Dr Neil Harrison: Webinar on neuroimaging (MRI, fMRI, SPECT and PET scans

[Sasha]

Those optical illusions are the result of beneficial adaptive strategies. Chronic illnesses are not beneficial. Let's keep that difference in mind.

But the illusions aren't a beneficial effect of beneficial adaptive strategies. They're a demonstration that brains do things that don't reflect cognition - that was the only point I was making there.

However, the idea that the brain can just malfunction independently is a hypothesis. [...] The brain... should not be the first option considered when hypothesizing about illnesses and should definitely not be the only option considered.

Harrison is talking about brain inflammation - I don't know that he's saying that it's independent of other processes in the body or that the brain is the only place we should look. I assume it's where he's looking because he's a brain guy.

So far we still have never cured any illness based on focusing on the brain as the source of the problem.

But there's a whole ton of diseases that we haven't cured. Maybe if we focused on the brain more, we'd cure a few. Or maybe not.

I'm happy that we've got people looking at the brain, mitochondria, the gut, the blood, the immune system, the muscles, the autonomic system, genomics, metabolomics, proteomics, all of it - we don't know what's wrong with us, and having a range of approaches seems like a good thing to do. I don't think we're too far off being able to synthesise our knowledge and narrow it down.

 

[Scarecrow]

Just flagging up that I've edited the transcripts for clips 75 and 76 to the original English.

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[duncan]

Duncan: @Scarecrow, psychs don't belong examining ME.
Scarecrow: "Why not? I mean I could name a few who I wish hadn't bothered but in principle, why shouldn't a psychiatrist study ME. Should they also not study, say, bipolar disorder?"

Psychiatrists should not study ME because it is not a psychological disorder, any more than cancer or TB or syphilis are.

I also believe that due to the nature of psychology, i.e. it is opinion-centric, and seemingly somehow above the pedestrian rules of Science, that it can indulge self-serving interpretations - not to mention those of the State, at times. I have seen this happen for Lyme theory and for ME/CFS theory and in my personal interactions.

So I don't trust them and I don't trust the discipline.

Are there exceptions? Sure. You and I can name a couple. But they are exceptions.

@Sasha, yes there are intelligent psychs. But in my experience I find far too many embrace their discipline before they do the truth.

Duncan: @@Sasha, behavior assessment is necessary with animals. With humans, not so much. Besides, it's kinda like objectifying or profiling - both of which I find repugnant.
Sasha: "But we are animals - and the fact that all animals show this reaction to high levels of cytokines helps establish sickness behaviour as a biologically driven behavior, not a psychological or cultural one.

I don't understand your comment about objectifying and profiling."

@Sasha, by its very nature the concept of sickness behavior is one step further from the individual being studied. Humans to a degree obviate the need for this concept. Worse, the objectifying nature of it allows its adherents to distance themselves from the human quality, e.g. feedback, person-to-person direct communication. It reduces humans to uncommunicative animals. Yes, we ARE animals, but we can provide direct input into medical models that other animals cannot. Sickness behavior allows the minimalization of dialogue. It makes patient reporting secondary to whatever the observer decides to focus on.

ETA: Clearly I still haven't got this copy and paste function down yet, despite @Simon and @lansbergen attempts at help. Sorry, It's late.

 

[duncan]

f "psychology" or "behaviour" or terms like these are going to be automatically treated like loaded phrases or double-speak every time anyone mentions them, then I think that in itself is a recipe for miscommunication. Again, I understand people's sensitivities but if we've got people looking at brain inflammation, that's a wholly different context

But they ARE loaded terms. I think we all know that.

I do appreciate we are dealing with brain inflammation. I agree it's a difficult tight rope to navigate. Still, I think it is incumbent on US to make sure we don't get led down a into a quagmire of mental vs physical. This is where this whole nonsense of perceived pain vs real pain emerges, in these grey, murky psych waters that FM patients get tossed into.

We need to be realistic and practical. Moreover, when you have to work too hard to understand what a psych is saying - when it should be easily understandable - then seldom will something good come of it.

 

[duncan]

I don't see an issue if they're intelligent psychs and understand science and biology. Neuropsychiatry is a discipline where biology meets psychology - and I hope that the science is now at a point where psychiatric illnesses are now being more understood as diseases of the brain, not the result of weird thinking.

I think that Cartesian Dualism is alive and well. When basic depression or MDD or bipolar disorder or anxiety are treated on the same organic, physical level as brain cancer, then maybe we have firm ground upon which to move forward with psychs. But we are not there yet.

 

[Valentijn]

The problem with any "mismatch in the brain" hypothesis is that it ultimately comes down to the experienced symptoms not really existing, even if there's an organic reason for brain to think we have symptoms when we don't. It's still a functional/psychogenic disorder, even if a biological cause is claimed for it. This is what all central sensitization descriptions for ME/CFS currently boil down to.

