On Mental Illness vs. Brain Disease: the Primacy of Science

“Monday Musings” for Monday March 7, 2016
Volume VI. No. 10/270


                           Royal Bethlehem Hospital, London


By Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*


In the limited life span of Neolithic man, roughly ten thousand years, we have experienced stunning advances in knowledge, humanities, civil and individual rights; and with the birth of our beloved America, a perfection and maturation of the rule of law. These are all good news, indeed Gospels. But what stands out, if one would do a meta-analysis of all factors advancing the cause of life and advocating the dignity of humankind, is the field of science and its contribution to improving the quality of life.

Let’s take the case of understanding and treatment of schizophrenia, a dreaded brain disease. Yes, I said brain disease. We have come far from the days of demonic etiology of schizophrenia, the days of snake pits, and inhumane treatment of patients with schizophrenia (note: I did not call these patients schizophrenics.) The life giving

transformation of care by pioneer institutions, such as England’s Bethlehem Hospital and our own Dorothea Dix Hospital, followed by the emergence of community psychiatry are eloquent testimonies of the evolution of care of severely ill psychiatric patients.

What is currently filling our psychiatric literature and journals is most promising. We are in the throes of making new scientific discoveries based on neurochemistry and high resolution MRI. We are learning that schizophrenia is a diseased or disarrayed neuronal web in the central nervous system, especially the brain. Scientists are in hot pursuit of finding an effective pharmacological agent to help treat schizophrenia. We have learned about the cholinergic neurotransmitters, the muscarinic and nicotinic neuro-receptors and dopamine1 and dopamine 2 agonists and antagonists.

A new group of drugs now under investigation, cholinergic agonists, mediated by two families of receptors, nicotinic and muscarinic receptors are in the final phase of clinical investigation. The nicotinic receptors are ligand-gated ion channels formed by pentameric (5) combinations of different a and b subunits, as well as homomeric (consisting one repeated unit) receptors. Activation of the nicotinic receptors leads to a rapid increase in sodium and/or calcium conductance that increase neuron activity and neurotransmitter release. This explains why persons afflicted with schizophrenia have such a hunger for cigarettes.

Saint Paul, a fascinating brain, and an elegant stylistic writer summed up the future of mankind in offering hope, charity and love. What science does for us is a combination of all three. It takes a tremendous amount of motivation and discipline (charity), tenacity and optimism (hope) and dedication and altruism (love) to pursue science.

*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association; and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012).

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