Shirah Vollmer MD

The Musings of Dr. Vollmer

Neural Networks

Posted by Dr. Vollmer on November 15, 2017

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The chemical imbalance theory is out. Neural networks are in. That is what I learned yesterday. With the introduction of Transcranial Magnetic Stimulation (TMS), a neuromodulation therapy for major depression and post-traumatic stress disorder, there is now the theory that mood disorders, and anxiety disorders are a result of a neural network failure and as such, therapies which jolt neural networks help patients feel better. Further, by examining EEGs and looking at brain electrical activity, clinicians might be able to predict who can benefit from TMS therapy. As I understand from Noah Phillips MD, a professor at the VA affiliated with Brown University, we, as psychiatrists, are exploring the notion that patients get better by changing the electrical activity in the brain, a re-boot, so to speak. At the same time, TMS, although FDA approved (it should be now called Food, Drug, and Device Administration), TMS is costly, time-consuming and not paid for by insurance. It is done at tertiary medical centers and in private practice. As with the use of psychopharmacology,  I am of two-minds about this technology. On the one hand I am excited about the new way we understand mood and anxiety, and the expansion beyond neuro-chemicals into neural networks makes a lot of sense to me. The brain is a complicated machine, and like a machine, things can go wrong, and re-setting it is very exciting. On the other hand, this technology supports the loss of a narrative. Patient is sick. Patient gets fixed. Next Patient. The medical model of human suffering dominates the clinical picture, and the individuality of the patient is lost to the physician, leaving the narrative to “lower-level” professionals. Clearly both can operate in harmony. Doctors could administer TMS and do psychotherapy, except that the model of care does not support combining these modalities using the physician as the deep listener. I am grateful to be so close to UCLA so that I can be exposed to the latest and greatest in psychiatric health-care. At the same time, I will always have a sadness when I go to lectures, that there is such little interest in the human component of mental health care. To put it another way, as psychiatry focuses on the brain, it has lost its mind.

8 Responses to “Neural Networks”

  1. Jon said

    Shirah, you say, “The brain is a complicated machine, and like a machine, things can go wrong, and re-setting it is very exciting.” I wonder about this. The brain is a biological organ. Is such an organ strictly a machine? Yes, there are machine like aspects to organ, but that does not make them machines.

    It is perhaps interesting that the brain has been modeled as the most complicated machine at the time of modeling – be it a telephone switch board or a computer, or any other models in between. However, I wonder what we might be missing in such models. Thus, I will extend your closing thought. It might be that we have yet to find our brain, much less our mind.

    • Thanks for the correction, Jon…a machine-like organ makes a lot more sense…and that is a much better way of putting it…and thanks for extending my closing thought..again..a much better way of saying it.

  2. Shelly said

    Let me play devil’s advocate here for a minute: let’s say that a patient of yours is bipolar, or is schizophrenic, or has another chronic, long-term disease. Say you’ve spent years and years trying to understand what stresses bring on the episodes and the narrative. Does it help the patient? Does it help the families who live with the patient? Now imagine that physicians can administer TMS and it brings relief to the patient and families both. Which do you think the patients and families will advocate for? Don’t forget I’m on your side, Shirah. But I also am familiar with both sides of the story.

    • Thanks, Shelly for your comment. If a patient gets better with TMS, that is good news and the story ends there. However, what about when that does not work? How do we understand that? Do we think the patient “failed” the treatment or the treatment failed the patient?. Our current use of language is that the patient failed. That should be the subject of another post. For now, my point is that I am all in favor of getting people well, in the fastest, least expensive way, and yet, sometimes people continue to suffer, and we need other tools to help those folks. I think that deep listening is an important component in the treatment tool box, and as you know, I fear that it will get lost resulting in patient suffering, and physician burn-out.

  3. Establish your Therapy Private Practice said

    Hi. I am a Licensed Professional Counselor in Virginia, USA. TMS is now practiced in my area. I find the majority of females need the relationship of therapy to support change, whether or not the TMS is successful. I’m glad that TMS is available now. Although a huge generalization, most heterosexual males move through the therapy process quicker.

    • Hello Establish Your Therapy Private Practice…I appreciate your comment. The relationship of psychotherapy, in my mind, is the critical feature, and the current trend to de-personalize the relationship makes me sad for both patient and provider. One size will never fit all, and although that is not cost-effective, it will always be true. Thanks again.

  4. Hi Dr. Vollmer,

    Good morning. A very well written article.

    I am curious to know about one thing. Modelling a brain as a network without considering the effect of chemicals that affect it’s functioning, is that accurate? Especially as you mentioned depression treatment.

    • Thank you, Gurudatt Rao.
      It is likely to be a combination of networks and chemicals, but to date, we have mostly focused on chemicals and now that we have stalled in that area, the field is pivoting towards being curious about neural networks. In essence, the field is still in its infancy. Thanks Again..

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