A Balanced Brain: The Science of Mental Health. Written by Camilla Nord. Princeton University Press; 304 pages. $29.95. Allen Lane. £25
In some areas of medicine, certainty is possible. Tests and scans will reveal the cause of your pain. Treatment, whether to fight an infection or restore hormonal balance, is usually effective. The only exception is mental illness.
Take depression, one of the most common mental disorders. There are 227 combinations of symptoms. Diagnose someone with depression. The drugs prescribed for this work better than a placebo in only 15% of patients. This has led some scientists to reject the idea that depression is caused by brain malfunctions, such as a lack of serotonin, a neurotransmitter that is the target of most antidepressants. They believe that depression is caused by adversity and that it is better treated by psychotherapy, which teaches people how to cope with the situation.
A “balanced brain” brings much-needed clarity to discussions. Camilla Nord heads the neuroscience laboratory specializing in mental health at the University of Cambridge. Her book is an enlightening summary of what scientists know about how the brain works and how they know it. Beware of “neuroborocks,” she warns. It’s a catchy story that pinpoints mental disorders to chemicals or regions of the brain. Mood, thinking, and sleep all involve numerous neurotransmitters and several parts of the brain.
She shows that mental disorders are caused by dysfunction and shaped by the environment. Scans have shown that some depressed patients share different patterns in certain brain circuits and the processes associated with those circuits. Part of the process is learning from experience and forming expectations. People with depression have a bias towards emotionally negative memories and cognitions. Antidepressants target the expectation management system, tilting negative emotional biases in a positive direction.
All treatments for depression, including psychotherapy, electrical brain stimulation, diet, sleep, and exercise, change some, but not all, brain systems. They work, but they don’t work for everyone. The problem is that there is no easy way to determine which brain systems are impaired in cases of depression. This means you should try one approach and then another to see what works. Finding effective drugs for mental illness is also hampered by the fact that each brain chemical has multiple roles. For example, the hormone dopamine is involved in addiction, attention, and exercise.
Many neuroscientists, including Dr. Nord, believe that current diagnostic categories for mental disorders are problematic. Some of the neural and cognitive patterns that cause depression also cause other problems, such as anxiety and loss of appetite. This explains why patients with mental disorders often have multiple problems. Finding new ways to pinpoint brain patterns in each case will not only help patients by providing personalized treatment, but also improve the search for treatments, Dr. Nord argues. . For patients, that’s reason for optimism.
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© 2023, The Economist Newspaper. All rights reserved. Published under license by The Economist. Original content available at www.economist.com.
A Balanced Brain: The Science of Mental Health. Written by Camilla Nord. Princeton University Press; 304 pages. $29.95. Allen Lane. £25
In some areas of medicine, certainty is possible. Tests and scans will reveal the cause of your pain. Treatment, whether to fight an infection or restore hormonal balance, is usually effective. The only exception is mental illness.
Take depression, one of the most common mental disorders. There are 227 combinations of symptoms that can be diagnosed as depression. The drugs prescribed for this work better than a placebo in only 15% of patients. This has led some scientists to reject the idea that depression is caused by brain malfunctions, such as a lack of serotonin (a neurotransmitter that is the target of most antidepressants). They believe that depression is caused by adversity and that it is better treated by psychotherapy, which teaches people how to cope with the situation.
A “balanced brain” brings much-needed clarity to discussions. Camilla Nord heads the neuroscience laboratory specializing in mental health at the University of Cambridge. Her book is an enlightening summary of what scientists know about how the brain works and how they know it. Beware of “neuroborocks,” she warns. It’s a catchy story that pinpoints mental disorders to chemicals or regions of the brain. Mood, thinking, and sleep all involve numerous neurotransmitters and several parts of the brain.
She shows that mental disorders are caused by dysfunction and shaped by the environment. Scans have shown that some depressed patients share different patterns in certain brain circuits and the processes associated with those circuits. Part of the process is learning from experience and forming expectations. People with depression have a bias towards emotionally negative memories and cognitions. Antidepressants target the expectation management system, tilting negative emotional biases in a positive direction.
All treatments for depression, including psychotherapy, electrical brain stimulation, diet, sleep, and exercise, change some, but not all, brain systems. They work, but they don’t work for everyone. The problem is that there is no easy way to determine which brain systems are impaired in cases of depression. This means you should try one approach and then another to see what works. Finding effective drugs for mental illness is also hampered by the fact that each brain chemical has multiple roles. For example, the hormone dopamine is involved in addiction, attention, and exercise.
Many neuroscientists, including Dr. Nord, believe that current diagnostic categories for mental disorders are problematic. Some of the neurological and cognitive patterns that cause depression also cause other problems, such as anxiety and loss of appetite. This explains why patients with mental disorders often have multiple problems. Finding new ways to pinpoint brain patterns in each case will not only help patients by providing personalized treatment, but also improve the search for treatments, Dr. Nord argues. . For patients, that’s reason for optimism.
For more on the latest books, movies, TV shows, albums, and controversies, sign up for Plot Twist, our subscriber-only weekly newsletter.
© 2023, The Economist Newspaper. All rights reserved. Published under license by The Economist. Original content available at www.economist.com.
