Author: Alexander Abi Saad (page 1 of 1)

I am a medical student living in Beirut, Lebanon, and aspiring to become a psychiatrist physician-scientist. I have a background in psychology, computer science and biology. I am passionate about science, mental health, statistics, creative writing and film. You can email me at alexander.abisaad@gmail.com or reach out to me via Twitter/X: @PsychAlexander.

Reflection
July 3, 2024 / 0 Comments

Maybe I’m Not a Psychopath and Other Lessons on the Psych Floor

Alexander Abi Saad

I went to medical school with a clear goal: to eventually become a psychiatrist. With a background in psychology, I knew I adored the field of mental health and was already sure that was the specialty I wanted to do. As much as I would like to have dedicated the whole program to psychiatry, I knew this wouldn’t be the case as we have to study every system to become an MD, condensed into just 4 years of theory and practice. The first two years were hectic and depressing. Half the subjects bored me to the point I couldn’t even function (who likes histology anyway?). This was coupled with my mental health hitting rock bottom. But somehow, I survived. Just last month, I began my third year. I chose my yearly schedule to start with the 4-week required psychiatry clerkship (medical school rotation in the department). To be honest, this wasn’t just an excitement-related decision, but it was also convenient to postpone the surgery clerkship (hence delaying a possible depressive episode). It also worked with my silly little dream of seeing Taylor Swift in concert during a July vacation, having a ticket already bought last year. Back to the main story, this rotation concluded a few days ago, making my passion for psychiatry and mental health grow more prominent and vibrant. I feel like the years of planning are already yielding something slowly erasing my previous years of distress, with the dream just having to be paused for now. Only for some time, as I finish the other clerkships and become a doctor. But right now, sitting on my couch at 1 AM, why not reflect on some lessons I’ve learned on the psychiatry floor since I haven’t posted on this blog for so long? Let’s go.

Psychiatry is for me. Definitely. Certainly.

If you follow me on X/Twitter, you’ve probably seen me ranting about this before. When I tell people I want to be a psychiatrist, they sometimes assume it’s a mild guess of a field I prefer over others. I don’t blame them. Many medical students are not sure about their future specialty, and that’s absolutely valid. However, it just gives me an unpleasant feeling when my dreams are assumed to be transient and “might fade away as I see what it’s really like.” But now I feel more confident saying that I want to do psychiatry since people know I’ve been on that floor. I’ve seen an overview of almost everything: interacting with patients, crises in the emergency room, ECT, and calm outpatient appointments. Hence, it’s not a theoretical job I imagine liking. I’ve seen it, I’ve lived it. And I’ve found myself there.

We Need More OCD Awareness

As an OCD patient myself, it’s hard not to realize how much obsessive-compulsive disorder (OCD) is left out of the conversation about mental health. I understand it’s not a competition, but OCD shouldn’t be dismissed because the public just doesn’t “dramatize” it enough as they do for other disorders. I realize the issue might stem from the mental health field itself sometimes, as OCD is often misunderstood and receives relatively less research. For instance, I was having a casual conversation with a trainee from a related field but from a different university, and she spoke about OCD in a manner that made me extremely uncomfortable. It wasn’t just uncomfortable, but also inaccurate and based on centuries-old prejudices. It made me wonder, what if I had been her patient? What if I heard these words uttered by my own therapist? I would have felt extremely uncomfortable if she was my healthcare provider, and probably too ashamed to talk about any OCD symptoms further. Luckily, I haven’t been in such a position before, but I think it would be foolish to deny its plausibility. This person didn’t seem very judgmental about other topics, so I’m not sure it’s a general character issue. Rather, it could reflect an underlying disregard for proper OCD education in our mental health educational systems. In other psychiatric conditions, there sure remains stigma and misconceptions, but people seem to at least have a basic understanding of what the conditions are. For example, many people believe schizophrenic patients to be violent. While this is an untrue and very dangerous belief, most people still probably recognize that schizophrenia is about symptoms like hallucinations and delusions. On the other hand, many healthcare professionals or members of the public probably can’t define or deal with OCD basics. While I don’t think pointing fingers will just solve the issue, there needs to be more work to ensure that OCD is taken for what it is: a serious, potentially debilitating disorder that is just as valid as other mental disorders.

