Psychiatry has not yet been able to come up with laboratory tests for psychiatric conditions
The two most exciting advances in the entire history of biology are unraveling the workings of the human brain and breaking the genetic code. No one could have predicted that we would have come so far and so fast. But there has also been a great disappointment. Although we have learned a great deal about brain functioning, we have not yet figured out ways of translating basic science into clinical psychiatry. Molecular biology, genetics, and imaging have not yet led to laboratory tests for dementia or depression or schizophrenia or bipolar or obsessive-compulsive disorder or for any other mental disorders. The expectation that there would be a simple gene or neurotransmitter or circuitry explanation for any mental disorder has turned out to be naive and illusory. An overabundance of dopamine in schizophrenics has yet to be found, a shortage of serotonin in the brain has not yet been found in depression patients, and gene expression is highly contingent on the environment. So for psychiatry too, the word “normal” has always been elusive.
We still do not have a single laboratory test in psychiatry. Because there is always more variability in the results within the mental disorder category than between it and “normal” or with other mental disorders, none of the promising biological findings has ever qualified as a diagnostic test. The brain has provided us no low-hanging fruit—thousands of studies on hundreds of putative biological markers have so far come up empty. As Roger Sperry put it in his Nobel Prize in Medicine acceptance speech: “The more we learn, the more we recognize the unique complexity of any one individual intellect, the stronger the conclusion becomes that the individuality inherent in our brain networks makes that of fingerprints or facial features gross and simple by comparison.” Teasing out the heterogeneous underlying mechanisms of mental disorder will be the work of lifetimes. There will not be one pathway to schizophrenia; there may be dozens, perhaps hundreds or thousands.
References
- Frances, Allen. (2013). Saving Normal CHAPTER 1. What’s Normal and What’s Not? (p. 25). New York, NY: HarperCollins.
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