Found it! Well, maybe not!

In the January 2016 American Journal of Psychiatry is an article titled Finding the Elusive Psychiatric “Lesion” With 21st-Century Neuroanatomy: A Note of Caution.  The first author is Dr. Daniel Weinberger, a big, big name in psychiatry for many, many years. (to learn more about Dr. Weinberger click here).

It makes it that much more noteworthy when someone of Weinberger’s stature writes “It has become research lore that structural changes in the brain are characteristic of many psychiatric disorders and are likely clues to primary neurobiology.” and then goes on to sound a cautionary warning that “the evidence that findings are neurobiologically meaningful is inconclusive and may represent artifacts or epiphenomena of uncertain value.” 

In other words what was found on scans may not be a real change in the brain but rather may be due to head movement (or other possible factors) during the scan. As they point outIs it so far-fetched to imagine that some patients have a harder time remaining motionless during the 10-20 minutes of the typical scan procedure compared to control subjects, many of whom are paid volunteers who often have considerable prior exposure to the constrained and noisy MRI environment?”MRI

Even more admirable is how the authors preface their technical critique (my bold):

Before offering our comments (with full acknowledgment that we ourselves have contributed in the past to the very literature that we are now raising questions about), we first advise the reader about the scope of this commentary:”.  Wow!!!

If you are a psychiatrist or psych resident I highly recommend reading the whole article (sorry but ya gotta pay to read the AJP).  If you’re an interested clinician who just wants the short overview click here to read the abstract.

I know someone who’s skeptical of medical science, pointing out that what’s recommended this year gets turned on its head the next.  This is actually what I love about it – the constant questioning of what is known and what we think we know.  I don’t think Weinberger undermines his credibility by pointing out that he is cautioning about work that he “contributed in the past to the very literature that we are now raising questions about”; it enhances his street cred.

MRI MAchine

Weinberger and co-author Radulescu conclude: “… we opine that current studies are plagued by so many possible systematic confounders that one can only wonder whether, like Wolfgang Pauli, “These results are not only not right, they are not even wrong!” We would caution that researchers and clinicians pause and rethink carefully the conclusions that can be drawn from these various MRI findings in psychiatric research.”

The human brain is the most complex thing in the universe (that we know of so far).  It doesn’t yield its secrets easily.  And as far as our understanding the complexity of it, well, as The Carpenters sang, we’ve only just begun.

It’s not that all the previous research on structural changes associated with psychiatric illness is bunk.  It’s just that we have to proceed carefully,  to realize how much we know, especially compared to not long ago and even more importantly, to know the limits of what we know.

Shalom Coodin



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