: a highly specialized yet highly articulate collection that asks probing questions without either equivocating or falling into the sort of polemics that would raise suspicion of professional bias.
The essays are blessedly no more than a few pages each, mere morsels for anyone who has stared down a 70-page research paper, and are broken into four parts, beginning bracingly with Stevan Harnad’s dismantling of how we can be so sure that certain areas of the vegetative (that is, somatic) brain lit up into the sort of images that have become ubiquitous in medical news can be so easily correlated with the cognitive workings of the very non-physical mind. The short version is it’s not that simple at all. And here we get at the thrust of the book: neuroscience is a young science and business startups, addiction research agencies, and journalists have been publishing claims predicated on brain imaging that are suggestive at best and downright misleading at worst. From the technical fallibility of brain imaging itself (David Mehler’s piece suggests brain imaging might have its own day of reckoning in the current replicability crisis) to the hype-driven snake oil of brain-training games sold to a gullible public, it’s clear that when we begin to scratch the surface of the underlying research an image of a brain can be as open-ended as a Rothko painting, potentially molded to the needs or biases of the observer.
What’s worrisome about society’s unexamined acceptance of all things neuro is how in turn a commerically-driven society shirks the biopsychosocial model for a Cartesian bio-reductionisic “this is depression because the brain in this fMRI scan lights up here” when in fact that otherwise affirming brain image is a Jenga tower of correlations with no conclusive data that depression, happiness, etc happens exclusively in any particular sector of the brain. Repeat after me: we are complex beings whom Laurence J. Kirmayer reminds us in a wonderful concluding essay aren’t nearly as self-sufficient for our needs as we would like to think, but who depend on a social network for healthy functioning.
If I have one quibble with the book is its editors’ decision to include comic illustrations throughout. I get it, they’re taking the piss out of some incredibly reductionistic claims, but in doing so I feel it cheapens the efforts of its authors. Also the paucity of female contributors will not be doing the publication any favours in hindsight.
Casting Light on the Dark Side of Brain Imaging (ISBN 9780128161791), published by Academic Press, is a great guide to a beguiling technology, and is recommended for mental health professionals, health researchers, and curious laypersons alike. Its broad selection of professional perspectives and concise arguments should be a model for others.
