Psychology was explained by the neurosciences
Neuroscience and Health Promotion
The neurosciences deal with the central nervous system and especially with the brain. They are therefore synonymous as brain research or brain research. The discipline emerged in the 1970s from areas of medicine, psychology, biology, chemistry, physics, computer science and related sciences, which had previously dealt with neural processes. At this point in time, however, disciplinary approaches alone were no longer sufficient to examine the complexity of the brain, so that neurosciences emerged as a new interdisciplinary research field (Heinemann 2012). The neurosciences include:
- Cognitive Neuroscience
- Computational Neuroscience
- Molecular Neuroscience / Neurobiology
In addition to these core disciplines, there are other areas in which neuroscientific methods and theories are used or neuronal processes are the subject of analysis and which therefore also use the prefix neuro. These include neurolinguistics, neuroeconomics, neuropedagogy, neuroethics, neurophilosophy, but also more unusual fields such as neurotheology. For health promotion, however, the first-mentioned core areas of brain research are of decisive importance.
Insights from the neurosciences
In general, the neurosciences have made fundamental advances over the past few decades in terms of knowledge about the brain and its functioning, which are relevant both for treating diseases and for preventing them (Kandel et al. 2012). Initiated by innovations in medical technology, brain research was able to gain important knowledge about neural processes. Processes in the brain can now be described more precisely than was the case a few years ago. Knowledge of the structure and functioning of the central nervous system leads to an increase in knowledge that is not only significant from a scientific point of view. It also has consequences for applied research and opens up new therapeutic options. It is already possible today to diagnose pathological changes in the brain more precisely and to treat them in some cases.
Technical advances include, in particular, new and improved methods of neural imaging. Examples include the (further) development of magnetic resonance tomography (MRT), computed tomography (CT) and positron emission tomography (PET). Electroencephalography (EEG) and magnetic encephalography (MEG), which are not actually imaging methods, also contribute to the improved possibilities of analyzing neuronal processes. The best known method of imaging, functional magnetic resonance imaging (fMRI), is a non-invasive method for displaying brain structures and activities. Non-invasive means that images of the brain are made without penetrating the subject's body or brain or exposing them to radiation (Hagner 2013).
However, technological innovations are not limited to imaging alone. The molecular biological analysis options as well as combined methods in which several measuring instruments are used have been newly or significantly further developed.
Using these new methods, it is possible to recognize pathological changes in the brain at an early stage and, as far as possible, to take appropriate treatment measures. Strokes, cerebral haemorrhages or tumors can be diagnosed with a CT. An MRI can also be used to detect abnormalities in the brain, for example lesions or so-called amyloid plaques, which are associated with Alzheimer's dementia. Certain brain activity patterns and structural changes as well as specific biomarkers are to be used in the future to diagnose mental disorders (Engel 2018). Even if the hope for such diagnostic options for everyday clinical practice has not yet been fulfilled despite intensive research, the vision of such a practice is unbroken.
Problems in Neuroscience
As impressive as these options sound, and some of them are, there are quite a number of them Problems.
First, it is still not known exactly how various neuronal diseases manifest themselves in the brain. Amyloid plaques, which show up in the brain before the first symptoms of Alzheimer's disease, are an indication of the disease, but there is still no evidence for a clear causal relationship between the observable phenomenon and the disease. It is no different with mental disorders. Although there are various indications as to which functions in the brain are disturbed in a mental illness, there is not a single disorder that can be clearly diagnosed on the basis of a brain image or another biomarker. This is not least due to the fact that mental disorders in particular are socially mediated and constructed to a high degree. This makes it questionable whether suitable biomarkers can ever be found for these complex socio-medical phenomena.
Second, it is problematic that, even with early diagnosis, treatment methods are still lacking for many neuronal diseases. This raises the question of the value and side effects of the diagnosis if a meaningful intervention is not possible. From an ethical perspective, in particular, it is problematic when people are confronted with knowledge that will permanently change their lives without the corresponding options for action being given (predictive medicine and individualized medicine; ethics in health promotion and prevention).
Similar successes but also problems can also be seen in the Neuropharmacology. From the 1950s, scientists began to systematically intervene in the neurotransmitter balance of the brain using psychotropic drugs. This is an important component of treatment, especially for diseases such as Parkinson's, Alzheimer's, other dementia and mental disorders such as schizophrenia and depression. This was made possible by the increasing knowledge about signal transmission and processing in the brain and corresponding pathological changes in the diseases mentioned above. In this context, the substances serotonin, noradrenaline and dopamine play an important role in the metabolism of the brain.
In the 1950s, the first antipsychotic drug, chlorpromazine, was discovered by chance and found to relieve schizophrenic symptoms. With the intensive research into Parkinson's disease in the 1960s, it was possible to show in detail that there is a connection between dopamine and the diseases Parkinson's and schizophrenia. It has been shown that the concentration of the transmitter dopamine is too high in the brain of schizophrenic patients, while this substance is too low in Parkinson's patients. This led to intensive research in this area and to the discovery of other transmitter systems that are important for mental illnesses.
