I hate to beat the drum of obviousness, but everything we think, feel or do has a neurobiological correlate.
If you run for 20 miles, most of us are going to be out of breath and heave air in and out of our lungs as they try and supply enough oxygen to our body. If you just found out you have to give a presentation to an audience of 4,000 people and giving presentations isn’t your livelihood, chances are you’re going to feel your palms go clammy and you may begin to sweat. If you feel intense anger or rage at another person, I bet I’ll be able to measure your blood pressure hit the roof. Even just listening to music impacts our brain’s functioning (see Koelsch, 2005 for a nice summary of this).
So why is it news that when we hook someone who has a mental disorder like depression, schizophrenia or ADHD to electrodes, or take a brain scan with fMRI or PET imaging, we’re surprised to find people’s brains with these disorders look and function differently than people’s brains without these conditions?
Yet that’s exactly what’s hailed as ground-breaking science here in this Washington Post article published earlier this week about a study looking at the brains of 53 people with attention deficit disorder (ADHD) compared to a group of healthy control subjects using PET brain imaging technology. The article discusses this JAMA study that found that people with ADHD have brains that look different than those without (Volkow et al., 2009). Specifically the researchers found that “ADHD patients had lower levels of dopamine receptors and transporters in the accumbens and midbrain — two key regions of the brain directly involved in processing motivation and reward.”
Okay. So what?
This study tells us nothing about how these dopamine receptors got the way they did. Instead, it joins the growing number of studies that analyze the brain and tell us things like, the structure of the brain may influence ADHD, or that hundreds of gene variations are linked to ADHD, or that, it’s not that people with ADHD’s brains don’t have enough dopamine, it’s that the brain pushes dopamine in the wrong direction influencing a ‘speed’ response between nerve cells. I could go on, but I hope you get the point.
Hundreds of studies have now been done analyzing the brains and genes of people with mental illness, but it doesn’t feel like we are any closer to the truth than we were 10 years ago.
One of the reasons is because none of these kinds of studies shed any light on the real problem — how did people’s brains come to have these anomalies in the first place? News articles (and sometimes even researchers themselves) subtly suggest that it’s the brain abnormality that is causing the mental disorder (in this case, ADHD). But it could just as well be the other way around — the ADHD may be causing the brain changes.
That’s why I find it interesting when researchers, like those who did the most recent JAMA study here, go out of their way to find people who haven’t taken medications for their disorder. The researchers don’t want their results contaminated by the neurochemistry of the medications.
But neurochemistry isn’t affected only by medications. It’s affected by everything we do. If you can change your very brain structure simply by driving a cab, imagine what efforts like psychotherapy can bring about. Even simple exercise can impact our brain.
Then imagine what a disorder like ADHD could do to your brain (rather than the other way around)… If ADHD is caused by some third factor, something non-neurological (say, only for the sake of argument, parenting skills), wouldn’t we still expect to see changes in the brain? Yes, we would. And we wouldn’t have any idea about this third factor if we weren’t looking for it. So while you might be technically correct in prescribing a medication to combat the brain changes, one could completely miss the underlying cause of the problem in the first place. (To emphasize, this is completely a hypothetical argument to prove a point.)
While I believe studies such as this most recent one add to our overall knowledge and understanding of conditions like ADHD (especially when it comes to pharmaceutical remedies for them), I don’t think it does much to help answer what causes ADHD. Nor does it put us any more firmly in the camp of understanding these as some sort of pure “biological brain illness.”
Having said that, I do believe that ADHD and other mental disorders have neurological correlates. And perhaps those correlates are more substantial and have a greater impact than other kinds of things in our lives. What I object to is positioning these kinds of brains scan studies as some sort of breakthrough in our understanding of these concerns when they aren’t.
Read the full article: Brain Scans Link ADHD to Biological Flaw Tied to Motivation
References:
Koelsch, S. (2005). Investigating Emotion with Music: Neuroscientific Approaches. In: The neurosciences and music II: From perception to performance. Avanzini, Giuliano (Ed.); Lopez, Luisa (Ed.); Koelsch, Stefan (Ed.); Manjno, Maria (Ed.); New York, NY, US: New York Academy of Sciences, 412-418.
Nora D. Volkow; Gene-Jack Wang; Scott H. Kollins; Tim L. Wigal; Jeffrey H. Newcorn; Frank Telang; Joanna S. Fowler; Wei Zhu; Jean Logan; Yeming Ma; Kith Pradhan; Christopher Wong; James M. Swanson. (2009). Evaluating Dopamine Reward Pathway in ADHD: Clinical Implications. JAMA, 302(10), 1084-1091.
11 comments
Thank you SO MUCH for this post Dr. Grohol. It may be “beating the drum of obviousness” to point out that everything has a neurological correlate, but I can assure you (based on fifteen years in the mental health field) that vast numbers of both lay people and professionals don’t understand the implications of this simple point. If they did, there wouldn’t be such widespread acceptance that brain disease and/or chemical imbalances are the primary CAUSES of psychological problems. As soon as folks really grasp that “everything has a neurological correlate,” it opens the door to a truly integrative theory (and practice) of mental health. These theories already exist, of course, but — like your point here — they have been largely ignored (for a variety of reasons). You can slice the pie in different ways, but if we could simply agree that there at least three irreducible “correlates” involved in all things human (bio-psycho-social, or objective-subjective-collective, or neurological-psychological-sociocultural), we may yet move toward a truly integrative approach to mental health. Thank you for all you do in this regard.
