Saturday, May 09, 2009

How medicine lost—and then slowly regained—its mind

Keith Loftin of Areopagus Journal advises me that my article "How medicine lost—and then slowly regained—its mind" is now in print. I don't seem to find it on line, so I am providing an excerpt below. By the way, if anyone cares, Areopagus (or Mar's Hill) was the place that ancient Greek philosophers used to congregate. Here's the excerpt:
The mind as a demonstrated non-material cause

Also, once neuroscientists got a chance to study the brain at work, they were able to look at the way the mind acts on the brain as a non-material cause. A useful outcome was new treatments for mental disorders such as obsessive compulsions.

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disease marked by distressing, intrusive, and unwanted thoughts (obsessions) that trigger an urge to perform ritual behaviors (compulsions) like constant, abrasive handwashing. UCLA psychiatrist Jeffrey Schwartz, a practitioner of Buddhist mindfulness, saw OCD as a good candidate for a non- pharmaceutical—essentially non-materialist—approach to treatment. That is because OCD sufferers are not delusional. They actually know that their beliefs are mistaken and their compulsive activities are useless. But they do not know how to stop them either. Yet giving in makes the sufferers worse over time. The more they give in, the more persistent the beliefs and behaviors become. It is as if their brains have been hijacked. During most of the twentieth century, OCD was little understood and considered very difficult to treat.

Schwartz used neuroscience techniques to identify the cause of the disorder. Specifically, the cause is most likely a defect in the neural circuitry connecting the orbitofrontal cortex, cingulate gyrus, and basal ganglia, from which panic and compulsion are generated. When this “worry circuit” is working properly, we worry about genuine risks and feel the urge to reduce them. But, Schwartz found, when that modulation is faulty, as it is when OCD acts up, the error detector can be overactivated. It becomes locked into a pattern of repetitive firing. The firing triggers an overpowering feeling that something is wrong, accompanied by compulsive attempts to somehow make it right.

He then developed a four-step program (Relabel, Reattribute, Reassign, and Revalue) to help patients identify and reassign OCD thoughts, until they felt that they were diminishing in severity. Schwartz was not simply getting patients to change their opinions, but to change their brains. Subsequent brain imaging showed that the change in focus of attention substituted a useful neural circuit for a useless one. For example, it substituted “go work in the garden” for “wash hands seven more times.” By the time the neuronal traffic from the many different activities associated with gardening began to exceed the traffic from washing the hands, the patient could control the disorder without drugs. The mind was changing the brain.
If the whole article goes on line, I will link to it.

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