Never lie to the patient.

On one day of my rotation, a patient presented with severe distress and denial of a recent traumatic event. I will not mention the details (for her privacy), but I will say it wasn’t a sexual trauma for clarity. Seeing some non-doctors try to reassure her that the event didn’t happen tore me apart. I felt like I wanted to scream at these people. As she indirectly asked me if that event didn’t happen, I couldn’t lie to her. I felt horrible but I hesitantly hinted at the truth. I tried to tell her “I don’t know,” but eventually I shook my head slightly to deny her false hope. It was the right thing to do. This brings me back to a topic I have explored in previous essays. Why do we do things just for our conscience when they won’t help the people? Isn’t telling her that the event didn’t happen just a nice act for a quick “relax” and for us not to feel rude? Why not have the more difficult, but needed conversation about the truth? Luckily, she didn’t hate me despite me not reassuring her with false hope. We actually had an agreeable chat later as I took her history when she was calmer and in less denial.

Today, I was watching “Scandal,” the TV show, and Olivia Pope told a similar story that reminded me of that patient. “Don’t ever promise an outcome we can’t deliver,” she told her associate. And I just wish more people lived by this. Indeed, it is our duty as health professionals to never guarantee anything we can’t ensure. Of course, we need to instill reasonable hope, as it can help with recovery and treatment outcomes. But false hope can be dangerous, and understanding the fine line between healthy and false hopes is something that I need more time to learn more profoundly.

Mental Health is Multidisciplinary. For real.

For years, I’ve studied that medicine is team-based and doctors from various specialties collaborate all the time. Of course, I understood the value of that idea, but I honestly thought it was an idealistic vision. Frankly, I expected most of the psychiatry patients to be entirely treated by psychiatrists and some psychologists. However, I was proven wrong. The floor was indeed very multidisciplinary. We had constant consultations from other departments such as neurology, gastroenterology, dermatology, cardiology, and others. At some point in the past, I even questioned why psychiatrists went to medical school. And I’ve heard this question asked by many others as well. For instance, why not teach more pharmacology to psychologists so they can prescribe medications? While I still think the distinction between psychiatry/psychology is vague and may not be necessary (debatable, but that’s a story for another day), I’ve become more aware of how essential general medical knowledge is for a psychiatrist. And how 2-3 additional courses in psychopharmacology wouldn’t be sufficient to fulfill this knowledge.

I learned something I already knew, again: The Mental Health System is Incredibly Flawed

In my country, insurance companies often (if not always) refuse to cover psychiatric fees. What is supposed to be a safe place for people at their lowest can become a luxury that many people cannot afford at all. But what can a medical student do? What can even a doctor do? Run in the hospital with $20,000 and pay the bills of 5 patients every day? It’s hard to be a hero when what’s needed is a proper system. But there are issues other than the finances. The hospital where I’m training is mainly for acute care, rather than long-term; so my understanding of long-term facilities is limited. However, the concept of institutionalization seems even more gloomy to me now. Another example of a flaw in the mental health system is entertainment: psychiatry floors are often just…dull. Patients often complained about how bored they were, which seems mundane but is actually quite important for recovery. Of course, other topics make the mental health systems flawed across the world: ideas of consent, psychiatric emergencies, and other complex issues cross my mind but their nuances are beyond the scope of this piece.

