Over at Freakonomics, they invited several prominent thinkers to weigh in on a rather lofty question: How much progress have psychology and psychiatry really made?
The answers are mostly interesting, with nearly everyone agreeing that the sciences of the mind and brain have made tremendous progress. That is, of course, the correct answer. When you think that, one hundred years ago, Ramon y Cajal had just published his “speculative cavort” laying out the neuron doctrine, or that we still had no effective treatments for any mental disorders (the frontal lobotomy would become popular a few decades later), it’s hard to deny that neuroscience, psychology and psychiatry have all made tremendous strides. It’s a classic example of the upward slope of science.
And yet, that easy answer also elides some interesting conundrums. I’d like to focus on the disconnect between progress in basic research and advances in neuropharmacology. As I noted above, science has learned an astonishing amount about those trillion interconnected neurons inside the skull. We’ve reduced the mind into a byzantine list of kinase enzymes, synaptic proteins, microtubules, neurotransmitters, etc. Consciousness is nothing but a certain kind of chemistry.
At the same time, the medical sciences have come up with some rather effective drugs that have helped treat a wide range of mental illnesses, from depression to schizophrenia. At first glance, it might appear that these new drugs are the payoff of basic research, that we’ve learned how to treat the mind because we know so much about the brain. But I’m not sure that’s right. Prozac, after all, was first invented as a treatment for high blood- pressure. (It worked in animals, but not humans.) And even though Prozac and other SSRI’s are prescribed in dizzying numbers, we still don’t know how they really work. (The over-simplified serotonin hypothesis has been largely discredited.) Or look at addiction, one of the most devastating mental illnesses. In recent decades, neuroscience has learned a tremendous amount about the substrate of addiction, with much of the work focusing on the dopamine reward pathway. And yet we’re still giving people methadone, which was invented in 1937. Neuroscience knows a lot about the pathways of long-term memory, having identified plenty of pertinent kinase enzymes (CREB, PKC, etc.),and yet where are the memory enhancing drugs? Why are still taking gingko biloba, which doesn’t even work?
I certainly don’t want to diminish the notable successes of the 20th century, where neuroscience and medicine have made strides by working together. (Parkinson’s comes to mind, where basic research into dopamine and the basal ganglia has led to dramatic improvements in patient care.) But I think that, while there has been real progress, the reality of progress has been a little messier than the narrative. I have no doubt that the billions of research dollars we’ve poured into neuroscience will have tangible and dramatic medical benefits in the future. I’m just not sure the future has arrived yet.