T-shirts! It’s not boot camp until you’re all wearing the same thing, and today we were outfitted with our very own camouflage uniforms. It’s another one of the thoughtful details that have made this week not only informative, but truly fun. It was a good moment for something light-hearted, as our topic for the day was more serious: social and affective disorders. Clinical psychologist Seth Gillihan presented us with the most consistent findings from the neuroscience literature on six different types of social and affective disorders: (1) Anxiety, (2) Major Depression, (3) Bipolar Disorder, (4) Schizophrenia, (5) Autism, and (6) Psychopathy.
In addition to giving us a wealth of information on how neuroscience has contributed to our understanding of each disorder, Seth emphasized two points. First, each of these disorders has both affective and social components (so it’s not correct to view/label a disorder as solely an affective or social disorder). Second, because the imaging (especially fMRI) technology is so new (less than 20 years out), what he told us today should be considered a provisional understanding. (Click below for more).
We had a short half-day today, with Seth’s lecture in the morning followed by a breakout sessions. Options for the breakout were:
Autism, led by Lauren Cornew
Post-Traumatic Stress Disorder, led by Seth Gillihan
Schizophrenia, led by Dan Wolf
Psychopahty, led by Yu Gao
I attended Seth’s session on PTSD, which is relevant for my research on rape and sexual assault, as well as my research on the costs of war. After the breakout session, we received our surprise t-shirts, and left camouflaged for the weekend. We’ll reconvene on Monday morning.
II. Important Lessons
Seth gave a very well organized presentation, the thrust of which was that fMRI studies are being used to better understand brain activity associated with a number of disorders. For disorders related to anxiety, fear is center-stage and it is the amygdala that plays a crucial role. In depression, there is a vicious circle of sorts: over-activity in parts of the brain responsible for emotion (limbic system), and under-activity in the executive function areas (dorsal cortex) responsible for regulating those emotions. I won’t go through all the correlates of other disorders Seth covered, but there seems to be some slow convergence happening and meta-analyses being produced to synthesize existing results.
At the big-picture level, the most important lesson of the day was the (frequently recurring) question of definitions and line-drawing: what constitutes a particular disorder. In his lecture Seth had us consider this example. Patient-1 has a depressed mood, insomnia, loss of appetite, fatigue, and suicidal thoughts. Patient-2 has a loss of interest, hypersomnia, increased appetite, agitation, and feelings of worthlessness. By our current definitions, both Patient-1 and Patient-2 would be diagnosed as having a major depressive disorder. As a result, fMRI will either uncover some process that underlies both, or run into problems if in fact we are grouping together heterogeneous problems in the same disorder.
Erik Parens of The Hastings Center for the Study of Bioethics further pointed out in our discussion time that although the DSM notes in its introduction that these disorders should be considered along a continuum, what ends up happening is that we treat them categorically. Gal pointed out that this compounds the problems with fMRI we talked about earlier in the week. Brain activation is not an on-off light switch, but rather a distribution with unique properties (varying across multiple dimensions, e.g. region, individuals, etc). In short, it’s really complicated in there! But this doesn’t mean we’d want it any other way. To borrow a joke Seth told: “If the brain were simple, we’d be too dumb to understand it.”
III. Who’s at boot camp with me?
One of the toughest things to do is explain complex scientific concepts in language that non-scientists can understand. That task is even harder when you have to do it in 500 words or less. But that’s the job that science writers have to do, and we’re lucky at boot camp to have several science writers participating.
Freelance writer Tom Valeo writes on neurology and cognitive neuroscience, Tom Heneghan is the Reuters Religion Editor and Senior Correspondent, Brenda Patoine is a freelance science writer and founder of ScienceWRITE Medical Communications, and Kris Rusch is a medical writer in the field of substance use disorders.
These writers have raised really important questions about the precision (or lack thereof) of the concepts scientists throw about. For instance it may be that the experimental construct of “fairness” doesn’t line up with conventional use. Science writers thus have to understand both what the scientists meant and how readers are likely to interpret the words. Not easy! They’ve pointed out too that it’s even harder in a media market where newspapers and magazines are cutting back on budgets.