The objective friend in psychiatry - can neuroimaging help?
I am not a clinician, but I have come to acknowledge the 3 C’s of the clinic: communication between the patient and physician, comprehension of the illness by the physician, and curing the illness. The middle ‘C’, that is, to comprehend the illness, is perhaps the most difficult to attain for several reasons. One being that illnesses are often multifaceted, and therefore to define the cause is a difficult task.
I remember when I had first started my A-level in Psychology, my teacher asked us if it is possible to comprehend a problem in a truly objective manner. My initial response was of course it is possible, you focus upon the problem you are trying to answer and forget all else. My teacher then explained, that no one can abandon their cultural, moral and political views, along with all else that constitutes the framework of their mind. Some subjectivity will always remain whether we are consciously aware of this or not.
From this experience, I then began to wonder if attaining objectivity is just a mere fallacy. Must I push my personality aside so that I can view a problem in its true nature? Is this possible? How can we actually understand the problems of the body and world when we ourselves are so affected by everything and anything? At that time, I failed to find an answer I was satisfied with, and therefore ignored the philosophical problem at best. As you might have guessed when reading my previous blog, I am interested in the philosophy and morality underpinning choices.
Since this time, I have come to acknowledge that we cannot escape from our thoughts, nor can we prevent ourselves from purchasing and owning new beliefs to clothe our mind. So instead we must advance and use our thoughts, to help function and achieve our goals in the best way possible. Objectivity is therefore a different perspective, and one that we can acquire through learning, rather than a ‘non-human’ one.
What sparked the recollection of such memories, is what I learnt from my thesis, and what I am currently learning in my degree in Genomic medicine. This being the creation and use of ‘Next-generation sequencing technologies’ in the scientific and clinical realm. This is an umbrella term for processes that determine the DNA structure of a person’s entire genetic material and encompass the dream triad to genomic investigation: the collection of large datasets of information, low in cost and time efficiency.
Specifically, such techniques are being utilised by psychiatrists, since a vast number of studies have identified a genetic basis underlying psychiatric disorders such as depression, anxiety and schizophrenia.
Another effective innovation is Babylon, an app designed to increase access to healthcare worldwide, whereby users are diagnosed, given treatment recommendation, combined with face-to face consultations with a clinician 24/7.
I have come to classify such innovations as the ‘objective friend’.
Often when we are faced with a difficult situation, the alternative perspective of a friend is able to guide us. In a similar manner, when faced with a complex medical case, innovations such as these next generation sequencing techniques provide guidance, in an objective way.
The general consensus of the challenges of such technologies, however, is the effectiveness of their clinical integration. In other words, are these innovations effectively able to navigate medical decisions?
Specifically, what I would like to know is how such tools, and future tools, are able to effectively prevent and treat mental illness globally? The low cost of such tools does not correspond to easy access, since their use is dependent upon healthcare policies. Furthermore, the odyssey to prevent and treat mental illness is stymied by the cost of treatment, and those whom fear the shame and stigma related to their illness.
In science, omission allows us to refine and understand in detail, but our ultimate mission in science is to care for all.
There are several effective innovations that have been utilised in mental health. An example being the communication of mental illness across social media, that is reducing stigma. Now when I scroll through Instagram, I am met with at least one post concerning this. Additionally, there are successful clinical treatments, such as counselling, cognitive behavioural therapy and mindfulness-based approaches, along with pharmaceutical therapies.
But recently, the question I have been asking myself is how the “objective friend” can help transform psychiatry? Would the objective friend benefit psychiatry? Starting with the first ‘C’ of the clinic: communication.
In psychiatry, diagnosis is based upon the patient detailing their symptoms, the responses to the questions a psychiatrist may ask, previous medical history, and other signs that may be observed, all referring to a diagnostic and statistical manual of mental disorders. Complications to achieving diagnosis involve comorbidity, whereby two different mental disorders may occur simultaneously, along with the severity of the disorder. Therefore, diagnosis can often be a lengthy process.
Once a diagnosis is made, and if a talking therapy, for instance was the agreed treatment, choosing and creating the most suitable one may take time, given the range of therapies to choose from. Furthermore, the benefit of such therapies can also take time. For some, pharmaceutical treatment may be prescribed alone or in combination with a talking therapy, however, to say this ensures a cure or improvement in the patient’s mental health would be false. Some patients do not improve with available pharmacological or psychological interventions.
Could the integration of neuroimaging be of help?
For his final reddit post, Professor Stephen Hawkings wrote:
“If machines produce everything we need, the outcome will depend on how things are distributed. Everyone can enjoy a life of luxurious leisure if the machine-produced wealth is shared, or most people can end up miserably poor if the machine-owners successfully lobby against wealth redistribution. So far, the trend seems to be toward the second option, with technology driving ever-increasing inequality.”
— STEPHEN HAWKINGS
echnology was originally made for those of a more affluent background, however this is not the case now. It is clear that with time and revision of a repertoire of innovations, their use increased across populations of varying economic backgrounds.
Next generation techniques give hope that low cost, highly effective neuroimaging techniques, can be made attainable, rather than a mere science fiction fantasy.
For neuroimaging techniques to be endorsing equity in the healthcare system, revision is needed.
The questions to consider now, are how can we adapt such techniques so that they are lower in cost and more available for use? How and to what extent can we integrate them into psychiatry? And most importantly, how can we use technology to help those who are suffering severely from mental illness?
As mentioned previously, the goal of objectivity is consciousness of several perspectives, rather than establishing a ‘non-human’ one. The same can be said for integrating technology into medical practice.
Neuroimaging as the objective friend in psychiatry, will incorporate several algorithms, facilitate deep analysis and produce a large quantity of data, to create a baseline to the diagnosis of psychiatry that is sensitive to cultural, social and political differences. This, in combination with the experience, empathy and compassion of psychiatrists themselves, can invest into the ultimate goal of global mental health.
Psychiatry is complex, and whilst most are familiar with the saying ‘the happiest person that you see with a smile on their face every day, could be the most depressed person that hides it from everyone’, some may not be aware that it is not so simple as to label neurons as having depression, anxiety or schizophrenia.
But just as we talk to a person and can begin to understand their experience, we can study our biology and begin to deepen our understanding.
I believe that by focusing on how we can utilise neuroimaging in a way that does not discriminate against our social, cultural and political differences, can embrace the complexity of psychiatry.