Treating a Patient Involves Treating the Family

Psychiatric patients are often accompanied or visited by family and/or loved ones. While we can label the patients with a diagnosis and/or symptoms, their family’s behavior can be even more concerning even if it doesn’t fit a clear label. In many cases, dealing with a patient was easy for me, but with the family not so much. You get all kinds of family: the calmly scared, the uninvolved, the judgmental, the dismissive, the loving one holding hands, the anxious falling apart etc. And the communication we needed to do with each differed greatly. At many points, families come with requests that are unreasonable and not necessarily in the best interest of the patient. I learned how important it is for me to constantly remember that our duty is to the patient first, and not to the family. I understand that dealing with a mentally ill family member may be challenging, but my patient will always be my priority. If the family treats the patient as an inconvenience, I cannot contribute to that.

Maybe, Maybe, I’m not a Psychopath

I know you might be reading all the above and thinking: what is this guy even doing? He’s just a med student. Why is he writing about being so “saintly”? Does he want an applause or something? Is he too confident that he’s such a good person? Far from it. In the first few days of the rotation, an old OCD obsession reoccurred in my mind: what if I am a psychopath? What if I am unable to feel empathy? What if I’m a bad person? When someone described to me a case that vaguely reminded me of my youth, I got uncomfortable. This made me even more questioning: can I only feel emotions that are related to me?

I spent quite some time describing this to my therapist, how I feel that although I care for my patients, I don’t feel that the “chemical empathy” sensation in my body is strong enough. To my OCD, if I’m not bordering on tearing up might mean I’m not empathetic, even if I am preoccupied with caring for the person. This sometimes made me “monitor” my emotional responses to stories, to check whether I was non-psychopathic enough. Naturally, my therapist told me how this was clearly another OCD theme (which it is) and I’m not really a psychopath. Of course, I believed her. Somewhat.

The thing is, these feelings didn’t match my behaviors. In the external world, I genuinely tried to make every patient comfortable, and for them to like me, and it kind of worked. Many patients found me pleasant. Sadly, OCD often turns beautiful things into issues and useless moral dilemmas. And the fact that being nice, being liked, and helping someone made me feel good about myself was a big question mark for OCD. Are you an evil person because you feel good when you help others? Is it about you?

Thankfully, my insight and control over this obsession increased after the first week. What helped was therapy and reminding myself that it’s actually a nice thing if my pleasure or “psychopathic manipulation” (obviously it’s not the appropriate description, but we’re dramatizing here) is gratified by helping others.

Back to the patients, I had one indicate an interest in being my friend (not feasible, but a flattering compliment nevertheless). Another patient asked me“I won’t ever see you again?” with a sad tone on my last day. At this point, I don’t think I was going all OCD anymore and was capable of appreciating these heart-warming comments that made me feel less of a failure. After all, wasn’t this obsession just a cynical way of trying to say the very normal, “I like to help others and to be liked?” And isn’t that what people write in their medical school motivation letters anyway?

October 10, 2023 / 0 Comments

A Middle Ground between Neurophysiology and Mysticism – Book Review of “Free Agents” by Kevin Mitchell

Alexander Abi Saad

You’ve probably read the sentence I was about to start with: “The question of free will has perplexed philosophers for centuries” countless of times already. But there’s indeed a reason why this topic continues to be debated, and it is because it has provoked an undying interest as we continuously learn more across centuries.

Do we have free will? What do we mean by free will? Does free will necessitate some mental entities that violate the physical laws of the universe? Can free will be compatible with biology and evolution?

These are all questions that keep some people awake (and the rest may sleep quite well – lucky for them). In his new book Free Agents, Dr. Kevin Mitchell, a neuroscience/genetics professor and author of Innate (2018), chooses the first side and attempts to delve deeply into the question bringing insight from his biological background. Not the kind that you’d expect, though. Most people from such a background would probably write about how free will is a mere illusion due to the workings of the brain, but he attempts to explain how we’re actually active agents with free will. In this post, I will review the book and explore if he provided a satisfactory argument for his perspective.

And the answer is…it’s complicated. If you thought any single book could solve the mystery of free will, then this book (or any other about the matter) is not for you. So instead, I will review the best ideas in the book and others I felt were misplaced or not well justified.

