Tag Archives: brain disease

A Compendium of Letters

“Monday Musings”  for Monday July 15, 2013

Volume III, No. 26/129

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(Editor’s Note: Today’s column is a compendium of letters to the editor of various publications)

Profligacy of our Postal Service

By Assad Meymandi, MD, PhD, DLFAPA*

Recent articles in the press re: USPS evoke some thoughts and suggestions. Postal service started by Cyrus the Great, the King of Persia (600- 530 BC), around 570 BC. He needed to have postal couriers to bring him news from the four corners of his vast empire on a regular and daily basis. His first person for the job, his Postmaster General, was a woman, a Postmistress by the name Mithra. She was Vizier of the Postal Services. Benjamin Franklin, a genius, a polymath, a polyglot, and fluent in history of civilization, in his writings made frequent references to Mithra. This little known fact also reflects the human right and equality women enjoyed in pre-Islamic Achaemenid Persia. Cyrus had two other female viziers also.

Thanks to our founding fathers, and especially to Benjamin Franklin, for more than 200 years, Americans have relied on the US Postal Service to deliver the mail through storms of all kind. But changing technology, a global recession, and rising debt now threaten the national mail service. Mail volume is expected to drop by 14% this year, and the USPS estimates that it will lose seven billion dollars. There is no question that by any measure the USPS’s financial condition is dire.

Among solutions contemplated is by USPS officials are closing of up to 700 branches and delivering mail five days a week or at least to stop Saturday mail delivery. USPS has tried to balance the budget by raising rates, trimming its work force through attrition and buyouts, automating mail sorting, realigning routes, and freezing executive salaries. Here are some thoughts about alternative solutions: Like Germany, Britain and Japan USPS ought to open its services to competition from private companies. In a recent report in Financial Time, professors of the London School of Economics suggest “profit motive would bring a drive for efficiency…”

As I travel around the world and observe national habits, I have not seen any country that offers so much in amenities to the postal carriers as we do in America. Our postal carriers seem to all have jeeps to carry them around. I suggest that USPS, like Germany, Britain and Japan mothball the millions of combustion engine jeeps they buy, fuel and maintain, spending billions of dollars on that one item and encourage the delivery to be carried on foot. Another benefit of such change in policy is trimming down the unwanted fat the jeeps carry around. Trimmer, and healthier postal workers save on the health bill. Obesity that causes diabetes, cardiovascular disease, hypertension and musculoskeletal problems, like chronic backache, could be prevented and truly billions and billions dollars in healthcare savings realized through switching from machine delivery to foot delivery. American profligacy is not only driving us to bankruptcy, it is literally killing us.

Assad Meymandi, MD, PhD, DLFAPA


 One Serpent or Two Serpents Caduceus

Letter to the Editor, News and & Observer

The wrong caduceus was used in the op-ed page article “Dying Well, Knowing the Cost”, N&O, June 13, 21013. Caduceus, a staff with two serpents is related to Mercury and all its functions and attributes including commerce. Caduceus with a staff and one serpent is medical symbol that goes to Asclepius. In 1902 through an error made by a culturally illiterate VA doctor in NY, the commercial caduceus was adopted as a medical symbol and never corrected. However in 1952, American Medical Association (AMA) took action to correct the symbol. AMA has taken further initiative of correcting the symbol in all its formal medical printings and communications.

A M

“Iran, 3000 Years of Stoning Women”

Letter to the Editor, The News and Observer, Raleigh, NC

I am writing to strongly object to the content of the political cartoon on the editorial page of N&O, Monday June 10, 2013. Among many evils going on in the world your cartoonist lists “ 3000 years of stoning women in Iran”.  A bit of history might be helpful.

