 |
 |
|
|
Perhaps Descartes is to blame.
As Representative John Porter (R-Ill.) heard last month at a hearing on Capitol Hill titled "Healing and the Mind," it was Rene Descartes, sometimes deemed the father of modern medicine, who more than 300 years ago put forth the notion that mind and body are distinct entities. To get permission to use cadavers for dissection, Descartes had to promise the Pope that he wouldn’t have anything to do with "the soul, the mind, or the emotions - those aspects of human experience heavily under the church’s jurisdiction - but would stick strictly to the physical," said panelist Candace Pert, Ph.D., a research professor in the department of physiology and biophysics at the Georgetown University School of Medicine in Washington, D.C.
Descartes got his cadavers, but this agreement "set the tone and influence for the future of Western science over the next two centuries, dividing the human experience into two distinct and separate spheres that could never overlap, creating the lopsided mainstream medicine we know today, enshrined by the National Institutes of Health (NIH)," she told Porter, who chairs the House Appropriations Subcommittee on Labor, Health and Human Services, and Education.
Panelist Steven Hyman, M.D., director of the National Institute of Mental Health, defended NIMH’s record of receptivity to a panoply of conceptual approaches.
While Descartes "made an error saying mind and body are separate," said Hyman, it is dangerous to minimize the significance of genes and environment and the value of psychotropic drugs.
"I think all of human disease is a complex and inextricable dance of genes, environment, and experience," Hyman continued. It makes no sense to "throw the baby out with the bathwater or say it’s just one or just the other."
He expressed alarm about the danger that recasting the role of mind as paramount in illness might reinforce stigma against mental illness. "You know we in psychiatry have fought a battle against stigma, a battle based on the idea that mind is so powerful that it causes everything and can control everything," he asserted. If society minimizes the role of genetics and biology, there is the danger that "we’re going to end up once again telling people that they are responsible for their illnesses," said Hyman. This could result in society "restigmatizing and traumatizing unfairly a very large population," he concluded.
Psychiatrist James Gordon, M.D., directs the Center for Mind-Body Medicine in Washington, D.C. He has long practiced and promoted the integration of alternative approaches into mainstream medicine, he told the panel. Gordon was the first chair of the advisory council for the NIH Office of Alternative Medicine (OAM), which investigates unconventional therapies. OAM and other NIH components are investigating the herb St. John’s Wort for depression. The office was instrumental in NIH’s endorsement of acupuncture for easing pain and nausea, which occurred the same day as the hearing.
How society defines health and illness determines how they will be treated, observed Gordon. In the 1840’s there was a psychiatric diagnosis called "drapetomania - an official psychiatric diagnosis - which turned out to be the unconditional desire of slaves to run away from their masters," Gordon said. "Our diagnosis is conditioned by the science of the times, by the sociology of the times, by the temper of the times."
Gordon became interested in alternative and complementary medicine after repeatedly observing the serious side effects of psychiatric drugs, he said.
"I was distressed by the use of psychotropic drugs. I saw the host of side effects that they produce. I was very interested in working psychologically and socially in creating healing therapy. . .but I also had to ask myself [whether there is] some way we can work with people biologically that will do less harm and will be more effective."
Although Gordon still practices psychotherapy with people who have serious psychiatric disorders, 90 percent of his practice now involves people with chronic disorders, he said. He now no longer distinguishes between conventional and alternative medicine, said Gordon.
If alternative or complementary approaches are not given credence by the rest of medicine, how do society and third-party payers determine what treatment should or should not be accepted and paid for, asked subcommittee chair Porter. "How do we determine what comes in and what doesn’t come in?"
Most research "gets in through the marketplace of ideas" after passing peer review, said Hyman. While review panels consist of people who have certain cultural biases, they operate in good faith, he said.
There are extreme historical examples of scientific bias, such as Galileo’s struggle with the church to acknowledge the reality of what his telescope revealed. "I suspect that on most of our review panels the prejudice is not quite so thick, but I am not going to deny that there are problems in the marketplace," Hyman conceded. The solution, however, is to subject research proposals to rigorous peer review, "making sure - and this is a job of institute directors - that there isn’t tendentious prejudice that gets in the way of any novelty or anything ground-breaking."
Despite the system’s imperfections, "I suspect that for any treatment, if someone were to propose a credible, double-blind trial and to show initial evidence that efficacy was likely, that treatment, whatever it defined itself as, would have a very good chance of getting NIH funding," Hyman asserted.