The Science and Science of Psychiatry?

NeuroAnalyis – An interview with Avi Peled, M.D.

Back in July 2008 Mr Ian was on a rant. A rant about professional exclusivity in the realm of understanding and curing mental disorders – how one profession purports to beholden the knowledge and the cure for “les maladies de la tête“.

It was a passing storm long forgotten – until I recently came across a psychiatrist in Israel who has been raising awareness of his theories on a potential cure for mental disorder.

NeuroAnalysis is the brainchild of Avi Peled, M.D. and is the title of his 2008 book explaining all about understanding mental disorder as requiring a multi-speciality approach to science-based diagnostics and treatment.

Avi has a webpage: http://neuroanalysis.googlepages.com/home

On there he describes his theory on how mental disorder diagnostics can become scientifically based by producing profiles of brain function which more or less identify which neurons or networks are misbehaving by comparison to other optimally functioning networks. Such science would obviously render the subjective and often contentious DSM/ICD as a redundant artefact, consigned to the history museums of Bedlam.

Clinical Brain Profiling (CBP)

Psychiatric mental disorders can be formulated in terms of disturbances to optimal neural network dynamics in the brain. CBP reformulates psychiatric mental disorders as disorders of the optimal neural network organization of the brain. It is based on excellent scientific work by many neuroscientists and psychiatrists, never-the-less it still needs to stand the proof (or refute) of scrutinizing empirical appreciation.

I asked Avi if he’d be willing enough to give a brief explanation of his cause to us here at Mental Nurse and he was only too willing to oblige in the form of answering several questions over a course of emails.

The process of NeuroAnalysis seems to take what we currently use in the form of psychiatry and psychology and directly adds neuroimaging to the diagnostic tool set. Is it as simple as that?

No it is not as simple as that and it is also not just a simple triad of observation tests and imaging. In general what I am trying to do is combine psychiatry with a scientific field (well established by now) called neural-computation. The field of computational neuroscience, as it is also called – as well as neural networks, artificial intelligence and so on – provides for the basic science of psychiatry because it provides the mathematics and algorithms that explain brain dynamic organization. As such it also provides the understanding of the brain dynamic disorganization.

The assumption is simple, brain optimal dynamic organizations allows for normal mental processes and perturbations; disturbances to the optimal brain dynamic organization cause mental disorders. We shall cure mental disorders by restituting the optimal dynamic brain organization. Of course this is very, very general.

You have to understand what we are dealing with. First and most general, we have the psycho-physic problem. How can a physical system have psychological phenomena? The brain is physical system, the most complex known but still a physical system. Neural computation provides the answer for that; nonlinear complex systems have “emergent properties” – the whole is more than the sum of parts – so mental functions, emotions, awareness, consciousness are all emergent properties out of the brain complexity.

How do we use this to help diagnoses and treatment?

Normal mental functions become disturbed (i.e., mental disorders) when the patterns of optimal brain organization underlying these properties collapses. The disturbances probably have their specific “collapsing patterns” just like cardiac arrhythmias have their characteristically disturbed patters.

Now all that is left to do is to identify the disturbed arrhythmic brain pattern if you will; and then design the intervention to correct it, – much like pacemaker corrects cardiac arrhythmias and resolves cardiac insufficiency – so will the “brain pacemaker” do with the “mental insufficiencies” i.e., the mental disorders.

But before you can identify the disturbed brain dynamics you must have some kind of hypothesis or theoretical framework telling you what specific brain disturbance relates to each of the known mental disorders. In other words, you need to generate the presumed disturbance in dynamic brain organization for each of the clinical manifestations we know of in psychiatry. This is actually what ‘NeuroAnalysis’ does.

I think it is also useful to create a new language about mental disorder calling them by the name of their dynamic brain disturbances rather than just by their descriptive clinical manifestation. I call this new nomenclature Clinical Brain Profiling and hope it can substitute the DSM.