It is the Persian Empire and not Iran that is over 3000 years old.  As a matter of fact, Persia and some of its cities go back 8000 years. Cyrus the Great and other kings of Persia are invoked in the 66 books of the Bible on innumerable occasions. Isaiah 45 is almost singularly devoted to the beneficence of King of Persia where he is named Messiah. Cyrus emancipated the Jews and established equal rights for men and women. In managing his vast empire, to be in touch with his emissaries, rulers in distant parts of the kingdom, Cyrus developed a formal service charged with sending and receiving communiqués to and from his lieutenants, thus the birth of the postal service which he called “Peyk”. The cabinet of Cyrus the Great consisted of twelve viziers (ministers or secretaries), several of whom were women. The first person in charge of the Royal mail service was a woman. Her name was Mithra (which in Zoroastrian parlance means, dignity). The father of the United States Postal Service (USPS), the polymath Benjamin Franklin, being the amorous type and a lady’s man, has referred to Mithra in his writings. In addition, we had Toorandokht and Poorandokht (both women) ruling the Persian Empire during the Sassanian (Sassanid) dynasty, 224-651 AD. Also, we are reminded repeatedly in the Old Testament that wisdom is a woman (Proverb 1-9), and in Greek the word for wisdom is Sophia. May be one of these days we will have a female US President to bring some wisdom and love to our dialectically torn nation. I have a granddaughter who will make a good candidate…

Cyrus Cylinder, the iconic representation of declaration of human rights, is now on tour in US.  Yes, under the Mullahs and the present day regime, the level of human dignity and civility has deteriorated.  But the regime is only 30 years and not 3000 year old.

AM

Letter to the Editor, The News & Observer, Raleigh, NC

 

Dear Sir:

Mental Health

Kudos to John Drescher for his insightful column N&O, June 1, 2013, “On Mental Health, Job isn’t Done”. The only correction I offer is that some studies reveal that over one third of NC inmates have a diagnosable mental illness (brain disease), not 15 to 20 percent as stated in the article.

For over 50 years, I have been involved in various capacities with the North Carolina mental health system. At no time the services to and for our patients have been as chaotic, sparse, and erratic as they are today. Fifty years ago, in North Carolina, we had a system in place that was truly superb. At Dorothea Dix Hospital, where I received my psychiatric training, in the late 50’s and early 60’s, patients had predictable, excellent,

and academically cutting edge treatment available to them with ready access. No patients had to wait for days and in some instances for weeks in emergency departments of general hospital waiting for a bed.  And no patients were put in jail and prisons because of lack of mental health treatment and shortage of psychiatric beds. We have certainly devolved and regressed. Taking care of patients with mental illness–and really it is brain disease—is a moral responsibility about which Thomas Jefferson and our country’s other founding fathers have expounded.

There is a glimmer of hope.  UNC system President Tom Ross, his chief of staff, Kevin Fitzgerald, Dean of UNC School of Medicine at Chapel Hill, Dr. William Roper, and WakeMed administrator William Atkinson have agreed to provide a psychiatric unit of 40+ psychiatric beds for Wake County.  With the projected population growth in our area, to do an adequate job, we need a facility with 500 psychiatric beds.  We can do better, and must do better.

AM

Editor, WSJ: I am submitting the essay below for op-ed page, or the letter in response to Mr. Gary Fields’ excellent article in today’s WSJ. Thank you

AM

Gary Fields’ comprehensive article, WSJ, June 8-9, 2013, on the dilemma of the families where there is severe mental illness is indeed of Pulitzer quality. Mr. Fields took a psychological and historical scalpel and ably dissected the huge problem of mental health care in America. However, here are some reflections:

In the debate of violence, especially gun violence, mental illness has gotten a bad rap. The alleged connection between mental illness and mass violence is not supported by objective data and science:  “substantial research shows that the vast majority of people with serious mental illness never act violently, and the vast majority of violent crimes -96 % by the best available data- is not perpetrated by persons with mental disorder” said Paul Appelbaum, Past President of APA, Professor of Psychiatry, Medicine and Law at Columbia College of Physicians and Surgeons. What we need to do is to face and design program of mental healthcare instead of warehousing the mentally ill in jails and prisons.

The APA position which I am advocating is to appoint a presidential commission to develop a vision for a system of mental health care, creating a mechanism for facilitating responses to key mental health issues such as designating a white house point person, improving early identification of youth with mental health problems and developing sensible, non- discriminatory approaches to ensuring that dangerous individual cannot gain access to guns. In his report and testimony Dr. Appelbaum stated “that people with mental illness who are engaged in regular treatment are considerably less likely to commit violent acts than those who need but do not receive appropriate mental health treatment.”

Another expert testimony at the Vice President Task Force was Dr. Thomas Insel, Director of National Institute of Mental Health stated that “Suicide, not homicide, is the most urgent public health problem associated with gun violence.  About 90% of suicides involved individuals with mental illness. Dr. Insel reported that “the popular association of homicidal violence and mental illness is tenuous at best..”  Despite common public perceptions, there is little connection between gun violence and mental illness.  Only 6 percent of violent crimes are committed by someone with a diagnosed mental illness, as opposed to 96 percent suicides that are associated with mental illness.

