Plasticity and Brain Profiler
A Unifying Theory for Psychiatric Diagnosis
Abraham Peled M.D.
Full Text Plasticity and Brain Profiler 2018_Peled
Psychiatry is facing the major challenge of etiological diagnosis. This is the ultimate challenge because it entails discovering the causes of mental disorders. Currently, because the causes of mental disorders are unknown, psychiatry has to make-do with a descriptive diagnostic approach that relies on symptoms (complaints) and signs (observations) of patients. Even though a majority of clinicians agrees that the brain is the organ of mental disorders, there is not even one disease in psychiatry that includes the brain taxonomically. An etiological diagnosis taxonomically involves a place in the body such as the appendix and the description of its pathology, e.g. appendicitis is the infection (the pathology) of that organ. A descriptive diagnosis has no such definition, “Depression” “Anxiety” do not entail a location in the body and do not define any pathology. Not knowing t the causes of psychiatric disorders has serious consequences on treatment. You cannot fix a system if you do not know what is wrong with it. Thus, it is absolutely critical that we psychiatrists discover the causes of mental disorders if we ever want to cure them.
Any discovery begins with a hypothesis; generating a set of testable-predictions about the brain-related pathology of mental disorders is a first necessary step. The second question to ask is, Do we have enough neuroscientific knowledge to formulate a reasonable set of testable hypotheses for brain-related mental disorders? Finally, we ask, is the neuroscientific knowledge accumulated so far, enough for a transformative (and translational) conceptualization of mental disorders into brain-disorders? In other words, is there enough evidence-based scientific literature to generate a preliminary etiological brain-related diagnosis for psychiatry?
An old Chinese adage states that “Wisdom begins by calling things by their correct names” meaning that unless we start reformulating mental-disorders as brain-disorders we shall not be medically wise in psychiatry. This is because today we are locked in a vicious cycle, where we do not have brain-related taxonomy for mental disorders because these have not been proven in research, thus we continue to use descriptive non-brain-related taxonomy, that impedes any advancement in discovery because it is not brain-oriented, and so on. To summarize; no testable formulation for discovery, no discovery, and no discovery causes us to stay with descriptive taxonomy, which in turn, does not allow for testable conceptualizations.
In light of these insights, the challenge of reformulating mental-disorders as brain-related disorders becomes critical to the extent that some degree of speculation is tolerated, in the service of breaking loose from the vicious-cycle halting any progress in psychiatry. Even though highly speculative, it is necessary to make the effort and attempt a novel brain conceptualization for psychiatric diagnosis, this should adhere as much as possible to the scientific literature accumulated to date.
Based on computational neuroscience, complex-systems-physics and the science of neuronal networks, an attempt for a preliminary brain-based psychiatry is made in this manuscript. The future diagnosis of mental disorders is presumed to involve neuronal network plasticity. Specifically, mental disorders result from alterations and “breakdown” in the plasticity dynamics of neuronal network whole brain organization. Disturbances to the optimal (symptomless) brain-organization cause mental disorders; these are detailed in this manuscript and used to generate the future brain-based diagnosis for psychiatry.
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