why study neurology?

mat mats_trash at hotmail.com
Wed Jan 16 05:04:17 EST 2002

> Er, actually that's exactly how it is done. 
> We throw them at patients with a 'best guess' hunch, then when we find
> it works, we construct the monoamine theory to explain it, then fiddle
> around with similar molecules to see if they work. There is lots of
> discrepancies when we find molecules which should work but don't and
> molecules which shouldn't work but do. This is much more true in
> psychiatry than in other fields.
> Just look at clozapine and the atypicals. Or how about that
> high-profile case a few months back with quinidine being used to
> alleviate symptoms of CJD? No one has any real idea (just a couple of
> hunchs) how it works, but it is proclaimed a scientific achievement.
> More like a serendipitous discovery.
> Then consider all those glutamate receptor antagonists, selective D4
> antagonists, orexin analogues and whatnot which were specifically
> designed to work but don't. Don't believe the hype of the biotech
> companies, most drug discoveries were not preconceived ideas but a
> "gosh, that's surprising."

Yes but you are not suggesting that these drugs work by any other
means than chemical interactions are you?  Just becuase you don;t know
which system(s) the drug is affecting doesn't mean its doing something
that can't be well defined on further study.  In my examples what I
was trying to convey that becuase these drugs modulate the activity of
brain systems (it doesn't matter which!) then these constitute what we
call 'mind'

> That's not what Nick said though...
> To paraphrase him, he said that the deterministic/reductive approach
> is next to useless when trying to find out what makes patients tick
> and how to help them.
> This puts it in a clinical context where the aim is to help people
> with their psychological disorders. Mind-body dualism may be false,
> but this framework is necessary when dealing with human beings.
> Psychiatrists, neurologists and doctors won't be helping many people
> by just giving them pills and sending them home while
> cognitive-behavioural therapy has been shown to be as effective as
> SSRIs in treating depression. In fact the very definitions of many
> psychiatric disorders are so fuzzy and functional that to claim that a
> pattern of chemical imbalances causes them is hard to believe.

But what I am saying is that such an approach can only go so far. 
Further by not even accepting that a reductionist theory may help you
are effectively cutting your nose off to spite your face.  Not even
allowing the idea that it might be a good way of helping patients is
just shortsighted. And I would add that the most fervent promoters of
the reductionist theory include psychiatrists, who better than anyone
realise that before we can understand the whole we need to understand
its parts (e.g. nobel-laureate Eric Kandel who in his nobel lecture
said 'In realised the only way was to take a radically reductionist

As to the second point, from reading the DSM-IV (for a laugh as you
do) some distinctions are fuzzy etc as you say.  However I am cautious
about saying that the cognitive functions we have conveniently divided
our minds into map isomorphically to any single or multiple
anatomical/chemical system.  On more 'radical' days I wonder whether
any of the cognitive functions we have are real but simply the
confabulation of a complex language and society! ho ho

> Rhetorical questions for Mat:
> 1) Do you think the mind (as you understand that word, since we all
> seem to be using it differently) is an emergent property of neuronal
> firings, chemical changes and whatever else goes on in the material
> brain?

Emergent is an ambiguous word and has been used by many as simply a
way of hiding a theory based on dualism.  I would say of course that
some brain functions cannot be understood just by examining a single
synapse in the same way that a cell can't be understood by looking at
a single enzyme.  But I only think mind emerges to the same extent
that we see a cell as composed of all its constituent proteins etc.
and subsequently having seemingly deliberate or purposeful action.  I
don;t believe a cell gains any soul as an emergent property, similarly
in the brain.

> 2) If so, then it can have new properties that its constituent parts
> do not, right? Then is it fair to say that treating at the level of
> the emergent property directly may be more effective in producing
> desired changes than treating at the level of the constituents in hope
> that the emergent property changes?

Thats just mis-guided.  If a person undergoes 'therapy' i.e.
discussing problems etc., then how exactly is the language and meaning
within it received and interpreted by the brain? Through something
other than its synpatic connections?  You can never jump outside the
system.  How would you treat the emergent property by any other route
than its synapses? When talking to someone you are changing their
synaptic connections and creating new emergent network patterns etc. 
Pharmacological agents, though undoubtably a much more crude tool than
language at the present time, have the same essential effects.  I say
this of course because I believe there is nothing other than the brain
which constitutes our mind.

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