Prevention, neurobiology, and children’s mental health

Screen Shot 2013-08-12 at 9.58.04 AMBy Jean Rhodes

In a recent New York Times article, Benjamin Fong wrote about psychology’s embrace of cognitive neuroscience, and the debates that surround the merits of the new large, federal investment in the Brain Initiative. After running through the arguments on both sides, he made an important point that is often overlooked but which is likely to have strong resonance for those of us who are working closely with our nation’s youth. He observes that:

“The real trouble with the Brain Initiative is not philosophical but practical. In short, the instrumental approach to the treatment of physiological and psychological diseases tends to be at odds with the traditional ways in which human beings have addressed their problems: that is, by talking and working with one another to the end of greater personal self-realization and social harmony.”

In “Biology as Ideology,” Richard Lewontin points to the profound difference between the fact that one cannot get tuberculosis without a tubercle bacillus and the claim that the tubercle bacillus is the “cause” of tuberculosis. Registering that tuberculosis was a disease common in sweatshops in the 19th century, Lewontin contends: “We might be justified in claiming that the cause of tuberculosis is unregulated industrial capitalism, and if we did away with that system of social organization, we would not need to worry about the tubercle bacillus.” Having narrowed their view of “cause” to the biological realm, neuroscientists today are effectively chasing tubercle bacilli, drawing our focus away from the social practices and institutions that contribute to problems of mental health.

We know, for instance, that low socioeconomic status at birth is associated with a greater risk of developing schizophrenia, but the lion’s share of research into schizophrenia today is carried out by neurobiologists and geneticists, who are intent on uncovering the organic “cause” of the disease rather than looking into psychosocial factors. Though this research may very well bear fruit, its dominance over other forms of research, in the face of the known connection between poverty and schizophrenia, attests to a curious assumption that has settled into a comfortable obviousness: that socioeconomic status, unlike human biology, is something we cannot change “scientifically.” That it is somehow more realistic, “scientifically,” to find a way to change the human being itself than it is to work together to change the kind of environment that lends itself to the emergence of a disorder like schizophrenia.”

In other words, perhaps we should be focusing at least as much on preventing disorders. We can focus on neurobiology, but we should be equally concerned with the widening gulf between wealthy and poor in our country and the consequent growing percentage (22%) of children growing up in poverty. Poverty, particularly when it is early and persistent, is—according to the National Center for Children in Poverty—“the single greatest threat to children’s well-being.” A growing number of children in our wealthy democracy, are living in poverty and are growing up in families with inadequate resources, attending schools that are characterized by violence and overcrowding, living in communities with few opportunities for enrichment, etc. Since many children carry innate vulnerabilities to psychological difficulties that are triggered by environmental stressors, shouldn’t we be just as concerned with preventing the stressors?

From my mentor George Albee’s vantage point, prevention–through political and social change–offered the only real hope of reducing the incidence of psychopathology. His mantra—“that no disorder has ever been treated out of existence”—propelled me and other students toward careers in public health, social policy, and community psychology. George wrote that, “Adherence to the medical model distracts attention from the social conditions that are far more important determinants of mental disturbance-and diverts resources from attempts to ameliorate these conditions.” (Albee, 1986, p. 893).  Identifying the biological substrate of disorders and and treating the casualties of  racial discrimination, poverty, and violence felt to him like trying to drain the ocean with cup.

Mentoring provides a lens through which literally millions of middle-class adults have seen the ravages of poverty: decrepit schools with stressed teachers, unsafe neighborhoods, deteriorating housing, and other difficult circumstances. Although many Americans may already know that nearly one in four children in our wealthy democracy lives in poverty, this inequality somehow remains compartmentalized and largely ignored in our day-to-day lives. Yet, deeply connecting with one child in poverty through a mentoring relationship can illuminate its pernicious effects, potentially mobilizing more sustained, authentic action. George was fond of Karl Marx’s observation that “The ruling ideas of a society are those that support the ruling class.” He once wrote that, “I would love to see a coalition between psychology and the oppressed and exploited that would speak with one voice against the ruling elite who reject the idea of social equality.” Although cognitive neuroscientists currently rule the ideas of contemporary psychology, there is a more contextualized analysis of mental health—and a just world is its own reward.