Thursday, July 24, 2008

Amen, Doctor

A long time ago, back in undergraduate school, one of the questions posed in a discussion group was how do we as students see the study of psychology from a theoretical perspective. The great "philosophical divide" was between the behaviorists championed by B.F. Skinner and his operant psychology and conventional psychoanalytic theory championed by Carl Rodgers and his followers.

The purpose of the question was not to judge the correctness of either approach but to clarify how each viewpoint reflected the theoretical framework of the study of behavior. As I see the arguments unfold about treatment theories and public safety I continue to go back to those discussions about the different approaches to studying behavior.

The terminology "studying behavior" is especially appropriate. If you look at the theories of B. F. Skinner there is a brilliant and elaborate set of rules about punishment and reward, behavior shaping and successive approximations. In the rat lab, we as students were able to shape the behavior of our white rats and get them to press levers for food and achieve remarkable success in training behaviors. At the end of the class and lab sessions, you might have been convinced that a rule book for psychology had been written and all behavior could be shaped and modified.

But every theory has its weakness in its application to all situations. When one looked more carefully at the theory, the principles of rewards and reinforcers were not defined in specific terms, they were defined by their effect on the behaviors of the organism under study. That is to say, they were defined functionally. If a stimulus were presented that increased a behavior it was a reinforcer. The theory did not explain why it was a reinforcer, just that it either was or was not a reinforcer. The problems came when you presented the same stimulus to two different people and got opposite results. Let's say, for example, you wanted to get someone to lift some weights and offered them money to lift the weights. One subject might do the lifting for money, the other may not. Money was a reinforcer in one situation but not in the other because the lifting behavior did not increase.

The same sort of problem exists in what might be called the bible of modern psychiatry, the DSM-IV manual. It is, if one examines it's approach, just what B.F. Skinner's definition of psychology is, a wonderful description. DSM-IV lays out in very detailed terms very elaborate criteria for the categorization of observable behaviors that then codifies the behavior and classifies it as a specific disorder. It is, when followed, a rather neat and tidy description of the behaviors associated with the disorder classifications.

Unfortunately, like B.F. Skinner, it does absolutely nothing to explain the whys of behavior. Realistically, there is no way to explain the why because what psychiatry is primarily based upon is a lot of clues and a great deal of accumulated observation mixed in with some great theories that has few if any real answers.

There should be very little doubt in any one's mind, except for the Tom Cruise's of the world, that real pathology does exist. We even have a pretty darn good idea of the areas of origin and some of the genetic and chemical process involved. But we still do not have definitive answers as to the precise nature of why.

This all leads to Dr. Amen. (Yes, that is his name, Dr. Daniel Amen) Dr. Amen is a psychiatrist that has taken the application of SPECT imaging and is relating the images of the brain to the observable behavior symptoms and interviewing data from psychiatric treatment to more precisely determine the areas affected in the brain from a variety of causes. He uses the SPECT imaging process to suggest medications and to evaluate the effects of those medications. It is a step beyond the typical clinical process and is a bold attempt to bring a higher order of observation to the process of diagnosing and treating problems with the brain. He is to be commended for his efforts to move beyond the boundaries of conventional psychiatry and bring some observable imaging technology to assist the process of understanding pathology and monitoring treatment.

The reliance on a manual and observation to create a diagnosis have lead to a great deal of criticism about the field of psychiatry. Some of it is justified. Those who suggest that the entire field is simply imaginary choose to ignore what has been carefully observed and codified. While it might be easy to suggest that brain function should be completely controllable by any person, clearly it is not and that assumption does not allow for any form of dysfunction. Suggesting that something as complex as the brain could not have disease or dysfunction seems preposterous when viewed in the light of all the other documented physical dysfunctions of the human body. Dr. Amen has chosen to take steps beyond observation and chosen to work toward greater quantification of brain function through observation methods that seek to expand our knowledge of the functions of the brain. I wish Dr. Amen and others like him success in furthering our understanding of the Whys of brain function.

Visit his web site at www.amenclinics.com to see his views on brain function and treatment for a wide variety of diseases. It is well worth your investigation.

1 comment:

Diane Magoto said...

I am intrigued by Dr. Amen's use of brain imagery to try to locate areas of the brain that cause psychopathology. The fact is that the DSM IV does not allow for shades of gray. As a result, it's a question of trial and error when a psychiatrist has you go on a particular med or combination of meds.

Seeing what is going on in the brain and localizing the exact nature of the problem seem very promising. People won't have to experiment for several years before finding the right meds that address the problem in the brain.