dr.K's tiips

Do we have to understand how the brain works in order to promote integrative approaches?

I am often asked how we can discuss the body/mind connections when we do not understand the workings of the brain. After all the brain is the location where presumably the body/mind interaction takes place.

This is of course a very valid point. The short answer is it makes sense to operate with some unknowns, rather than not move forward at all.

To answer that more broadly, the advent of modern medicine has afforded formidable progress in our understanding of anatomy, physiology, pathology and disease formation. Those discoveries have shed important light on the structural and physiological aspects of the brain and its unique position regulating itself and the rest of the body. However, despite heroic efforts by neuroscientists, the way the physical brain interacts with the more abstract aspect of its function such as memory, thoughts, and feelings, remains for the most part elusive and poorly understood.

Needless to say the brain is distinct from all other elements of the body since, to put it simply, your brain IS you. The aspects of the brain that make you who you are, your memories, experiences, moods, thoughts, feelings do not yield their secrets easily to our sophisticated exploratory tools. It is already clear that modern medicine will eventually be able to replace (or grow) almost any organ of the body. But there is no question that your brain cannot be transplanted without killing what makes you who you are. If you get a new, different brain you simply stop existing.

Since all attempts to link the abstract workings of the brain to their material basis have so far been thwarted, rather than “wait” for the brain to become comprehensible, medicine has forged ahead without this complete knowledge. As a result, the idea that medical models can be explained without the role of the brain, especially as it pertains to the mind, has become the prevailing principle of contemporary medicine. It is not based on science but rather on convenience. It is the “looking under the lamppost” phenomenon of medicine.

It is conceivable that the brain would remain an unsolved mystery for a very long time. But Integrative Psychiatry is not presuming to unlock the mysteries of the brain. Rather, it proposes to examine, and integrate the dialogue between the brain and the body in health and illness. For that we do not need to know how the brain works. We need to know how it interacts with the body and how, through the brain, our thoughts and feelings influence the body and vice versa. For instance, we know that premenstrual hormonal changes cause irritability and depression in women. We do not know how mood and thoughts are influenced by hormonal changes: but we can examine the connection. Indeed, after millennia of misunderstanding or ignoring the monthly emotional suffering of countless women, recognizing the phenomenon resulted in research and effective treatments while the exact mechanisms in the brain remain unknown.

By focusing on the interplay between the brain and the body, we can identify numerous cross influences (i.e., the influence of the body on the thoughts and feelings and vice versa) and their effects on health, and recovery. While such observations have been made sporadically throughout medical history, we would like to come up with a coherent, encompassing approach to such integration, and help medicine recognize and incorporate that crucial “missing link”.