I hope that my book formulating the disturbances of brain dynamics in mental disorders will lead to powerful insights that will ultimately direct us to develop effective real cures.

What is the underlying theory on how the brain creates what we see as symptoms of a mental disorder phenomenon?

In understanding the theory; a failure or dysfunction of one or more components of the complex neural networks would be responsible as the neural origins of what manifests into what we generally call mental disorder, and thus ought perhaps be considered more aptly as sub-optimal function of the complex neural network?

It happens that the brain is a non-linear complex system thus needs to be dealt with the relevant sciences of complex system physics.

Failure or dysfunction of one or more components of the complex neural networks can cause the network to dysfunction. However these networks are robust designed to withstand even up to 80% damage to brain tissue – so it is not that simple. What probably happens is not a failure of a component but a failure of the organization among many components.

Let me explain; let us take the metaphor of an orchestra playing music. The music is the emergent property of the organized (coordinated) playing of each musician. The neuronal activities are the musician players in the brain and the mental functions are the emergent (properties) the music.

Now take two orchestras with multiple musician players each. The players of one orchestra play in a well coordinated manner and the music is in tune. In the other orchestra the players do not coordinate their playing, each player is a bit off-track from all the others. I do not need to tell you what happens to the music. Now if you isolate one player from one orchestra and another from the other orchestra you will not notice a difference. This is what happens in psychiatry today; isolating brain regions or synaptic neurotransmitter activity, and comparing patients and healthy controls don’t lead us anywhere.

We need to identify the disturbed pattern of coordinated activity and correct it. What makes an orchestra play in a well coordinated manner? The conductor. What has the conductor in his service to do it? He sees everyone and everyone sees him, in other words he has full connectivity with all players. In the brain the frontal cortex has high connectivity with all brain regions and systems. The frontal cortex is the conductor of the brain, no wonder that hypofrontality (reduced activation of frontal cortex in schizophrenia is a replicated finding – but no one can explain it other then I)

What knowledge or understanding do we already have on the optimal function of the brain and it’s inter-relational function of those ‘parts’ – and how much further do you think we need to be?

We have the beginning of the understanding but we need much more. If you really want to understand this in-depth you have to take a break and see this fascinating talk by my friend Giulio Tononi [1h 12m]; it is about consciousness – How the brain generates consciousness – Consciousness is directly related to mental disorders as these disorders involve altered conscious awareness

Giulio and a few others are formulating the algorithms we are looking for in psychiatry – they are also developing the algorithms of signal processing that are needed. For example if you want to investigate functional connectivity in the brain you need to have the methods to process signals like EEG and fMRI from the perspective of connectivity. For example – if you use ICA (independent component analysis) it detects the number of independent components contributing to the signal. If the system is disconnected (in our metaphor -each player in the orchestra is playing regardless of the others) then you will have many more independent sources than if the system was well coordinated.

I have to tell you that the field of signal processing is an entire huge body of science related to computer and electrical engineering. The psychiatrist of the future will have to be a complex systems physicist as well as a signal processing engineer and other things too.

Given the complex inter-relationships of neural networks, how simple or difficult is it (going to be) to identify the component parts and the interdependent relationships with other component parts that are responsible for something, say for example, such as lability of mood?

It will not be easy – but we have no choice but to get there. I believe that mood is an emergent property of ‘optimization dynamics.’ In the sense that during brain activity brain dynamics as a whole can have deoptimization dynamics or optimization dynamics with reduced and elevated mood respectively. You probably know the SSRIs (antidepressants) are synaptogenetic (generate spines synapses and dendrites) thus the brain becomes more ‘plastic’ (i.e., changeable) able to move from deoptimized states to more optimal dynamics resulting in the emergent property of elevated mood or antidepressant effect.

Once we have the technology to perform Clinical Brain Profiling – by what methods do you envisage ‘optimising’ treatments might change – or what might remain the same?

