Brain Stimulation: Literally Speaking

 

Deep Brain Stimulation (DBS), Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), and Vagus Nerve Stimulation (VNS) are all FDA approved treatments for neuropsychiatric disorders, heralding the new modality of treatment for psychiatric diagnoses. Darin Dougherty MD from the Division of Neurotherapeutics at a Harvard-affiliated hospital, presented his studies, demonstrating that when subjects were given active treatment, versus sham treatments, there was a high placebo response. To date, he has not been able to show the effectiveness of Deep Brain Stimulation, but he believes, that is because he has not determined where to place the electrode in the brain. Nevertheless, whereas drug companies used to sponsor most of the psychiatric research, now there is a lot of research sponsored by those who make these machines, such as Medtronics. Procedure-based psychiatry is the frontier, with hope of targeting a more specific area of the brain, moving us forward from ECT in which the entire brain has to seize in order to achieve the desired results. If we could localize the emotional brain, we could tickle it, and make folks feel better, or so the hope goes, for our future. In this way, this is an exciting time to be a psychiatrist, with the hope that like our medical colleagues, we hope to be able to offer our patients both pharmaceuticals and medical procedures which “fix” the underlying problem. Do I think this will put psychotherapists out of business? On the one hand, I would welcome the immediate relief that these procedures promise. On the other hand, I cannot imagine a substitute for working through difficult life decisions in a way in which one approaches junctures with thought and deep appreciation for the gravity of the decision. As always, I imagine these procedures could enhance psychotherapy by giving folks who are paralyzed by life’s traumas a way to move forward in psychotherapy so that they can navigate their world in a deeply conscious way. My work dovetails the work of those like Dr. Dougherty and so I welcome his neurotherapeutic  innovations.

Mirror Neurons

Marello Dapretto PhD http://faculty.bri.ucla.edu/institution/personnel?personnel%5fid=46838 spoke today about how mirror neurons are abnormal in those with ASD-autism spectrum disorder. It was one of those lectures where I felt like I already knew this, and so I was not learning anything, but at the same time, she was demonstrating with pretty fMRI pictures that what I/we have suspected for years, is finally being proven with our imaging technology. That is, we now can demonstrate that those individuals with ASD have a defective wiring in their ability to imagine what others are thinking or imagining. In other words, their “theory of mind” is impaired, and the level of their impairment matches the level of defect in their mirror neurons. In other words, this is a continuum of damage, resulting in the “S” or the spectrum concept. Sure, there are workarounds to the mirror neuron system. Children can learn to understand human behavior and they can learn empathy, but they will have to bring in another neurological system since their mirror neurons do not fire properly. For years, in my training from 1986-1991, we told families of those with ASD that there was a “wiring problem” without any specific knowledge about what that wiring problem might be. We felt certain that parents should not blame themselves for the social awkwardness of their children, but at the same time, parents can help fix the problem. Listening to Dr. Dapretto today, confirmed what we told parents, back in the day. Phew!