Mixed Mindset

Mitchell begins his book by stating that often the topic of free will is conjugated to discussions about moral responsibility and blame. Although the presence (or lack thereof) of free will has obvious consequences on morality, overly focusing on that aspect might mean we are biased and looking at the answer that makes us comfortable. This might render us disregard reality. About this, he writes:

“It is coming at the question from the wrong end, picking an answer we like and seeing what edifice of arguments we need to build to support it. Instead, I would like to know what kind of free will we actually have.“

I found this idea to be a captivating way to start the book with. I totally agree that if one aims to understand whether we have free will, we need to not limit ourselves to how that affects society. It might be sad or uncomfortable, but we need to study what’s really happening not what we think is nice. Unfortunately, this discomfort-tolerant approach was undermined with the author insisting on another idea – that free will as recent neuroscientists often frame it as an illusion is quite far from our experience and accordingly, he is skeptical. It seems to when it comes to this, he might have modified his orientation and hypothesis to look for something that is convenient – to accommodate his own experience. And frankly, I liked the first move more.

Excellent – Top-down causation and Systems Approach

One of the book’s biggest strengths is its emphasis on a possible top-down causation and systems (such as the whole animal or its brain) affecting the smaller parts (such as neurons). Throughout the book, Dr. Mitchell brilliantly explains how systems (like humans) have goals and meaning and these might affect the working of smaller components. This is against the traditional perspective of reductionist science, where most causation is believed to be upward, i.e. smaller compartments affecting the bigger ones. Systems approaches are increasingly gaining interest in science, engineering, and medicine; as they might provide more comprehensive answers than reductionist ones that have often resulted in incomplete pictures of reality. Accordingly, his emphasis on that was coherent, consistent and relevant to any area of the sciences even beyond the horizon of the book and free will.

Good – Relationship between Evolution and Free Will

Mitchell achieves the goal of showing how biology and natural selection may have led to the emergence of free will, out of a need to survive. With million of years, living organisms might have found themselves in circumstances where simply reacting passively to the environment was not enough to shield themselves from predators or find food. Hence, he argues that free will (or agency) doesn’t have to be a gift from supernatural entities. Rather, it could be an evolutionary driven adaptation of biological systems to ensure their survival in harsh and often unpredictable surroundings in the world. The associated concepts were also beautifully explained, and they bring a cohesive perspective, where it seems free will is more about biology. It feels as if it’s some middle ground between physics/pure neurophysiology on one side and religion/mysticism from the other.

Mixed and Excessive Criticism of Anti-Free Will Studies

Although Mitchell does a great job of articulating his arguments and often dispelling myths and incoherences such as exaggerated statements by scientists, sometimes he goes a bit foo far maybe. For instance, let’s discuss the famous Libet experiment that is often used to say free will is an illusion. In this controversial study, scientists were able to predict beyond chance the direction of a person’s hand movement before the person seemed to choose (though not with 100% accuracy). The study was criticized by Mitchell on the premise that the behavior tested is mundane and not the same as deliberate behavior where free will actually might matter and lead to consequences.  He cited other studies that failed to show that prediction in more important decisions. However, the problem might be due to technicalities, such as sample sizes. Additionally, the inherent complexity of the more sophisticated decisions might need more advancements to be studied. Though the Libet experiment’s results is often blown out of proportion, it does still challenge our notions of choice and free will. On another page, Mitchell adds, “Nothing in philosophy or physics or neuroscience or genetics or psychology or neurology or any other science undermines the idea that we do have the capacity for conscious, rational control of our actions.” To say that neuroscience or other sciences have completely eradicated the possibility of rational control of behavior free will is a reach, but to say they haven’t at least challenged or undermined it is one as well.

Random note – I’m not sure why at some point he said that our psychological traits do not affect our moment-to-moment activities but only affect our general patterns on the long run. Some traits, such as the tendency to approach/avoid or to be anxious, clearly affect our immediate behaviors. I also liked the Audiobook version and when he changed the word from “see” to “you’re hearing” because it’s the audio version (or something like that).

