Liberal Brain, Conservative Brain?
Posted on October 1, 2007
In a fascinating study published in Nature Neuroscience online entitled: Neurocognitive correlates of liberalism and conservatism, David M. Amodio at NYU and others at UCLA found intriguing evidence that liberals and conservatives actually have differing brain function:
I was able to download the full study, which was a randomized study involving 43 right handed participants. (Left-handed people can have different functional brain activity.) During the study, half the participants were shown “W” or “M” images on a computer screen, and told to push a button if they saw a “W” and not push the button if they saw an “M”. They were shown an random pattern of “W”s and “M”s where “W”s outnumbered “M”s by about 4:1. Incorrect responses generated an error message. The other half of the participants were given opposite instructions, and the opposite pattern. The correct and incorrect responses were tallied, and it was found that those who had identified themselves as “strongly liberal” had a strong tendency to perform better on this test than those who identified themselves as “strongly conservative”. Also, the more “liberal” participants tended to have a higher degree of excitation in the dorsal anterior cingulate when presented with the less-frequent letter. This would suggest that liberals “noticed” the unusual letter more strongly than conservatives.
While the study is relatively small, the authors point out that there have been other studies which have begun to point out consistent differences in liberals and conservatives on behavioral tests.
I find this very interesting, because it suggests that differences between conservatives and liberals may not only be in how they interpret their environments, but also in how they perceive their environments based on neural functioning.
So can one say that liberals’ brains function better than conservatives’ brains? Well, the answer in not so clear cut. First of all, it is a single study, and will need to be replicated to confirm the findings. Secondly, there was variation: Some liberals did fairly poorly on this test, some conservatives did fairly well. And finally, the trait of enhanced recognition of “unusual” stimulus may or may not be survival enhancing, depending on the circumstance. Sometimes its better to ignore the exception, at least for the time being (”The show must go on!”), and other times its important to pay careful attention to exceptions (”Stop the presses!”).
‘Tags’Neurobiology’Politics’» Filed Under News | 1 Comment
Using Medication
Posted on September 24, 2007
Medication presents me with an interesting and, at times, difficult dilemma. As a psychiatrist, it one of the more useful, powerful weapons in my arsenal for helping my patients feel better. However, its introduction can bring with it unintended ramifications. As an example, I recently saw a patient who had been struggling with a clinical depression for several months, and finally came in. As it turned out, there were several environmental stressors which had placed her in a psychologically difficult bind, which with the help of family we seemed to be able to address effectively. She and her family were very reluctant to accept medication, and while I did think medication would have been appropriate, and would enhance her likelihood and perhaps speed of recovery, I decided not to insist. We agreed on therapy and watchful waiting instead, and to revisit the question if need be.
So what are some the issues with medication?
Pros:
1) Known effectiveness. Antidepressants are known to be the most effective treatment for depression, slightly edging therapy. Of course, the combination of both seems to be the most effective. For other conditions, medication may be even more strongly indicated.
2) Ease and convenience. Taking a pill once or even twice a day is very convenient, and doesn’t take as much time or require the often emotionally difficult work of therapy.
3) Cost. Medication is often expensive, but for some conditions there are generics. In any case, particularly if one doesn’t have insurance, once a week or more therapy can be much more costly.
Sounds good so far, but what are the downsides?
Cons:
1) Negative self-esteem. For many people, there is a belief that “needing” medication means there is something intrinsically wrong with them. Thus, by accepting medication they are accepting that they are “bad” or “faulty” as human beings. This can have the unintended result of creating a loss of motivation or self-esteem, which can interfere with the healing process, and set the stage for treatment resistance or treatment failure. Or, it can exacerbate pre-existing feelings of poor self-esteem which likely contributed to their current problems, and make things worse.
2) Dependency. I will go into this more in another post, but one issue which both psychiatrists and therapists have to address is the issue of dependency. Some patients will come to depend on the medication as a kind of “security blanket”, or transitional object, which represents the doctor, and “health”. When this dynamic is present, it can make the likelihood of sustained remission off medication much lower.
3) Stigma. Besides the personal issues, there are the real issues of what it means to “society” when a person is on, or has been, on psychotropic medication. I recognize that when another physician or therapist takes a person’s history, and that person’s history includes medication, there is a difference in perception, and likely unconscious judgments compared to the person who has never been on medication. Never mind the perceptions and judgments of lay people who may happen upon that history.
4) Known and unknown side effects. Unfortunately, medicines have side effects. For some people they are not noticeable, for others they may be so severe as to preclude using that particular medication. In addition, risks of birth defects or long term potential side effects must sometimes be considered.
So where does all this leave us? In my case, I weigh the pros and cons with my patient and talk it out. In particular cases, I may advocate strongly for medication, in others I may be more neutral, as in the case above, in other cases I may discourage it. It sometimes helps that often I see a patient in referral from another therapist, because then I have an idea that the therapy alone approach has failed. Also, the opinion of another experienced health professional that a patient needs medication, especially when the patient has been seen by that person for awhile, can be a helpful (though not certain) indicator.
As I read over the above, I see there is much left to say, but this is a blog entry and not a book, so I hope I have given the reader something reasonable to consider. There are other pros and cons. In the final analysis, it will up to the patient to choose, and then it will be incumbent on me to try to support that decision as best I can.
‘Tags’Psychiatry’» Filed Under Philosophy | Leave a Comment
Being a Doctor
Posted on September 18, 2007
I recently attended the annual American Conference on Psychiatric Disorders, which was held here in New York City on September 7th and 8th. This was a chance for me to reconnect with others in my profession, and to catch up on some of the latest research, which I feel the need to do periodically as I tend to be relatively isolated in my private clinical practice. During one of the initial sessions, the presenter projected this slide summarizing his definition of a physician:
“A physician is
-An expert at a particular set of skills
(History, examination, differential diagnosis)
-The custodian of a body of knowledge
-An advocate for the patient”
A sub context of the presentation, was that psychiatry in the past had been overly concerned with therapeutic issues, as there had been relatively little known about actual (biological) causes of mental illness.
I have to admit feeling very disappointed as I heard that definition. As a result of our training, we do have expertise in a certain set of skills, and carry a certain unique body of knowledge and experience which differentiates us from our peers in mental health. But I think we miss the mark entirely if we do not place firmly in the center of our definition the role of healer.
I know in my own case, my desire to become a physician was all about being able to help people who were ill in the most effective manner possible. And for me, especially as a psychiatrist, the “how” is just as important as the “what”. How people perceive me, how I relate to them, can make all the difference in a patient’s outcome, and I don’t believe the above definition captures that. Interpersonal therapeutics are extremely important, and will always remain so, despite whatever advances we may make in genetic or molecular neuropsychiatry or neurobiology. There are a number of trends in modern psychiatric training that are troubling to me, and that of minimizing interpersonal therapeutics, in favor of diagnostic classification and over-reliance on pharmacology, is one. I hope to discuss others as time goes by.
‘Tags’Psychiatry’» Filed Under Philosophy | Leave a Comment