I'm not too bothered by psychiatrists studying ME. But is focusing on fatigue a reasonable way to study ME? No, not at all. It sounds like he thinks understanding fatigue is the key to understanding PEM. But my experience as a patient strongly suggests that PEM is worlds apart from fatigue. If someone really wants to understand PEM, trigger it and run tests ... don't just ask patients about fatigue and try to specify which part of the brain is making patients think they are fatigued when they are not.

 

[Sasha]

Psychiatrists should not study ME because it is not a psychological disorder, any more than cancer or TB or syphilis are.

Neuropsychiatry studies brains - and brain chemistry and structure - in relation to behaviour and cognition. I agree that ME isn't a psychological disorder (in the sense of being caused by disordered thoughts) but it may be an organic disorder of the brain (and possibly of other organs/systems at the same time).

Having a neuropsychiatrist study something doesn't imply it's a psychological disorder. It's important to distinguish between the sort of silly psychiatry of the "it's all in your head" school and the biological approach of neuropsychiatry.

Duncan: @@Sasha, behavior assessment is necessary with animals. With humans, not so much. Besides, it's kinda like objectifying or profiling - both of which I find repugnant.
Sasha: "But we are animals - and the fact that all animals show this reaction to high levels of cytokines helps establish sickness behaviour as a biologically driven behavior, not a psychological or cultural one.

I don't understand your comment about objectifying and profiling."

@Sasha, by its very nature the concept of sickness behavior is one step further from the individual being studied. Humans to a degree obviate the need for this concept. Worse, the objectifying nature of it allows its adherents to distance themselves from the human quality, e.g. feedback, person-to-person direct communication. It reduces humans to uncommunicative animals. Yes, we ARE animals, but we can provide direct input into medical models that other animals cannot. Sickness behavior allows the minimalization of dialogue. It makes patient reporting secondary to whatever the observer decides to focus on.

My point about sickness behaviour was that the fact that it is observed in animals supports it being due to a biological process in humans. I don't see the relevance of your point.

 

[Sasha]

But they ARE loaded terms. I think we all know that.

I do appreciate we are dealing with brain inflammation. I agree it's a difficult tight rope to navigate. Still, I think it is incumbent on US to make sure we don't get led down a into a quagmire of mental vs physical. This is where this whole nonsense of perceived pain vs real pain emerges, in these grey, murky psych waters that FM patients get tossed into.

We need to be realistic and practical. Moreover, when you have to work too hard to understand what a psych is saying - when it should be easily understandable - then seldom will something good come of it.

I agree we've got to be careful but we've also got to be careful not to attack scientists doing possibly productive and helpful research just because they've got "psychiatrist" as part of their title.

 

[Sasha]

The problem with any "mismatch in the brain" hypothesis is that it ultimately comes down to the experienced symptoms not really existing, even if there's an organic reason for brain to think we have symptoms when we don't. It's still a functional/psychogenic disorder, even if a biological cause is claimed for it. This is what all central sensitization descriptions for ME/CFS currently boil down to.

I don't see that interpretation as necessarily flowing from the "mismatch" hypothesis - it sounds more to me as one that recognises that the perception of pain arises from genuine, organic damage (inflammation, in the case in point) and seeks to come up with a theory for what it is about the signals from the damage that leads to the subjective perception. The fact that the perception is subjective is unavoidable - pain is an experience that we feel as a subjective symptom, whether it's from a broken leg or an inflamed brain.

I'm not too bothered by psychiatrists studying ME. But is focusing on fatigue a reasonable way to study ME? No, not at all. It sounds like he thinks understanding fatigue is the key to understanding PEM. But my experience as a patient strongly suggests that PEM is worlds apart from fatigue. If someone really wants to understand PEM, trigger it and run tests ... don't just ask patients about fatigue and try to specify which part of the brain is making patients think they are fatigued when they are not.

I agree that PEM is much more than fatigue - it's all your symptoms, magnified - but studying any one of them might also be a clue to what's going on with the rest, if they're all driven by cytokines or some other ultimate trigger that cascades the whole lot (I'm thinking of the work the Lights did).

If scientists are seeing constant inflammation in the brains of PWME, do they need to impose an exercise challenge to do their particular studies? I don't know.

 

[Sasha]

The problem with any "mismatch in the brain" hypothesis is that it ultimately comes down to the experienced symptoms not really existing, even if there's an organic reason for brain to think we have symptoms when we don't. It's still a functional/psychogenic disorder, even if a biological cause is claimed for it. This is what all central sensitization descriptions for ME/CFS currently boil down to.

I don't think that's true (according to Wikipedia, anyway!):

A functional disorder is a medical condition that impairs the normal function of a bodily process, but where every part of the body looks completely normal under examination, dissection or even under a microscope.

So if a biological cause is claimed for something, then by definition, it's not a functional disorder.

Is that wrong (genuine question)? This seems to be a key point.

 

[lansbergen]

So if a biological cause is claimed for something, then by definition, it's not a functional disorder.

That can not be true.

Function is the special purpose or activity for which a thing exists or is used

The function of the heart is to pump blood through the body.

 

[Sasha]

That can not be true.

Function is the special purpose or activity for which a thing exists or is used

The function of the heart is to pump blood through the body.

