Science and Research Update
 October 2013
In This Issue
Recent Research Findings You Can Use
Featured Articles
Clinical Trials
Quick Links
NAMI New Jersey thanks the NIMH Outreach Partnership Programfor giving us access to the latest research on mental illness to disseminate throughout the state of New Jersey.
NAMI New Jersey will send out regular Science Updateto highlight some of the advances in mental health research through the year.
Every issue will include a "Recent Research You Can Use" articles as well as links to featured articles and clinical trials. 

Please distribute this newsletter widely! 

Recent Research Findings You Can Use
In each newsletter Steven Silverstein, Ph.D. (Director, Division of Schizophrenia Research Executive Director, The Violence Institute of New Jersey Rutgers University Behavioral HealthCare and Robert Wood Johnson Medical School Department of Psychiatry Rutgers Biomedical and Health Sciences) will have a column detailing the latest in mental health research.  In this edition and as part of Mental Illness Awareness Week, Dr. Silverstein refutes the argument that psychiatry is a pseudoscience.


In a recent NY Times article, Nobel-Prize winning neuroscientist Eric Kandel responded to recent claims that psychiatry is a pseudoscience.  The gist of the negative side of the argument is that: 1) psychiatry is not a real science because we do not know exactly how the biological processes of the brain give rise to thoughts and feelings - and that such knowledge is essential for psychiatry to be a real science; and 2) compared to fields like chemistry and physics, with many established facts, psychiatry is excessively dominated by theory, and consists of research findings that seem to only apply to a portion of people with a given diagnosis and that are often difficult to reproduce (including those based in 'hard science' fields such as genetics).  Kandel disagrees with these positions.  He notes that psychiatry is moving ever closer to an understanding of how brain processes lead to psychological experiences, and that this will continue to accelerate with further advances in genetics, brain imaging, and other technologies.  Moreover, he gives revealing examples of progress towards understanding both the biological bases of specific psychiatric conditions, as well as how basic psychological processes (e.g., memory) are altered by these conditions.  He also notes that the effectiveness of both pharmacological and psychological interventions can be studied in a rigorous fashion.


To Kandel's points I would like to add a few others that I think will be of interest to the readership of this NAMI NJ newsletter. First, science is not defined by what is being studied, or by how many years a field of study has existed.  Rather, it is defined by the extent to which the scientific method is used.  The scientific method refers to the belief that we increase our knowledge of how the world works by developing theories and specific hypotheses, and then testing these in a systematic fashion that, over many studies, either rules out alternative explanations for the observations (or 'findings'), or leads to the rejection of the hypothesis and the development of new ones.  This is what distinguishes science from other 'ways of knowing' such as faith or intuition.  Viewed in this way, the relevant question here is whether psychiatry builds on its knowledge base through carefully-designed research studies vs. through untested ideas, appeals to authority, tradition, or other methods.  The answer to this is that it is clear that progress in psychiatry involves much science, as evidenced by the thousands of research studies (many of which are of very high quality) published every year that build upon past findings, and that affect how we understand mental disorders and how we treat them. Importantly, even while there is still much we do not understand about how brain processes lead to conscious experience (although much progress has been made in this regard), we can nevertheless continue to generate evidence towards answering "the ultimate question" as posed by Gordon Paul:  "What treatment, by whom, is most effective, for this individual with that specific problem, under what set of circumstances."  Indeed, knowledge regarding this issue continues to accumulate.


Does this mean that every decision made in psychiatry is based on universally accepted facts?  No. There are still many areas that need to be researched further so that we understand the causes of mental disorders better and so that we can develop more effective treatments.  Given the relatively young age of psychiatry compared to other fields, and given how complex the brain is, it is possible at this point to focus either on how far we have to go, or on how far we have come.  The debate noted above essentially reflects these 2 different viewpoints.   Because psychiatry is continually developing its knowledge base, it would benefit consumers and families to educate themselves as much as possible about the evidence in support of (or against) any intervention that is recommended to an identified consumer, as well as about the pros and cons of other available options. 


