The Magic of Neuroscience

I’m sure that none of you missed it. On “60 Minutes,” Jeff Lieberman, head of psychiatry at Columbia University, explained to the obviously entranced reporter Steve Kroft, some aspect of “schizophrenia” visible in an MRI scan.

Lieberman, who in the segment is wearing a white coat as though he were a wet-bench scientist, seems to be pointing at part of the ventricular system, the apparatus in the brain for circulating cerebral-spinal fluid. And though one can’t really tell from the TV image, it looks as though the ventricles may be enlarged.

Enlarged! This is sensational, Dr Lieberman! You’ve discovered something of capital importance in this swollen, heterogeneous, inchoate basin of symptoms called “schizophrenia.” A biological finding!

Except that the first images of enlarged ventricles in schizophrenia stem, alas, not from the New York State Psychiatric Institute’s imaging department, but from Heidelberg University in 1955. And Gerd Huber, who used a technique called air encephalogram to make those first dramatic images, has now been totally forgotten by everyone (Gerd Huber,1955).

Dr Lieberman is a perfectly respectable psychiatrist, though the white coat is a bit of piling Pelion on Ossa, as they say, meaning over the top. He is currently president of the American Psychiatric Association, and it was doubtless the wish of APA executives to highlight the public presence of their presidents, who otherwise are figureheads who serve for a year, that led Psychiatric News, the mouthpiece of the APA, to run on the front page a big photo of Lieberman explaining stuff to the entranced Kroft.

It is inconceivable that in 1955 anyone in Germany outside of psychiatry knew of Gerd Huber’s existence. Because, to my knowledge, he never appeared on TV. For European academics in those days, appearing on TV, rather than being the coveted opportunity for self-promotion that it is today, was seen as slightly debasing, throwing the pursuit of science, an otherwise selfless and unheralded calling, into the muck of the streets.

So this is where decades of wars on the brain, campaigns against “mental illness,” and all the rest of the PR hoopla have led us: to “neuroscience” as a means of institutional branding and donor recruitment.

Meanwhile, actual psychiatric science languishes. Neuroscience is a totally legitimate field, but its payoff for clinical psychiatry has been minimal.

Neuroscience has led to no new drugs. Clozapine (Clozaril), hyped as the revolutionary new “second generation antipsychotic,” was patented in 1963.

As for neuroimaging, in some patients with “schizophrenia,” some images swim into view in modern scanning techniques; for other patients with the same diagnoses, nothing is visible. And in other disorders the same images appear. This is because schizophrenia is not a specific diagnosis and its “phenotype” (those aspects of the clinical presentation that are supposedly biologically determined) is not well specified. This is true of most of the other common diagnoses in psychiatry, such as “major depression”: all are heterogeneous products of ill-understood neurobiological systems that lie widely scattered in the central nervous system.

For years, psychiatrists shunned white coats and wore tweed jackets, because they didn’t need to worry about being splashed with patients’ blood and vomit, or to minimize the microbiological burden that they swept into the sick room.

Now they’re wearing white coats on TV and explaining on camera imaging findings known for sixty years. Is this progress?