What to Do? 

For nearly 50 years, I have been involved in various capacities with the North Carolina mental health system. At no time the services to and for our patients have been as chaotic, sparse, and erratic as they are today. Fifty years ago, in North Carolina, we had a system in place that was truly superb. In the late 50’s and early 60’s, patients had predictable, excellent, and academically cutting edge treatment available to them with ready access. Taking care of patient with mental illness, which is really brain disease, is a moral responsibility about which Thomas Jefferson and our country’s other founding fathers expounded. America has a moral obligation to provide care for the mentally ill.

Assad Meymandi, MD, PhD, DLFAPA

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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On the Brain and Behaviour, Part IV

Monday Musings for Monday June 24, 2013

Volume III, No. 23/126

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NIH Neuroscience Center Building, Rockville, MD

(Editor’s Note: This is part IV of a four part series on Brain and Behaviour. In Part I, June 3, 2013, the general topography and physiology of the brain was discussed. In Part II, Monday June 10, the topic of Epigentics was explored. In Part III, June 17, the emergence of ‘Age of Mind’, marriage of psychoanalysis and neurosciences was examined. Today, Part IV, we conclude the series by offering an example of such marriage in the form of a book review to enhance our understanding of what lies in the future of the union of psychoanalysis and neuroscience.)

 Brain and Behaviour, Part IV

PSYCHOANALYSIS AND NEUROSCIENCE

By Assad Meymandi, MD, PhD, DLFAPA*

PSYCHOANALYSIS AND NEUROSCIENCE

Edited by Mauro Mancia. 436 pages. $199.00

Springer.  New York, NY

The faithful readers of this space recall that we begun reviewing books about mind, memory, neuroscience and the brain many years ago. The first book reviewed in this series was the book by Harvard clinical and research psychologist, Daniel L. Schecter, Searching for Memory, the Brain, the Mind and the Past. The last book reviewed in this series was the Nobel Laureate psychiatrist Eric Kandel’s book, “The Emergence of a New Science of Mind,” published in the October 2011.

We now offer the review of a fascinating book, “Psychoanalysis and Neuroscience,” edited by the enormously sage of the Italian Academia, neurobiologist and psychoanalyst Mauro Mancia. First a word about the author/editor:

Mauro Mancia is Professor Emeritus of Neurophysiology, University of Milan, Italy and Training Analyst of the Italian Psychoanalytical Society. His interest is in the link between neuroscientific knowledge and psychoanalytic theories of mind and he has written extensively on the subjects of narcissism, dreams, sleep, memory and the unconscious.

Interest in dream goes back to Sumerian recordings going back to some eight thousand years ago.There are abundant references to dreams in Torah, the Bible, the Holy Quor’an and other celestial books, such as Avesta, the book of Zoroaster, written 500 BCE. But it was not until early last century that Freud published his work on understanding and interpretation of dream that a firm connection between dream, memory and “mental” history began to evolve.

Fast forward the clock. Neuroscientific interest in dream started in 1953 with the discovery of Rapid Eye Movement (REM) sleep by Aserinsky and Klietman, taking psychophysiologic findings of dream into the realm of biology. There are many exciting discoveries in the area of psychoendocrinology of dream and memory coming out of many sources and laboratories both in US and abroad. Here is the title of one of the recent articles: “The Role of the Inter-relation Between Serotonin (5-HT), Muramyl Dipeptide and Interleukin-1 (IL-1) in Sleep regulation, Memory and Brain regulation,” by the editor of this book and his colleagues, published in American Journal of Physiology. 

The book is organized in four parts.

Part I:

Memories and Emotions: consists of eight chapters written by experts in their respective fields.This segment examines one basic message: memories stand out and last longer when they are accompanied and highlighted by emotional experience. The message of this section of the book is the importance of interconnection of memory with emotions. With scientific detail and elaboration, the authors demonstrate the proteins in amygdala and hippocampus responsible for retention of memories are parts of the limbic system that overall is responsible for housing emotions denoting the common neuronic pathway for memory and emotions. In 1940s, while mapping specific components of the limbic system, Paul D McLean invoked the romantic notion that the limbic system is “the anatomy of emotions.”