What’s the issue with Descartes and Dualism?

Mitchell seems to be in some kind of intellectual feud with Rene Descartes, a French philosopher of the 16thand 17th century, who’s famous for his work in the philosophy of mind. It’s very clear Mitchell doesn’t like him much as he often pejoratively uses the term “dualism” (that Descartes is known for). I think it would have been interesting to specifically label it as “substance dualism” – the classical dualism where the mind is formed of a substance other than the material world, an idea that’s obviously ridiculous in the age of neuroscience and is the one Mitchell is actually referring to. However, I think the distinction is important because of a similar more modern version: “property dualism“. This one suggests that mental content might have emerging properties beyond physical ones that may actually be compatible with Mitchell’s views (and mine). Interestingly, despite Mitchell criticizing dualism often, he seems to fall into a dualist trap himself once. “Brains do not commit crime: people do,” he confidently states. Even if one is to believe in Mitchell’s version of free will, it has to be mediated the brain so this sentence was rather out of place in the book flow.

So what about free will? Do we have it?

The notion of free will lacks a comprehensive agreed upon definition. And many authors, scientists and philosophers each define it their way and go with that flow. Mitchell is no different. And the book title is quite honest about it as he uses the term “Free Agents”. It seems that’s exactly how he operationalizes “free will” as some causative agency . This definition clearly seems to work with biology and evolution, and mostly with physics and math as he isn’t directly suggesting any magical/supernatural component. However, it might not be in line with how many people typically define free will, as the intimate sense of being able to make a decision that’s not fully neurologically based or statistical. And thus, the questions could remain largely unanswered for many. As for me, I don’t think it’s the perfect definition (there isn’t any) yet since it doesn’t provide a mechanism of how free will is directly exercised despite physical factors and randomness, but it’s of the good definitions that I like and am comfortable to say they might exist. 

Conclusion

Overall, Free Agents does not and cannot offer a final answer to the question of free will. We don’t have a full understanding of how the brain or mind work to be able to have clear answers, and at the end of the day, all of us will have our beliefs that are at different ends of the spectrum.

But what the book surely adds is many interesting ideas to the free will narrative and storyline that will continue to evolve with generations. Whether you’re a hardcore determinist or a spiritual free-will proponent, this book can be quite interesting and flows nicely as it’s not boring and doesn’t get stuck in one idea forever. I admit, it didn’t blow my mind. But this is perhaps because I have already read extensively about most of the topics so the only new stuff I got from it are his direct new ideas – which I loved. So I could have enjoyed it more if I had no nuanced perspective on what “optogenetics” or “heritability” were for example. But overall, it’s a good read that I do recommend. Now that we’re done, I will use my causal agency to go back to my life and pretend that I have full free will regardless of whether it’s an illusion or not.

June 9, 2023 / 0 Comments

Why Humanity Should Remain at the Core of Brain And Mind Science

Alexander Abi Saad

The human brain is one of the universe’s most complex known structures. The mind is even more complex in many ways. One can conceptualize the mind as the software and the brain as the hardware that itself is affected by multiple pathways. Genes, they express themselves. Hormones, they circulate. Neurons, they fire. They connect too. They constantly interact with the environment as well. Together, they lead to complex cognition, affect and behaviors from our simple head movement to our deepest feelings that make us who we are. But to argue this is the end is not merely reductionist, but also irrational and harmful. I am a deep believer in the power of biology in shaping who we are and as a potential therapeutic strategy for complex psychiatric disorders. I love genetics and neuroscience. GWAS, polygenic risk scores. You name them. I’m probably – but humbly – am one of the people who are most excited about such topics on the globe (no citation available, though). But their findings don’t really mean what some people think. No matter how much knowledge you may have about these fields, you can walk into a mental health professional who knows them too. But you want more, you want to be seen. You have a story, and you want it to be heard. No amount of fMRI activation patterns (for readers not familiar with fMRI, it is a modified version of MRI that can detect which brain areas are active during specific time/tasks by measuring blood flow; fMRIs are commonly used in neuroscience research) papers will make you feel as valid as a compassionate smile on someone’s face that tells you, “I feel you.” This post is not a poem, but a bridge asserting that brain, mind and behavioral sciences do not have to be in disharmony with a warm, humanitarian perspective. In fact, I will argue why humanity and complex dynamic conceptualization of the mind should remain at the core of the scientific pursuit of mind and behavior.

