(Following is an excerpt of a column by Dr. Laura Lee Hall, NAMI's deputy director of policy and research and trained neuroscientist.)
I must confess. I have sometimes felt discouraged by the newspaper and science journal headlines heralding breakthrough achievements in AIDS, cancer, Alzheimer's disease, and genetics over the last 6 months. Don't get me wrong. It is not that I begrudge improved treatments for the many terrible diseases that afflict humans and cause suffering. Nor do I doubt that many seemingly unrelated scientific advances will ultimately enhance our understanding and treatment of brain disorders like schizophrenia, severe depression, bipolar illness, OCD, autism, and others. I surely know that the scientific advances in these other areas were hard won by advocates and scientists, along with a healthy dose of luck.
This knowledge does not assuage my impatience. I still long for the front page headline, a real breakthrough in understanding or treating schizophrenia or manic-depressive illness.
The March 14th issue of Science, a premiere scientific journal, went a long way toward feeding this hunger. While not devoted to brain disorders per se, this issue of Science, with its split brain featured on the cover, is devoted to cognitive neuroscience. And a dominant subtheme is research relevant to serious brain disorders like schizophrenia and depression. It moves beyond the sometimes slogan sounding age of neuroscience rhetoric we use to lobby for research, end discrimination, and comfort ourselves; it attaches meat to this mantra-like bone.
This issue of Science includes:
An opening editorial, "The Science of the Mind," by associate professor of Psychiatry and Neurology (!!) at Harvard Medical School, Dr. Marilyn S. Albert. She celebrates the multidisciplinary advances that together have improved our understanding of human cognition. She highlights the growing recognition that distributed brain networks, not a single brain region, underpin complex behaviors. Dr. Albert also points to significant advances in brain imaging (which is approaching, notably, real time measurement) and Alzheimer's disease genetics (a disease with complex genetics as suspected in schizophrenia and bipolar illness which nonetheless has evolved to a state of scientific elegance and surprising harmony). Albert almost offhandedly remarks, to the satisfaction, I am sure, of many NAMI members, "[t]he remarkable progress that has been made in recent years is beginning to generate excitement outside of the scientific community because of its relevance to our daily lives in shedding light on . . . brain-related diseases (such as schizophrenia and Alzheimer's disease) (emphasis added).
A leading scientific article by well-known schizophrenia researcher Dr. Nancy Andreasen. "Linking Mind and Brain in the Study of Mental Illnesses: A Project for a Scientific Psychopathology" heralds the remarkable converging of separate lines of scientific inquiry in schizophrenia and depression. After covering some of the well-known (and sometimes frustrating) truisms of mental illness research (for example, the tenacious lack of diagnostic biological markers, the continued uncertainty about psychopathology being continuous with normal mental functions versus discrete illnesses, and the seemingly unresolvable conundrum of whether it is more wise to focus on symptoms versus specific diseases), Dr. Andreasen synthesizes diverse and apparently unrelated lines of inquiry into these two serious brain disorders to arrive at a remarkable conclusion: we are converging on an understanding of the neural substrates of schizophrenia and depression. Cognitive neuroscience's schizophrenia theory that this is a disorder "of consciousness or self-awareness that impairs the ability to think with 'metarepresentations,'" is shown to be remarkably consistent with neurobiology's working memory hypothesis of schizophrenia, as well as neurophysiology's gating theory, and clinical psychiatry's brain imaging data.
In essence, these separate research world's are settling on similar brain regions and conceptualizations of a fundamental cognitive dysfunction in schizophrenia. Ever the student of history and literature, Andreasen notes the consistency of this modern age nexus with the pre-eminent fore-father of modern schizophrenia research, Eugen Bleuler, who emphasized the cognitive underpinnings of schizophrenia (and gave the disease its now unfortunate name--schizophrenia, literally meaning fragmented mind). Similarly for depression, Andreasen shows us how neurological, psychological, and psychiatric research all point toward the prefrontal cortex and amygdala in "melancholy." Perhaps most refreshingly (at least to me) is that this article moves beyond the ideological espousement of mind and brain, so often invoked by the resistors to modern neuroscience. As Dr. Andreasen concludes "[t]hese advances have created an era in which a scientific psychopathology that links mind and brain has become a reality."
Subsequent articles on the neural substrates or learning and language development.
These articles, while perhaps a little dense for the non-scientist (or, to be precise, the non-cognitive neuroscientist!!), I hope will give hope to NAMI members as they did to me. Progress in scientific research is certainly not the sausage-making that legislation is, for example, but it sure can be hard to see progress. This issue of Science reflects progress.
(Note: The reader may want to visit Science on-line at http://www.sciencemag.org
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