My understanding (possibly wrong) is that "functional" is used by the psychsomatic branch of psychiatry as a euphemism for "all in your head". It causes a lot of confusion (possibly deliberately, because not all psychiatrists want you to know that they think your illness is "all in your head") because the true, everyday meaning of "functional" is the one that you give - it just means "how something works".

So if a biological cause is claimed for something, then by definition, it's not a functional disorder.

So I think my statement is correct, but only because I'm using the word "functional" in the way that biopsychosocial-model psychiatrists use it - that is, to mean "all in your head".

 

[Scarecrow]

The problem with any "mismatch in the brain" hypothesis is that it ultimately comes down to the experienced symptoms not really existing, even if there's an organic reason for brain to think we have symptoms when we don't. It's still a functional/psychogenic disorder, even if a biological cause is claimed for it. This is what all central sensitization descriptions for ME/CFS currently boil down to.

First of all, if there is a mismatch, I think we all know that it couldn't possibly account for the complexity of symptoms experienced. So, if it even is 'a thing', at most, it can only be part of the puzzle.

I understand why you have lumped functional and psychogenic disorder together but I think it's a mistake to do so, even though some neurologists use them interchangeably. Just because they do doesn't mean we should, even if we understand their tricks - and I'm well aware that you understand their tricks better than I do!

If the mismatch theory is correct, then the disorder is merely functional in a strictly literal, non-doublespeak way. No reasonable person would wonder if a functional disorder in the liver was psychogenic. Similarly, it's totally illogical to conflate a functional brain disorder with aberrant thought processes.

 

[duncan]

I agree we've got to be careful but we've also got to be careful not to attack scientists doing possibly productive and helpful research just because they've got "psychiatrist" as part of their title.

I think it is just as important not to assume someone is a scientist simply because they have "neuro" as part of their title. Or that they will focus on the organic nature of our disease - their pedigree will, to one extent or another, almost always anchor them to the concept of the mind. For some strange reason, most of these folk can't seen to disentangle the mind with some sort of "ultimately the patient is wrong; it's the patient's fault."

I didn't attack him. I expressed concerns over his wording, and I discussed how I interpreted parts of that wording. I also said I don't trust psychiatrists, and I stand by that.

 

[Scarecrow]

So I think my statement is correct, but only because I'm using the word "functional" in the way that biopsychosocial-model psychiatrists use it - that is, to mean "all in your head".

And there's the problem in a nutshell. The word has become perverted to the extent that you almost have to define it as you use it.

 

[Sasha]

I think it is just as important not to assume someone is a scientist simply because they have "neuro" as part of their title [...] their pedigree will, to one extent or another, almost always anchor them to the concept of the mind.

I don't think that follows - I don't think there's anything in a neuropsychiatrist's training that would anchor them to the concept of the mind.

I didn't attack him. I expressed concerns over his wording, and I discussed how I interpreted parts of that wording. I also said I don't trust psychiatrists, and I stand by that.

That's your view and you're completely entitled to it - and I understand that this is an area of great sensitivity and has been caused by some extraordinarily damaging psychiatrists who've barged into the ME/CFS field and have dragged the name of their discipline through the mud.

However, I do think it's important that we don't tar all psychiatrists with the same brush and we keep in mind that some of them are genuinely studying the brain and understand that ME/CFS is an organic disease which is showing up in the brain - and that they're trying to help us.

 

[Scarecrow]

I also said I don't trust psychiatrists, and I stand by that.

Psychiatrists strike me as a lot like dentists. You can have a bad experience with one - or several - and fear having any contact with any of them ever again.

 

[duncan]

Psychiatrists strike me as a lot like dentists. You can have a bad experience with one - or several - and fear having any contact with them ever again.

You can also talk to dentists while you are being worked on, and maybe the pain will leave you with a sense of atonement for all the things a psych would say you've got wrong?

I am not simply extending from personal experience. I am talking about more globally relevant incidences where psychs have been viewed by communities of patients as championing them, only to let them down. The signs were there; the patients ignored them.

 

[Scarecrow]

I am not simply extending from personal experience.

Me neither.

My point was that if you are unlucky enough to have an early experience with a dentist who lacked all skill and made no effort to minimise your pain and it put you off dentists for life, you'd never be aware that most dentists are not like that. And you'd probably suffer for it needlessly.

 

[duncan]

I am all for a brain doctor studying ME. Ditto for Lyme encephalopathy. I will take a neurologist nine times out of ten. (Incidentally, I can name famous neurologists that get it grandly wrong, too, but at least their basic programming usually is sound)

But a doctor of the mind potentially presents with too much baggage. History amply demonstrates that.

That of course does not mean every psych is like that. But they have to work really hard to earn my trust. I need to see I can trust them to rise above their discipline, the dogma that characterizes it, and the embedded tendency to somehow find a way to paint the patient as flawed, as not interpreting reality correctly. I don't care if they say there actually may be an organic reason at the root of this self-deception. The message is the same: The patient is wrong.

I read what this guy wrote, and it concerns me. Hopefully, I am misunderstanding him.