A New Approach

A more sophisticated, comprehensive approach is necessary for treating anx­iety and depression. The new approach needs to take the following into consideration:

• anxiety and depression commonly occur together;
• these illnesses are, in large part, the result of brain dysfunction;
• there are specific types of these illnesses; and
• there are a number of effective treatments that are specific to each type.

A major problem with the current approach to mental health treatment is that psychiatrists, and others treating mental disorders, never look at brain func­tion. Psychiatrists are the only medical specialists who never look at the organ they treat. The lack of brain imaging has kept psychiatry behind medicine's other specialties, decreasing our effectiveness with patients and reinforcing mental illness stigma and noncompliance with needed treatment! Odds are if patients are having serious problems with their feelings (depression), thoughts (intrusive, frightening ones), or behavior (aggressive or self-destructive), the (routing physician will not order a brain scant He will prescribe psychotherapy or powerful combinations of medications without ever looking at how a spe­cific patient's brain works. He will not know which areas of his patient's brain work well, which work too hard, or which do not work hard enough.

This is the equivalent of orthopedic doctors setting broken bones without X rays, car­diologists diagnosing coronary artery blockages without doing angiograms or fast CT scans, or internists diagnosing pneumonia without ordering chest X rays or doing sputum cultures. Yet the state of the art in psychiatry is to not look at the organ it treats. Essentially, the diagnostic practices of psychiatrists have not changed for 150 years. Because the right treatment optimizes brain function, giving a person more access to his or her own abilities, and the wrong treat­ment makes things worse and demoralizes patients and families, it is time to start looking at the brains of individual patients. Typing anxiety and depressive disorders based on brain dysfunction will be one of the next major movements in psychiatry. It will help us stop blaming difficult behavior on misguided will and lead us to consider and optimize the brain.



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