The case against reductionism and genetic determinism

From blank state psychology (an essentially refuted hypothesis that asserts that we are born without predispositions and are entirely the product of our environments) to simple neurochemical (such as the famous misleading “serotonin deficiency”) theories of depression have filled popular culture and even scientific history. We’ve seen reductionism of human complexity in so many forms. History keeps proving it almost never works though, particularly in the case of most human behaviors. No single gene means you will necessarily have depression. And no single environment will necessarily mean you will have PTSD. And no geneticists (at least the regular ones!) aren’t trying to say otherwise. The truth is simple: although similar in many ways, everyone remains unique. Every mind has its complex connections that have been shaped by their inherent biology and their environment to create a reality that is far too specific to be exactly replicated by any other person’s brain. Even identical twins (monozygotic) have their differences. Random genetic mutations lead to noticeable accumulation of differences in the genome the more the older the twins grow. Their environment are also not identical, which leads to differences that are partially mediated by epigenetics. These twins remain very similar but not entirely. The key part is not entirely. So really, every one of us is unique. Despite that, there is a continuous sentimental fear of biological psychology (particularly behavioral genetics) among a significant proportion of the public and non-biologically oriented mental health professionals. This is usually due to the belief that biologists are here to take away the complexity of the human condition, reduce it to a small set of predictable nucleotides that can explain every feeling we have, rendering them “meaningless.” Such fears often revolve around a dystopian eugenic society (an immoral practice of “improving” society’s makeup). These concerns are definitely not unwarranted because history has shown how reductionism (including biological) can relate to harmful ideologies that have hurt and killed millions. Meanwhile, billions of dollar funding into the biology of mental health in the past few decades has not yet led to complete accounts of neuropsychiatric pathologies, and have had little to limited practical clinical advancements. Some even argue against the concept of mental “disorders”, but this is outside the scope of this article. The idea of a biological research about the complexity of the human seems dystopian to many, borderline eugenic to others, but it doesn’t have to be this way. As stated earlier, the criticism is sometimes fair and need to be addressed – but it is often fatalized as if eugenics is the only possible outcome and often scientifically unsound conclusions are made about biological psychiatry. Enhancing socioeconomic determinants of mental health and quality of lives of people and battling harmful ideologies don’t necessitate denying basic reality: at the end of the day, we are biological beings. Pretending we aren’t can hinder scientific and psychotherapeutic practices. Even those who believe in spiritual accounts of the mind can still admit the brain may be a mediator for certain clinically relevant behaviors and emotions. But admitting that doesn’t mean you’re on a journey to rebuild eugenics. In fact, biological research is compatible with an egalitarian society that promotes the well-being of everyone, including marginalized minorities It may be true that the scientific genetic and neuroscience literature has yet to revolutionize the outcomes and prognosis of schizophrenia for example, but this is because of the enormously complex nature of mental health. I admit, reductionist biological approaches that do not take into account the fundamental humanity of the affected people and reduce the conditions to void symptoms are partly to blame – and that’s what I am arguing against in this piece. But neither of these things mean biology is irrelevant or too complex to be studied. You put the same two people in the same environment, one might strive, the other might struggle. Understanding that this is likely (at least partially) due to their genetics doesn’t take away their uniqueness, their humanity, or the role of their environment. Each person still has their unique stories that may have fundamentally altered why one of them strived and the other failed. They both still deserve to succeed, the one who didn’t might need more help to adjust. We can build a society that seeks to do just that, embrace differences, and help people attain their optimal level of well-being (however they define it). Some even argue for the use of biology as a tool to fight against social inequalities. In her book “The Genetic Lottery: Why DNA Matters for Social Equality”, Dr. Kathryn Paige Harden, a psychologist and behavioral geneticist firmly denies genetic determinism (that genetics entirely and fixedly determine human behavior) and explores how understanding the importance of genetics in complex human traits (such as educational attainment) may be a tool for positive change someday by modifying environments to suit people’s biological needs so they can thrive, thus minimizing inequalities and leading to a more egalitarian society. She might seem too optimistic for some, but it seems at least evident she’s not here to recreate a eugenic movement. Our happiness, misery and educational attainment being related to DNA and neurons doesn’t make them less joyful, sad, authentic and definitely not less modifiable. It just means one of the lenses through which we can look at them is biological, which might help improve them for the person’s best interest (which they can determine themselves). A potential critique of my position is that it seems too utopian, as it’s very hard and will take long-term significant efforts from everyone to reach, but this article is more theoretical in nature, and I don’t see any theoretical reason why this is not possible. Curing cancer or Alzheimer’s are optimistic and highly challenging as well, but we don’t stop trying. And I don’t have to abandon biology as a potential for better care in mental health either.