To date, there are no drugs that could cure neurodegenerative diseases in particular, but at least these processes can be slowed down and quality of life can be maintained for a longer period of time. So far, the importance of the neurosciences has primarily been that in the case of neuronal diseases, health-impairing phenomena and effects can be recognized early, treated and alleviated, so that "secondary" and "tertiary" prevention or health promotion is better possible for people with chronic diseases Prevention and Disease Prevention; Medical Prevention).
Similar to diagnostic procedures, however, neuropharmacology is still facing major challenges. To date, in spite of all the advances in this area, both research and the correct attitude of patients with appropriate medication are based to a significant extent on the principle of trial and error. There are currently a number of antidepressants that intervene in the neurotransmitter balance in different ways. However, whether and how exactly one of these drugs works in a patient in a specific dosage must be tried out in practical application.
Despite the better understanding of the neurotransmitter household and the proven effect of Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of depression, there is still no scientific study that can prove a causal relationship between the drug and its effect at the neuronal level. This is not least due to the fact that the phenomenon to be treated cannot be defined neurobiologically alone, but social factors play a very decisive role.
For some psychological disorders, especially attention deficit hyperactivity disorder (ADHD), but also for other psychological problems such as depression, excessive aggression, anxiety or sleep disorders, it is not always necessary to administer medication directly, thanks to the findings of neuroscience. Rather, it can be used in combination with other forms of treatment Neuro feedback can be used to help people with these symptoms. This is a method in which a person's brain activity is made visible to them in real time. Electroencephalography (EEG) is usually used for this. The patients are taught techniques how they can consciously control their brain activity and gain greater control over their cognitive functions (patient counseling / patient education).
Neuroethics and Brain-Computer Interfaces
Other areas relevant to tertiary prevention are neuroprosthetics and brain-Computer interfaces. There is a close connection to neuro-feedback here. In neuroprosthetics, prostheses are developed for people with physical limitations that control them using their thoughts. With neurofeedback, patients learn to use their thoughts in a targeted manner in order to carry out very different operations with a prosthesis, whereby communication between the brain and the machine or prosthesis is ensured via an interface. A distinction must be made between invasive and non-invasive interfaces. The non-invasive methods include measuring brain activity by means of EEG, while invasive methods not only read the activity, but also stimulate the brain in order to partially restore vision in certain forms of blindness, for example. While some procedures are still in development, others are already firmly established in rehabilitation today and thus help to substantially improve the quality of life of people with disabilities.
Neuroscience and Prevention
The neurosciences not only aim to explain, alleviate and cure neuronal diseases, but also to describe human development processes and thus to contribute to primary prevention and health promotion in general.
Neural development processes from childhood to advanced adulthood play an important role in imparting knowledge. The neurosciences were able to empirically show how the brain develops over the entire lifespan and how it is possible at any age to learn new skills and to keep them in mind. The brain is also able to compensate for malfunctions in an area that may arise, for example, as a result of an accident. Certain brain regions can then take on tasks that were previously carried out by the damaged areas. This property of the brain is also known as neural plasticity. The Neuropedagogy tries to use this knowledge and to improve and promote education and rehabilitation.
It is undisputed that early childhood learning, for example, can be decisively improved through optimal conditions and factors that have also been worked out by brain research, and thus health can be promoted in the long term. It should be noted, however, that many of these findings are not strictly neuroscientific. Rather, they are based on classical psychological research and have often been known for many decades. The merit of the neurosciences is to confirm these (learning) psychological theories also neurophysiologically. They therefore help to ensure that these findings are recognized by a broader public and that they are disseminated.
Neuroscience and the concept of health
However, the neurosciences not only contribute to prevention and health promotion, but also fundamentally question the concept of health and what is considered "normal". This becomes particularly clear with a view to the so-called Cognitive Enhancement (Heinemann 2010).
Cognitive enhancement, also known as neuro-enhancement or brain doping, refers to the use of psychotropic drugs to improve performance in healthy people. With the development of modern, psychoactive ingredients based on neuroscientific findings, it seems possible not only to treat diseases such as depression or Alzheimer's, but also to increase people's performance and psychological well-being beyond the normal range. This discussion also touches on health promotion: Can the drug-based increase in performance and well-being still be regarded as the best possible use of health potential?
For example, if healthy people take medication to treat ADHD, this has a stimulating effect, analogous to high doses of caffeine. The physical resilience increases and a feeling of tiredness does not set in so quickly. Measures that increase cognitive performance and psychological well-being beyond the natural level are propagated by prominent representatives of the neurosciences and promoted with scientific research. Neuroscientists were also involved in founding companies to develop such drugs. In the foreseeable future, the neurosciences promise nothing less than a happier life with simultaneously increased performance and health - and that ostensibly free of side effects.
