The Mind-Brain Connection: An Interview with Andrew J. Gerber, MD, PhD, Medical Director/CEO, Part 1
We sat down with Dr. Gerber recently to hear his perspective on the mind-brain connection. Learn about his views and his research below:
Q: Please tell us what you know to be true about mental illness and the mind-brain connection.
AJG: What I think has become increasingly clear in the last two decades is that to really understand what goes on in individuals who suffer from mental illness, you can't focus only on the machine that is the brain, nor can you only focus on the idea of a mind that is independent of a body. You have to have a perspective that includes them both, and by that I don't mean “speak about the brain,” full-stop, next paragraph, “speak about the mind.” That is better than speaking about only one, but a truly integrated view weaves together the mind and the brain. Of course, how to do that is what's been the challenge for literally thousands of years. We’re better able to do this now than before because we actually have some techniques and theories that tie these things together and help us understand why some people develop mental illnesses and some people don't.
Q: What damage results from this false dichotomy between the mind and the brain?
AJG: We have had such a poor understanding of the working of the brain because it's so complicated, and it made sense to have two separate theories. That is, one physical theory of the brain that you could put your hands around, and then totally separate mind or psychological theories. The fields of psychology and psychiatry just inherited that view, but of course that's the area in which that view is the most damaging. For example, we've started to learn about treatments that address mental illness using the brain metaphor, things like medication or electroconvulsive therapy (ECT), and they sound extremely different from treatments that address those same illnesses using the mind metaphor, such as psychotherapy. And in fact, they’re less different than we might have thought. When you actually look at the effects of medication on the functioning of the brain, you can see changes that are quite similar to the effects of psychotherapy on the brain. We have happily moved into an era where we don't see either treatment as in combat with the other. Most people in psychotherapy have also tried medications and ideally most people on medications would have also tried psychotherapy, not because one or the other is going to be the answer, but because the combination tends to be the best solution, particularly with more complicated and severe kinds of mental illness. It's certainly what we live and breathe at the Austen Riggs Center; our patients come with multiple complicated problems. And if we were holding out for just one simple answer, either mind or brain, that is, just psychotherapy or just medication, we would be doing them a disservice. Almost all of our patients are involved in both kinds of treatment.
Q: How does your background in clinical practice and in research inform your view?
AJG: People sometimes wonder about the combination and they say, “Aren't they two entirely different perspectives?” I tend to see them as complementing each other. A clinical perspective teaches you a number of things. It roots you in the relationship. You realize very quickly that at the core of any clinical encounter is a relationship between two people. I don't know that one could learn that, and certainly not as powerfully, without being a clinician. The second thing is that you learn to be enormously practical and pragmatic. You learn that it's so much more important to help people rather than stick to a theory. You also learn that patients and their families are often the best sources of theories or explanations.
What I get out of being a researcher is different, but related. Part of the scientific culture is a certain amount of skepticism about one idea being right and this links up to the last idea about clinical work being practical. In research, you learn that it's very easy to just look for evidence to back up your own theory, but if you force yourself to be more systematic, you often learn things that you wouldn't have if you were just looking for evidence of what you already believed. And in some ways, the whole culture of science and research to me is about humbly acknowledging how biased we can be. I also find it useful with patients because it reminds me how patients can get very convinced of one way of seeing the world and need our help to challenge those ideas and to consider that there are other ways.
The other thing that research teaches me is not to generalize too much from single examples or small numbers of examples. I think we're good at telling stories about individuals and that's part of who we are as humans, but I think we have an unfortunate tendency to think that because we know one story that means it’s everybody's story. And research has all sorts of elaborate methods, statistics being the most obvious one, to compare what we know about a small number with what we know about a larger number. One of the first principles of research is be skeptical when you have a finding that is a small number, and you need to test whether it actually holds true with larger numbers or with other populations, because often, it doesn't. I find that kind of way of thinking and working to be enjoyable and challenging, and also ultimately to be very useful in my clinical work.