Humane compassion at the core of efficaciousness of mental health interventions

Despite advances and a multitude of approved drugs for the treatment of mental disorders, scientific research indicates that psychotherapy continues to be an important tool in mental health treatment, and for good reasons. Connecting with people, letting them express themselves and validating them can be as important as any manual or drug for their healing. The literature comparing psychotherapy to medication is mixed, due to methodological differences in trials for pharmacotherapy and psychotherapy so it is often hard to choose which is better. But some ideas are already clear: psychotherapy is a comparable tool and can be a better choice in some cases than medication. Sometimes, the combination of both is optimal as well. Thus, it is important for mental health management not to be a quick pill-prescription because this is unlikely to suffice for long-term management of most conditions. To improve that, psychotherapeutic interventions should always be considered alone or in combination with medication or lifestyle changes for any mental health condition. Providing one-on-one humane listening and seeking to change someone’s mind for the better may be in many situations just as powerful (or even better) as that serotonin reuptake inhibitor. And most importantly, any clinical decision for which treatment modality is best should carefully consider the patient’s circumstances.

(Editor’s Note: No references are provided because most research is condition-specific and depends on context whether acute, chronic, long-term and other factors such as age. If you are interested in the literature comparing specific treatment, there are probably review papers so consult the specific literature on that condition).

On another note, the criticism of reductionism of human complexity is often addressed at psychiatry and biology. But these disciplines aren’t the only guilty ones. Modern psychological research and practice have also showed some reductionism. The rise of manualized, short-term, highly structured mental health therapies is often portrayed as a cornerstone of “scientific revolution” in contrast to “outdated” longer therapies such as psychodynamic. However, such an assertion is not fully right. While Cognitive-Behavioral-Therapy (CBT) may have its advantages, it is not necessarily the only therapeutic tool that is scientific. I do believe classical psychoanalytic theory may not be testable or very relevant to our 21st century thinking, but I cannot deny some psychodynamic therapies have also established themselves as evidence-based and may be more helpful to many people and for many conditions. Yes, this most probably isn’t due to Freud’s psychosexual stages of development, which I believe should be abandoned. But it could be due to the increased humane connection this school of thought tends to focus on. Focusing on the connection between a therapist and the patient may be as important as some recently defined worksheets to follow on a weekly basis. In fact, the evidence has continuously supported that one of the biggest element predictive and mediating of improvements in therapy is the therapeutic relationship between the patient and the clinician regardless of the theoretical approach, which only makes the argument provided in this article more pertinent. “Evidence-based” doesn’t have to mean simplistic or overly rigid, it just means the therapy has to work according to clear changes in the person’s life and well-being.