Second, it is very important to understand that what is practiced clinically does not always reflect what is known through scientific studies.  This problem is not unique to psychiatry, although it definitely characterizes this field.  An often-cited report from the Institute of Medicine several years ago identified gaps of 10 to 20 or more years, typically, before scientific findings affect clinical practice.  Moreover, even when new findings (e.g., that a new type of cognitive-behavioral therapy is effective for reducing delusional thinking) are known by clinicians, it is often difficult for this to affect clinical practice at agencies due to lack of funding, which limits opportunities for staff training, or for clinicians to have the time to conduct the interventions, or to receive appropriate supervision.  These are some of the reasons why it is critical for NAMI NJ members and others to advocate (to state mental health offices and to politicians who decide how much funding is allocated for services) that the best available evidence-based interventions be offered at mental health centers. 


Third, although we are learning much about the brain, there is a bias in the research field, and among the general public, to overemphasize the importance of studies using brain imaging and new technologies, and to minimize the importance of studies of psychological theories of psychiatric symptoms, or of psychological treatments.  Several research studies have now shown that when an article has brain images created from functional magnetic resonance imaging (fMRI) data, readers are more likely to assume that the findings are important, even when the study is poorly designed and the results are relatively meaningless.   The over-eagerness to find biological causes of, and solutions to, psychiatric problems in this country stands in contrast to what is happening in other countries (such as the UK and other European nations), where there is a much greater emphasis on psychological understanding of how beliefs and experiences lead to symptoms, and how psychological treatments can be helpful.  This is not to say that biology is less important than has been claimed.  Better understanding of the brain and how it affects experience, and vice versa, is critical for advancing psychiatry.   However, it is equally important to study psychological questions (e.g., how a person's beliefs about themselves affect whether or not they develop depression after a serious life stress).  Because of this, and because of the data on effectiveness of psychological interventions, I suggest that no consumer be satisfied when medication is offered to them as the only solution for psychiatric symptoms - unless data can be provided demonstrating that outcomes for a given condition are as good or better when only medication is used.


In his article, Kandel suggested that mind and brain are inseparable.  In essence, creating the experience of the mind is part of what the brain does.  However, progress towards a truly scientific psychiatry will only occur to the extent it should when both sides are understood.





Steven Silverstein, Ph.D.  


Featured Articles
The following articles have been selected by the National Institute of Mental Health and are some of the cutting edge research in mental health.

NIH Approves High-Priority Research Within Brain Initiative


National Institutes of Health (NIH) approved initial areas of high-priority brain research to guide $40 million of NIH fiscal year 2014 funding within the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative. The initiative aims to accelerate work on technologies that give a dynamic picture of how individual cells and complex neural circuits interact. The ultimate goal is to enhance understanding of the brain and improve prevention, diagnosis, and treatment of brain diseases.


Positive Relationship Factors May Help Break Cycle of Child Maltreatment


The Centers for Disease Control and Prevention (CDC) announced the release of a

Journal of Adolescent Health special supplement investigating the role of safe, stable, nurturing relationships and social contexts in the cycle of child maltreatment across generations. Efforts focused on enhancing relationships between parents and children, as well as between parents and other adults, may be a helpful prevention strategy for breaking the cycle of child maltreatment and promoting life-long health.


Versatile Proteins Could Be Target For Alzheimer's Drug: NIH-Funded Discovery Began With Asking How the Brain Learns to See


A class of proteins that controls visual system development in the young brain also appears to affect vulnerability to Alzheimer's disease in the aging brain. The proteins, which are found in humans and mice, join a limited roster of molecules that scientists are studying in hopes of finding an effective drug to slow the disease process.  

Lifestyle Intervention Improves High Schoolers' Health, Social Skills, Grades


A teacher-delivered intervention program promoting healthy lifestyles improved health behaviors, social skills, severe depression, and academic performance in high school adolescents, a study has found. Routine integration of such programs into health education curricula in high school settings may be an effective way to prevent high-risk teen populations from becoming overweight or obese, and could lead to improved physical health, psychosocial skills, and academic outcomes, according to the study. The study, supported by the National Institute of Nursing Research appears in the online September issue of the

American Journal of Preventive Medicine. It is one of the first studies to report multiple immediate improvements that were sustained over time using a teacher-delivered, cognitive-behavioral skills-building intervention program incorporated into a high school health education class.

Clinical Trials

NAMI NJ along with NIMH encourages people to participate in clinical trials to advance mental health care and knowledge


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