Amazingly this is the easy part – the technology to alter the brain activity and control it – or in-other-words – the technology to built the ‘brain pacemaker’ that will optimize brain activity and cure mental disorders is already here.

TMS, or transcranial magnetic stimulation and DBS, or deep brain stimulation; but most amazing – Optogensis Neuromodulation – I believe something like this will be the key.

You’ve said that future psychiatrists might have to be a complex systems physicist as well as a signal processing engineer and perhaps other things. In your fictional book, written with Debbie Brand, you have identified that in future psychiatrists could be known as Optimizers for restoring brains to their optimum working – which is the title of your book “Optimizers 2050″.

It’s perhaps unusual for a psychiatrist to write a fictional piece of work to demonstrate a potential application of a technology that is yet to be properly understood but this is what you did with “Optimizers – 2050″

What was the principle behind writing this book? Why did you choose this particular manner or medium to demonstrate your theory?

You are absolutely correct it is generally unusual for a psychiatrist to write a fictional piece of work to demonstrate a potential application of a technology that is yet to be properly understood. You ask why I chose this particular manner/medium to demonstrate my theory. Well the answer is out of despair.

I am not getting through to my fellow psychiatrist colleagues. I do not have the resources to prove my theories by myself. I need large powerful research groups to do it. But my fellow psychiatrist colleagues seem intimidated by this – I see it in the responses I get from talks I give on the subject. I tried to get colleagues who were working on the DSM V interested but I was ignored.

I thought that through a narrative manner they may digest it easier; that by demonstrating in a story how we could really cure patients in the future will make them more interested.

I gave a talk this summer at Mount Sinai NY and invited an eminent colleague to hear – the best thing he could comment about it was “Not in our lifetime” – and this is considered a good response! At least he did not put it off entirely like others did.

Unfortunately I have to conclude that my fellow colleagues are not ready for it yet. You know, in the letters that Sigmund Freud wrote to his colleague and friend Wilhelm Fliess he writes:

“I am pretty much alone here in the elucidation of the neuroses. They look upon me pretty much as a monomaniac, while I have the distinct feeling that I have touched upon one of the great secrets of nature.“

[Sigmund Freud - 21/5/1894 Letters to Wilhelm Fliess 1887 - 1902].

With better understanding of neural networks and their function and dysfunction, do you consider it possible to also – or instead – develop psychological therapies to a scientific level?

In my book you will see I explain that psychotherapy is actually a biological treatment because of “experience dependent plasticity“.

Does this theory of neural networks not abrogate the whole concept of psychopharmacology? As you cannot alter the location of a neural connection by chemicals (I think)-

Psychopharmacology in the future will be plasticity enhancing allowing better results of psychotherapy and of experiential educational and rehab programs

If you were given a free reign and unlimited access to resources – how would you want to develop your theory?

The theory is preliminarly developed and ready for the test – I need centers of imaging to prove or refute it. It has to be within mainstream science and academy.

In current reality and given their are many conflicting psychiatry and psychology and neurology opinions – how do you envisage the future significant developments (if any) of psychiatry?

In the past neurology and psychaitry were united. In the future; psychiatry, neurology and psychology will unite hopfully under a new name – maybe ‘NeuroAnalysis’

and finally… in a sci-fi sort of way: Given that neuroanalysis and optogenesis may lead us to diagnose and cure ‘faulty thinking’ – it would also lead us to be able to identify and alter any thinking.

Do you have any concerns as to how this potential for inducing ‘conformity’ may lend itself to more wrongful applications than right ones….. or am I just being paranoid?!

You are correct – every scientific development has its evil side – like atomic energy. It is up to humans to control it. But this is all highly philosophical – all I want to do is to cure my patients.

Many thanks, Avi.

Avi Peled M.D. is Chair of Rehab’ Dept’ SM, Mental Health Center;

and holds academic position of ‘Technion’, Israel Institute of Technology

Author of ‘Optimizers 2050′ and ‘NeuroAnalysis‘