Part II:

The second part of the book consists of three chapters. It examines the sensorimotor side of “empathy pain,” the role of the anterior cingulate cortex in affective pain, and social cognition and response to embodied stimulation.

Part III:

Also consists of three chapters. It is perhaps the most exciting part of the book. It deals with “The Dream in the dialogue between Psychoanalysis and Neuroscience.” One chapter dissects the neurobiological and psychoendocrinological anatomy of dreams and memory formation. In recalling events of the past as practiced in psychoanalysis, the brain’s physiology and even anatomy and morphology stands to be changed. This part of the book reminded me of another significant book recently published, “Train your Mind, Change your Brain” in which author Sharon Begley, a Wall Street Journal neuroscience reporter, shows how thinking can change the brain functionally and anatomically.

Part IV:

The two chapters of this part discuss fetal behavior. While the word embryology is seldom used, the authors of these two chapters examine in detail the onset of human fetal behaviour, and neurophysiologic impact and influence of nursing on the early organization of the infant mind.

With the knowledge that the basic instrument in the discipline of psychoanalysis is recall of memories, dreams and transference, the 21 authors of this book make a good case why there should be a robust and constant conversation between psychoanalysts and neurophysiologists. It is time for these disciplines to learn about and from each other. The authors invite readers, in most scholarly and convincing manner, that psychoanalysis, a powerful reservoir of volumes of memories, should integrate resources with neurophysiology and enjoy the mutual fertile and rich products. It is the expressed purpose of the book to further elaborate and understand the relationship between memory, dreams and neurobiological changes occurring during the experience and the course of psychoanalysis. This holy partnership is encouraged and the authors, like priests, are willing to bring about this holy matrimony to the world of science.

The downside of the book: It is a rather difficult read, I guess because it is a translated work. I do not know how much psychoanalysis and neurophysiology the translator, Mrs. Judy Baggott, has had. To a linguist, conversant with a variety of Eastern and Romance languages, the slip of the translator shows fairly frequently. Her skirt should be longer!  However, this minor flaw should not dissuaded anyone form tackling this enormously informative and scholarly work.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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On the Brain and Behaviour, Part III

Monday Musings for Monday June 17, 2013

Volume III, No. 22/125

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Brain  and  Behaviour,  Part   3

Thinking  About  Thinking,  Episteme,  Chrestomathy

Twenty  First  Century , The  Age  of  Mind

By Assad Meymandi, MD, PhD, DLFAPA*

Editor’s Note: This is part III of a four part series on Brain and Behaviour. Part I, June 3, 2013, the general topography and physiology of the brain was discussed,  Monday June 10, the topic of Epigentics was explored.  Today we examine the relationship between psychoanalysis and biology.  Next week we will review some of the books about the subject to enhance our understanding of what lies in the future of neuroscience.

In preparing for this essay, obviously I was drawn to psychoanalytic literature of the late 19th and early 20th century. But the further I dug, the more it became obvious that psychoanalysis did NOT start with Freud. Many of Freud’s teachers and predecessors had expounded on the theory of unconscious. Plato, Shake­speare, Kant, Schopenhauer, Nietzsche have all dealt with and expounded on the possibility of the unconscious, the soul and metaphysics. Yes, I was taken all the way back to Aristotle, a student and rival of Plato, whose writings are so very organized and detailed, making the reader feel like they are biting into stone. Aristotle had a lot to say about psyche (soul), God, ether and metaphysical phenomena. Psychoanalysis thrived in the first 60-70 years of the 20th century, but experts fear the threatened demise of the field.  What is the answer? The answer lies with uniting psychoanalysis with biological sciences. Let me elaborate:

In a recent discussion with an academic colleague who was identifying the twentieth century’s greatest achievement as the discovery of the atomic bomb, I argued rather forcefully that the contribution of the twentieth century was advancement of Father Gregor Mendel’s genetics through the discovery and understanding of RNA and DNA by James Watson and Francis Crick in 1953. They were awarded Nobel Prize for Medicine or Physiology in 1962. We celebrated at the University of North Carolina and Research Triangle Park, in 2003, the 50th anniversary of the discovery by having Dr. James Watson amongst us. The understanding of DNA and subsequent expansion of the knowledge and advancement of human genome project which was completed in 2003 by Dr. Craig Venter, Director, The Institute for Genomic Research, in my opinion, was the greatest achievement of the 20th century.