Even more so, the focus on completely structured, time-bound therapies is not entirely rooted in science. Rather, it may be rooted in a desire to appeal to capitalistic institutions, policymakers and insurance companies that demand “quick fixes.” Such approaches do not necessarily mean better science, they mean more capitalistic-friendly evidence. And it doesn’t have to be this way. If you check any therapy techniques textbook, you will find a plentitude of techniques with reasonable theory that warrant empirical investigations, with little empirical investigations – partly due to lack of interest from funding sources. This is not to say that CBT or other highly-structured interventions do not work. They are sometimes better than other therapies, but their “gold-standard” status is not entirely based on objective considerations and may be debated.

There is unlikely to be a fit-all psychotherapy for any condition. Biology may help understand and predict who might benefit from which approach in psychotherapy. But most importantly, any consideration of therapeutic procedures is likely to benefit from considering of the unique humanity of each beneficiary and scientific clinical trials should have this embedded in their methodology.

But why does all of this matter?

Science is undeniably a powerful tool, but it’s also risky. As you may have had to argue in your high school French class essays, science can be a tool for good or bad. But the conceptualization of the science’s philosophical landscape does not only affect how it’s used, but may also affect how robust it is.

It is highly assertable that science is a suitable technique for studying complex human behaviors. However, one needs to remain humble about available evidence at this stage. Our current understanding and tools for mental health treatment are limited. Of course, we have issues of accessibility and scalability that are related to economics and sociology more than scientific psychology, but the science itself is not perfect either. While many benefit from mental health treatments, others may receive a multitude of approaches without much improvement. The need for a better classification system and conceptualization of psychiatric diagnoses is already evident in academic circles as current tools such as DSM-5 or ICD-11 are imperfect. Including the complex, non-reductionist humanity we have within us in such new frameworks is not merely a moral duty, but it also may lead to better accuracy and usefulness of such paradigms as they become more reflective of phenomenological reality.

(Editor’s note: I just really wanted to use “phenomenological” in my first post here, bear with me, it just means consciousness and awareness. I could have simply said, “conscious reality”).

Thus, remaining faithful to the humanity in us doesn’t hinder scientific progress; rather, it promotes it. Understanding diversity, context, interpersonal differences in experiences that we know very little about can also lead to better conceptualization of disorders. Increasing resources and evidence base for warmer, more humane psychotherapy forms can also help fullfill the gap that current evidence-based treatments may have. Another aspect is realizing our limitations: understanding the instrinisc complex subjective part of having a mind can make us aware of the complexity of the topic. We won’t have mental health fully figured out by next year or next decade. Knowing that can lead to more accurate and timely expectations of scientists.

Concluding Remarks…

To achieve such a humane scientific study of the mind and body, continuous communication between disciplines and ethical guidelines is needed to dynamically determine what is appropriate research/application and what is not. Keeping humanity and compassion at the core of brain and mind research ensures that ultimately, the goal is to celebrate the diverse minds we have, not force people into becoming people they aren’t, not erase anyone, but instead improve the quality and well-being of everyone. This maintains the science robust, and their humanity sacred.

Acknowledgements

It’s not a thesis, just a blog, I know. But some ideas used in this blog have been adapted from ideas by people I have enormous respect for. I would like to thank Ms. Loulwa Kaloyeros, a psychologist at the Lebanese American University (LAU) and my instructor in multiple undergraduate courses whose approach and interaction partially inspired me to write this post; Mr. Sarkis Guedjelian, a clinical psychologist/psychotherapist based in Beirut whose critical idea on manualized therapies was adapted for this post; and Dr. Kristian Kemtrup, faculty member at San Francisco State University, whose criticism of CBT as a “gold-standard” was also adapted for this post. Other not mentioned academics in psychology may have influenced this blog because no idea or articles comes from nowhere, but I have synthesized them my way with my overall perspective!