The Future of Psychiatry: Eric Kandel Says It Lies With Biology. Kandel is a Nobel Prize-winning neuroscientist who has elucidated some of the basic neural principles behind behavioral and cognitive functions by studying the simple nervous system of Aplysia (a snail). His most renowned findings relate to the structural changes associated with learning and memory, and the gene expressions that control them. But his proclamation that “the time has come
for psychiatry, … long an art
more than a science, to reinvigorate itself by embracing
biology” has been old hat for fifteen to twenty years already to anyone practicing in the field! Modern psychiatrists have evolved beyond the old dichotomy between “organic” disorders marked by obvious brain lesions and “functional” ones reflected solely in behavior. Kandel’s observation that, “Insofar as
psychotherapy works, it’s got to be doing
something [in the brain], and if it does, one should be able
to detect it with various imaging techniques” is trivially, reductionistically, obvious to us all. I know I link to all those exciting functional MRI findings pouring out these days, showing the localization of various cognitive functions, but that’s just entertainment in a sense. Neural insights and behavioral insights have a profound mismatch of scale; the former are either too fine-grained or too coarse-grained to contribute measurably to the latter or, certainly, to have any impact on clinical mental health practice .
Kandel is more right than he appears to know with his following statement — that “…it’s
really a question of time and resolution…” It’s a long way from a nervous system whose connections you can count on the fingers of one hand to the operation of human consciousness (or the unconscious) embedded in the almost infinite connectivity of the brain, which remains a “black box”. A mechanistic understanding of the complexity of its function or dysfunction is still overwhelmingly — some might say impossibly — distant, and modern psychiatry will for a long time — certainly for the remainder of my professional career, and those of my trainees — have room for and require “artistry”, Kandel’s straw man. Believe me, our nonpsychiatric medical colleagues scoff at psychiatrists as much for going too far as pretenders to a scientific grasp as for the nonscientific “witch doctor” aspects of our practice.
Kandel appears to acknowledge some of this, as the essay indicates in its penultimate paragraph, in a reply to his critics. And he’s absolutely right about the potential for the cross-fertilization with neuroscience to go the other way: “As psychiatrists and neuroscientists
find more common ground, the former could help define for
the latter the mental functions that should be most closely
studied.” Most neurologists make the sign of the cross and cower in the corner when confronted with a consultation question about the higher mental functions such as cognition, emotion or complex behaviors. They remain much more comfortable with disorders of more ‘lowly’ functions such as sensation, balance, coordination or movement that can be tested and measured readily.