Now, facing the 21st century, with wars going on every corner of the globe, humans killing humans for a few pieces of mud prized as land, the need for understanding human behavior makes psychoanalytic research more urgent.  And I believe we have the opportunity to develop further understanding of ourselves, the new science, the science of mind, provides us with a powerful instrument for further development of the field. If the 20th century was known for the discovery of DNA, genomics and epigenetics, the 21st century will be known for the discovery and understanding of the science of mind. And the promise of establishing such a discipline rests with espousing psychoanalysis with biological sciences, neuroscience and neurobiology. Of course, the concept of scientific understanding of mind is not new. Sigmund Freud in “Beyond the Pleasure Principle” wrote an increase in plasma ACTH and glucocorticoid is a response to stress as adults. Thus, differences in an infant’s interactions with his/her mother–differences that fall in the range of naturally occurring individual differences in maternal care– are crucial risk factors for an individual’s future response to stress. In the same book he further elaborated, “The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones….we may expect [physiology-and-chemistry] to give the most surprising information and we cannot guess what answers it will return in a few dozen years of questions we have put to it. They may be of a kind that will blow away the whole of our artificial structure of hypothesis…” Further reference: in his classic paper “On Narcissism” he wrote, “We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.” On the cusp of 21st century, we really need a contemporary Freud to orchestrate the disparate parts of the symphony of life, psychoanalysis, biological sciences, genomics, neurosciences and neurobiology to produce the rich symphony of better understanding mind and ultimately life.  Well, we do have a few contemporary Freuds, one is Eric R.Kandel whose most recent book, “The Science of the Mind”, we reviewed in this space. Dr. Kandel who is a Nobel Laureate psychiatrist and professor at Columbia University insists that to save psychoanalysis and pump vigorous life into this elegant field, we need to bring about fusion of the two disciplines of psychoanalysis and biology. Otherwise, there is a wide spread concern about viability of psychoanalysis as a scientific discipline. For example, Jonathan Lear. Others have argued that psychoanalysis and psychoanalytic literature from Freud to Hartmann to Erickson to Winnicott, will be read as a modern philosophical or poetic text alongside Plato, Aristotle, Shake­speare, Kant, Schopenhauer, Nietzsche, and Proust (the literature I went through for preparation of this essay). On the other hand, if the field aspires, as I believe most psychoanalysts do aspire, to be an evolving, active contributor to an emerging science of the mind, then psychoanalysis will survive. There is no doubt that psychoanalysts could and did make many useful and original contributions to our understanding of the mind simply by listening to patients. We must at last acknowledge that at this point in the modern study of mind, clinical observation of individual patients, in a context like “the psychoanalytic situation that is so susceptible to observer bias is not a sufficient basis for a science of mind. Psychoanalysis research is depleted from opportunities to add more knowledge,” so say the late Kurt Robert Eissler (1908-1999) and Hartvig Dahl (1924-2007). Marshall Edelson in his book “Hypothesis and Evidence” offers a persuasive argument that the holy marriage between psychoanalysis and biology must take place: “we must bring psychoanalysis and biology together.”

Psychoanalysis is based on the concept that individuals are unaware of the many factors that cause their behaviors and emotions. These unconscious factors have the potential to produce unhappiness, which in turn is expressed through a score of distinguishable symptoms including disturbing personality traits, difficulty in relating to others, or disturbances in self-esteem or general disposition. As I have suggested earlier, most biologists believe that the mind will be to the twenty-first century what the gene was to the twentieth century. I have briefly discussed how the biological sciences in general and cognitive neuroscience in particular may contribute to a deeper understanding of a number of key issues in psychoanalysis.

As things stand now, psychoanalysis is falling behind biology. Psychoanalysis and biology must marry to reinvigorate the exploration of the mind. I should say at the outset that although we have the outlines of what could evolve into a meaningful biological foundation for psychoanalysis, we are very much at the beginning. We do not yet have an intellectually satisfactory biological understanding of any complex mental processes. In the next century, biology is likely to make deep contributions to the understanding of mental processes by delineating the biological basis for the various unconscious mental processes, for psychic determinism, for the role of unconscious mental processes in psychopathology, and for the therapeutic effect of psychoanalysis.  Biology has the potential to enlighten these deep mysteries at their core.