“…none of these kinds of studies shed any light on the real problem — how did people’s brains come to have these anomalies in the first place? News articles (and sometimes even researchers themselves) subtly suggest that it’s the brain abnormality that is causing the mental disorder…”
Something that I have been thinking and saying for years, and few listen. Some, indeed, claim that “chemical imbalances” and the like ARE THE cause of mental illnesses and to say anything else borders on treason.
“So what?”
As a wise person said, “as the sphere of our understanding increases, so too does our perimeter of the unknown.” Dare you imply, such ‘meager’ knowledge impairs or delays the advances which ‘should’ be making in their place? Yes, we do need an understanding greater than the parts we’ve yet uncovered, but I feel we gain nothing by detracting the value of advances which we, as individuals, fail to grasp the whole value of. So what, we discover bread mold helps stave bacterial infection! Who knew, what a world of antibiotics it would open up, regardless of how little we may know about how their extremely nuanced effects unfold?
I am a mother to a child with ADHD and WOULD BET EVERY DIME I OWN that this occurred in utero. I felt the hyperactivity then, it never stopped once born, and to this day, same deal. I say the brain CAUSES behavior and our experiences have some affects on the brain, which then causes new or different OR the same behavior.
Being male I cannot say I have had the same experience, but my sister-in-law once said that her babies were different from their beginnings in the womb, so it seems clear that people are different from the beginning. Experience then modifies the brain which then modifies experiencing which then…
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Adam — One of the fears is that we are indeed “advancing knowledge” with such studies, when, in fact, we are doing nothing of the sort. It’s like ancient civilizations that observed that if they had a rain dance, rain would eventually appear in the sky. They believed that because there was an association between their dancing and the rain eventually coming, the dancing *caused* the rain.
I fear many researchers are barking up this same tree. Computers show the brain lighting up, and we take this lighting up as having more meaning than we should.
Julie and David:
I have no doubt that humans are “hard-wired” in many ways from birth. And no one could deny that many disorders, developmental disabilities, etc. are evident right from the get-go. But the “brain causes behavior” theory is just too simplistic to make sense of human experience in general. Neurology is always involved (a “correlate”)–and may even be fundamental–but that does not necessarily mean a neuro-physiological intervention is appropriate. If a tiger walked into your living room, your neurological/brain state would change dramatically, but although the brain is most definitely involved, it wouldn’t make much sense to medicate yourself in order to get your physiology back to baseline. You could achieve that far more effectively by leaving the room and locking the door. That’s a behavior, and your brain and bodily states would change as a result of it. Did your brain cause the initial stress response? Did the tiger cause it? If you were the tiger’s owner, you might not be stressed at all. In this example, the neurological level is not the most important level to focus on. This example represents one end of the spectrum, while congenital disorders or brain damage are on the other end. Things like depression and anxiety are in the middle. The tricky part involves the question of how best to treat psychological problems. Even if a problem is congenital and totally a brain thing, that still doesn’t mean that it can’t be effectively dealt with using psychological and/or behavioral techniques (as opposed to medical or pharmaceutical), because — as Dr. Grohol is pointing out — EVERYTHING (including therapy, meditation, lifestyle choices) has an impact on brain functioning and neurological structure. Our society is increasingly buying into to the idea that drugs are always the best way to change the brain (and behavior). Maybe in some cases that’s true, but people can’t make an informed choice if they don’t even realize that there are other ways to make deep, structural, lasting changes to both brain and behavior. Unfortunately, many people don’t realize this.
Dear Dr. Grohol, Bob, David, Judie, Adam,
This is so important, to get this out and about!
Re. Brain functions as cause: For me it’s a chicken or egg discussion really. A child in the womb is being influenced by chemical circumstances in the mother’s body, and cells do respond to external influences with certain types of behaviour. See also the work of Dr.Bruce Lipton for example (his book “The Biology of Belief” is highly recommended).
On the other hand, brain functions can be influenced by external input,
True! – I just wrote an article about the influence of Tai Chi on symptoms of ADD and ADHD, based on a university research sometime in the late nineties! Why did no one do any more research on this, opposed to the millions which went into the development of medication??
I experience and see the influence of EFT, a simple stress relief method on many disorders; like chronic pain and also symptoms of ADD and ADHD in children. (EFT has a Open Hands policy – you can find their free manual and lots of testimonials and ideas how to use it on their website http://emofree.com
I’m so happy to have found this website, beating the drum together feels much better 🙂
The brain chemistry will change with the use of any alternative therapies, as stated also with the use of EFT, Emotional Freedom Techniques. Hypnosis, EMDR, etc. all of these ways of dealing with our energy bodies will change the way our brain works. We alter our bodies by altering our emotional, neuro chemical state.
Ya’ll are all wrong the BRAIN has noting to do with this.
An interesting article though I am surprised at your labelling of ADHD as a mental disorder. It is a neuro difference or diversity and can be seen as evolutionary and important and beneficial to society. Issues come with society, education and the workplace forcing everyone into boxes.. Many great researchers and entrepreneurs had/have ADHD, the very brain wiring that makes them successful. Whilst finding strategies and support for the issues ADHD can create (many due to trying to survive in a predominantly neurotypical world) i. e. anxiety, addictions, risky behaviour would be benificial, are we really looking to ‘prevent’ or ‘cure’ anyone who does fit ‘normal’?
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