In reality, however, the reality is different. In the case of the drugs discussed, an increase in performance can only be ascertained in scientific studies in very specific contexts. If healthy people take drugs to treat ADHD, at best this has a stimulating effect, analogous to the consumption of a drink containing caffeine. This performance-enhancing effect only occurs when the person concerned is tired and less able to concentrate. However, the normal level of cognitive performance of a well rested person is not achieved with it. If well-rested test persons take these means, their ability to work is even reduced. No sustainable, positive effect can be proven with other psychotropic drugs either. In addition, the drugs mentioned are not free from side effects. It is also not to be assumed that drugs free of side effects will be developed in the foreseeable future. In this respect, in the current discussion and advice to potential consumers, it should be noted that the health risks associated with the consumption of performance-enhancing agents are not ignored or played down.
The neurosciences have been able to gain groundbreaking insights in the past decades, for example to understand the processing and integration of various sensory stimuli or emotional and social information. Therefore, there are now improved diagnosis and treatment options for neural, especially neurodegenerative, diseases and mental disorders. Some of these achievements, which are widely relevant for health promotion and treatment of diseases, were presented and discussed as examples. Much of the increase in knowledge so far has been related to understanding and functioning of the brain and not to practical interventions. The neurosciences are still a long way from a complete understanding of the central nervous system.
Nevertheless, great potential is ascribed to the discipline in various areas of society, including health care and in the education sector. In order to be able to exploit this and to increase the evidence of neuroscientific findings and interventions, brain research is currently being extensively funded. The European Union is therefore supporting the so-called Human Brain Project with over 1 billion euros.The Obama administration in the USA had launched the BRAIN Initiative (Brain Research Through Advancing Innovative Neurotechnologies) and has funded neuroscientific research with up to 4.5 billion US dollars for 12 years from 2014 onwards. The aim of these two major projects is to fully understand the central nervous system and how it works by 2025 (funding of health promotion). It is questionable, however, whether the hopes associated with these initiatives can be realized.
Even in the so-called Decade of the Brain from 1990 to 1999, the neurosciences lagged far behind the goals they had set themselves. At that time, one of the promises was to find a unique biomarker for all mental disorders that could be used to diagnose these diseases. In fact, even in 2019, there is not a single mental disorder for which there is such a biomarker (Voigt, & Rüppel 2019). So a certain skepticism towards such promises is appropriate.
This is an attempt to address the obvious weaknesses of neuroscientific research, in particular the discrepancy between claim and reality Memorandum "Reflexive Neuroscience" (Tretter 2014). Here, some neuroscientists are calling for even greater interdisciplinarity, which also includes the humanities in particular, if the results of brain research are to be interpreted critically and thus more adequately and placed in their social context. As welcome and important as this initiative is, it has received little attention in the neurosciences so far. In day-to-day research and research practice, there have so far been no indications that a reflective and thus more critical attitude towards one's own results is being established. Although the Human Brain Project, for example, was criticized by prominent neuroscientists, this criticism relates primarily to the management and the content of the project. At the level of research design and interpretation of results, reflexive neuroscience has so far remained without consequences.
In contrast to what some pronouncements from brain research and media reports on the discipline make, the impulses they emanate for sustainable health promotion (in the sense of strengthening resources) or even primary prevention have been limited so far. It will be decades before the discipline can develop the potential that is emerging. Some of the claims and goals may not even be able to be realized.
Engel, A. K. (Ed.) (2018): Neuroscience. A basic textbook in biology, medicine, and psychology. Berlin: Springer.
Hagner, M. (2013). The Mind at Work: Historical Studies of Brain Research. Göttingen: Wallstein Verlag.
Heinemann, T. (2010). Neuro-Enhancement - Social Progress or New Dimension in Medicalization? In: Liebsch, K., & Manz, U. (Eds.): Living with the Life Sciences. How is biomedical knowledge translated into everyday practice? Bielefeld: transcript, 131–152.
Heinemann, T. (2012). Popular science: brain research between laboratory and talk show. Göttingen: Wallstein Verlag.
Kandel, E., Schwartz, J., & Jessell, T. (2012). Neuroscience: An Introduction. Heidelberg: Spectrum Academic Publishing House.
Tretter, F. (2014). Memorandum "Reflexive Neuroscience". Psychology Today.
Voigt, T. H., & Rüppel, J. (2019). The death of the clinic? Emerging biotechnologies and the reconfiguration of mental health. Science, Technology & Human Values 44(4): 567–580.
Human Brain Project: www.humanbrainproject.eu
White House BRAIN Initiative: https: //braininitiative.nih.gov
Ethics in health promotion and prevention, financing of health promotion, medical prevention, patient counseling / patient education, predictive medicine and individualized medicine, prevention and disease prevention
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