We have seen that one point of convergence between biology and psychoanalysis is the relevance of procedural memory for early moral development, for aspects of transference, and for moments of meaning in psychoanalytic therapy. We have considered a second point of convergence in examining the relationship between the associative characteristic of classical conditioning and psychological determinacy. Here, I want to illustrate a third point of convergence: that between Pavlovian fear conditioning, a form of procedural memory mediated by the amygdala, signal anxiety, and post-traumatic stress syndrome. Psychoanalysis and cognitive neuroscience would accomplish two goals, one conceptual and the other experimental. We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.

The American psychologist best known for his maternal-separation and social isolation experiments on rhesus monkeys, Abraham Maslow, demonstrated the importance of care-giving and companionship in social and cognitive development. He conducted most of his research at the University of Wisconsin-Madison. As an aside, the etymology of the word companionship comes from Latin for bread—PAIN—nutrition.  Another psychologist, Hans Selye, had pointed out as early as 1936 that humans and experimental animals respond to stressful experiences by activating their hypothalamic-pituitary-adrenal (HPA) axis. The end product of the HPA system is the release of glucocorticoid hormones by the adrenal gland.

The prefrontal association cortex has two major functions: it integrates sensory information, and it links it to planned movement. Because the prefrontal cortex mediates these two functions, it is thought to be one of the anatomical substrates of goal-directed action in long-term planning and judgment. Patients with damaged prefrontal association areas have difficulty in achieving realistic goals. As a result, they often achieve little in life, and their behavior suggests that their ability to plan and organize everyday activities is diminished.

What To Do?  What is Next?

For one thing, we must transcend territorial imperative, and learn to speak each other’s language– neuroscientists the language of psychoanalysts, and psychoanalysts the language of neuroscience. For many years both the Association for Psychoanalytic Medicine at Columbia and the New York Psychoanalytic Institute, to use but two examples, have instituted neuropsychoanalytic centers that address interests common to psychoanalysis and neuroscience, including consciousness, unconscious processing, autobiographical memory, dreaming, affect, motivation, infantile mental development, psychopharmacology, and the etiology and treatment of mental illness. The prospectus of the New York Psychoanalytic Institute now reads as follows: “The explosion of new insights into numerous problems of vital interest to psychoanalysis needs to be integrated in meaningful ways with the older concepts and methods as do the burgeoning research technologies and pharmacological treatments. Similarly neuroscientists exploring the complex problems of human subjectivity for the first time have much to learn from a century of analytic inquiry make a significant fraction of psychoanalysts technically competent in cognitive neuroscience and eager to test their own ideas with new methods.” The challenge for psychoanalysts is to become active participants in the difficult joint attempt of biology and psychology, including psychoanalysis, to understand the mind. If this transformation in the intellectual climate of psychoanalysis is to occur, as I believe it must, the psychoanalytic institutes themselves must change from being vocational schools- guilds, as it were- to being centers of research and scholarship.

We have precedence, the Carnegie Foundation commissioned Abraham Flexner to study medical education in the United States. The Flexner Report, which was completed in 1910, emphasized that medicine is a science- based profession and requires a structure education in both basic science and its application to clinical medicine. To promote a quality education, the Flexner Report recommended limiting the medical schools in this country to those that were integral to a university. As a consequence of this report, many inadequate schools were closed, and credentialed standards for the training and practice of medicine were established. To return to its former vigor and contribute importantly to our future understanding of mind, psychoanalysis needs to examine and restructure the intellectual context in which its scholarly work is done and to develop a more critical way of training the psychoanalysts of the future. Thus, what psychoanalysis may need, if it is to survive as an intellectual force into the twenty- first century, is something akin to a Flexner Report for the psychoanalytic institutes.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in Chief, Wake County Physician Magazine(1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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Schizophrenia, A Brain Disease

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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.  They are individual suffering from schizophrenia) 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.

 

Research scientists in neurobiology 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 a Distinguished Life Fellow American Psychiatric Association, Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill.  He is the Founding Editor and Editor in chief, Wake County Physician Magazine(1995-2012)

 

September birthdays of States:  California, State #31, joined the Union on September 9, 1850.  State Motto: “I have found it”

“Monday Musings” for Monday September 24, 2012

Volume II. Number 34/86

 

Schizophrenia, A Brain Disease

By Assad Meymandi, MD, PhD, DLAPA*

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