“You can Imagine...”
Making the Invisible Visible: New Perspectives on Brain Health
Jeremy G Richman, Ph.D. and Jennifer L. Hensel, MS
The brain is just another organ. Like the heart, lungs, liver, kidneys, and skeletal muscles, the brain is another collection of tissue and cells that together coordinate critical bodily functions. And like any other organ, the brain can be healthy or unhealthy. Unique to the brain, however, is the difficult nature of its study. It is housed inside our skull; cannot be removed from or replaced in a living animal; regenerates slowly, if at all, when damaged; reveals no sense of its function based on its structure (i.e., it is not WYSIWYG [what you see is what you get]); and is extremely complex in its functionality. As a result, we know very little about the brain relative to our other organs, and it has taken on a near-mystical quality, shrouded in mystery and invisible complexity. When we consider that the brain is responsible for the integration of our senses and coordinating movements; houses our memories; and is the source of our consciousness, personalities, and behaviors, it is not surprising that our introspection tends to elevate the brain to a special, magical status.
The lack of understanding and the invisible nature of the brain and its functions have a number of negative consequences. When we don’t understand something, we fear it. The fear and trepidation that have built up surrounding maladies of the brain have created a barrier for people getting help for themselves or for their loved ones. This is entirely understandable. What parent or patient wants to go to the doctor and hear the overwhelming diagnosis that his or her child or him- or herself is callous unemotional, schizophrenic, depressed, bipolar, or has attention-deficit hyperactivity disorder? There are many problems with our diagnoses of brain ailments, not the least of which is that we have not actually identified any pathology; rather, diagnoses are provided based on symptoms, and we have effectively labeled the individual. The dangerous consequences of giving someone a label can last a lifetime— decreased self-worth, misconceptions by others, unfulfilled potential, and ultimately a self-fulfilling prophesy (becoming the diagnosis). It would be ridiculous to go to the doctor with a radius bone protruding through the skin of my forearm and the doctor diagnosing it as a broken bone. But if I go to the doctor feeling overwhelmingly sad or depressed and answer yes to five out of nine questions on a questionnaire, the doctor would diagnose me as depressed—a label without any underlying pathology, information, or value.
We are often ashamed of diseases that we don’t understand. Not so long ago, no one was said to have died of breast cancer. In fact, when I was in school, we couldn’t even say the word ‘‘breast’’ on television. Now, because of intensive community support and demand of scientific research to understand the underlying mechanisms of disease in the field of oncology, we understand breast cancer, its causes, various forms, and many preventions and treatments. There is no mark on one’s character from getting cancer of any form. When it comes to brain illnesses on the other hand, we are still ashamed and afraid to discuss our problems because the problems are still invisible. However, as Patrick Kennedy says, it is a matter of chemistry and not character.
We need to make the invisible visible. As scientists, we frequently ask ourselves ‘‘blue sky’’ questions—trying to assess what an ideal world or situation would look like. We need to shed light on the brain and its mysterious functions and possible maladies. We need to bridge the biochemical sciences that represent the pathologies with the behavioral sciences that identify the symptoms of brain dysfunction. Taking a lesson from history, we can imagine it on par with the invention of the compound microscope, built by Anton von Leeuwenhoek. Using his new microscope, Leeuwenhoek discovered what he called ‘‘animalcules’’ and what we now know to be single-cell microorganisms—bacteria. The discovery of bacteria brought a thunderous and intensive focus, a full-blown paradigm shift, to the scientific and medical landscape of what caused diseases. Robert Koch, the father of modern bacteriology, created four postulates. These famous principles linked bacteria to specific diseases, and thereby made obsolete the predominant miasma theory of disease, which held that diseases such as cholera, dysentery, and plague were caused by bad air. What is the key importance of these discoveries? Leeuwenhoek made the invisible visible, and Koch made the visible understandable and meaningful.
Our nation is at a historic technologically driven scientific crossroads where it is possible to make brain disease visible and understandable. President Obama’s initiative to map the human brain is a great start. But it will require some ‘‘blue sky’’ and innovative thinking before it leads to impactful discoveries and paradigm shifts. To be sure, new technologies are being developed at an amazing pace. We have functional magnetic resonance imaging and positron emission tomography scans that provide invaluable insights to the brain’s previously impenetrable black box filled with inaccessible secrets. We are creating rapid and highly sensitive methods for identifying the presence or absence of proteins and other biochemicals associated with particular dysfunction. These imaging and biochemical modalities will lead to the development of brain disease biomarkers. However, these technologies are currently expensive, inaccessible, and/or fail to provide sufficient temporospatial resolution. Now is the time to begin thinking outside the box, in innovative and novel ways to correlate behavioral symptoms with biochemical and genetic markers to facilitate the diagnosis of brain maladies with a high degree of sensitivity and specificity. Once we understand the correlation between the behavioral and biochemical components of brain diseases, it becomes possible to define efficacious treatment regimens for patients. In other words, we need innovative technologies that will pave the way to making brain maladies understandable. The term ‘‘mental’’ illness will become obsolete like the miasma theory of disease, and we will simply credit the diseased organ with brain illness while we strive to insure brain health.
Because of the fear and trepidation deriving from the mystery and misunderstanding related to the brain, we have created many myths about the brain and brain health. In coming issues of Violence and Gender, we will expand on each of these myths in more detail:
1. Myth/misconception: Biology is destiny. Our genes define us and our fate, and we have no control. Fact: Our personality and behavior are influenced by both our biology (our genetic makeup or our ‘‘nature’’) AND our environment (how we are ‘‘nurtured,’’ our circumstances). Both our nature and our nurture play a role in our everyday lives, but it’s not the whole story—we still can control our choices in life.
2. Myth/misconception: Brain health problems can’t be cured. Fact: Every day, new technologies and innovations are developed to understand the brain a bit more. The ability to study the brain and determine why it may not work properly is becoming more accessible every day. As we learn more and expand our ability to understand the brain, we can develop medicine and therapies to treat—and even cure—brain health problems.
3. Myth/misconception: People with brain illness should be isolated and ignored because we do not understand why they behave the way they do. Fact: Isolating and ignoring people with any type of illness will only make the problem worse—and we will all suffer as a result.
4. Myth/misconception: People who have brain illnesses are violent. Fact: Most people with brain illness are not violent or a danger to the public. However, brain illness can contribute to impaired judgment and an increased potential for violent behavior. To ignore the link between brain illness and violence can result in more harm than good—by not being aware of the danger and treating aggression or violent behavior in addition to the brain illness, lives might be lost that could have been saved.
5. Myth/misconception: There is usually one problem in the brain when someone suffers from brain illness that leads to violence. Fact: Violence is a jigsaw puzzle made up of lots of different pieces, both social and biological (behavioral and biochemical—‘‘tell me about your mother’’ and ‘‘pee in this cup’’). We need to piece them together to understand and prevent future violence as well as to learn how the social pieces interact with the biological pieces to shape violent behavior. We need to research how the pieces fit together. Once we understand, we can then create effective interventions and therapies to help overcome the causes of violent behavior.
To summarize, it is time to take the fear away from the symptoms of brain illnesses by focusing on the organ itself, the brain. Pushing the frontiers of brain health research and understanding the correlation between behavioral and biochemical components of brain diseases can make the brain and its pathologies visible. People who suffer from brain pathologies leading to illness deserve to understand, to see, to have made visible exactly what it is in their brain that has gone awry and how to treat the problem. Every brain deserves to be healthy.
Address correspondence to:
Jeremy G. Richman, PhD
The Avielle Foundation
PO Box 686
Newtown, CT 06470