By Ayden Jacob
(ED NOTE: Ayden Jacob will be holding a Google Hangout to discuss this article on his “Neuroscience Weekly” Channel, on Thursday May 1, at 9 pm EST at www.InternetMedicine.com/neuroscience-weekly)
April 30, 2014
Although the biomedical community has propelled their research efforts in the field of neuroscience, virtually all neurological disorders remain elusive on the molecular and electrophysiological level. The brain-mind relationship is a territory traversed by few academics, and yet it may contain the lurking secrets to the workings of conscious thought and decision making. A fundamental consequence of the elusive mechanisms of the brain results in our inadequate understanding, and further categorization, of psychiatric patients. Our understanding of the miscommunication between physiological brain networks in psychiatric patients is weak, and scarcely provides us with a basis to cure the disease at hand. Scientists and physicians, as well as health-care policy makers and the judicial system, all have a unique interest in gaining a better grasp on the chaotic functions of a psychiatric patient.
The advent of neuroradiology may very well provide the right tool by which we may assess the neuro-substrates that are responsible for character abnormalities found in mentally-ill patients. The dynamic field of nuclear medicine continuously influences the domains of neuoethics and neuro-law, two nascent fields emerging in the neurosciences. Philosophical questions hitherto unanswered due to our inability to grasp the human mind are currently being evoked throughout the biomedical community with grave implications in forensic psychiatry. Of dramatic interest to practicing psychiatrists and attorneys is the potential capability of neuoro-imaging technologies to detect and outline a brain region that correlates to specific phenotypic abnormalities.
Particularly, a database which outlines, at least in a hypothetical manner, the neuro-anatomical regions which may catalyze violent or criminal behavior would alter the entire judicial and mental –health system as we know it. The medical community is intrigued to know if there exist biological markers within the brain matter of a criminal. This insight may allow us to detect a future risk of crime, thus preventing severe delinquency by healing the mentally ill prior to their violent crimes, or even by excluding those who cannot be treated from vulnerable situations before the crimes are committed. Although radiologic engineering has pushed our scientific understanding of the brain to a new horizon unmet hitherto, there are grave limitations to each modality.
Of utmost importance is to recognize man is not machine, and machine is not machine; hence, images manifesting irrational scientific views of the brain cannot, and should not, replace the position of a psychiatrist. An image may tell a thousand words, but it cannot grasp the human mind. Behind each image is a living, breathing human being with a unique genetic makeup, a distinct culture, an exclusive societal environment, and an all-together special story. Consequently, although we aim to inculcate the dynamics of modern medicine into the courtroom by claiming that these machines are capable of ‘telling us something,’ we must never cross that ethical boundary in which the human being must be assessed and categorized by another human being. There is a subtlety which needs to be respected here, both in clinical practice and in the courtroom: images are just that, images – nothing more. And although we aim to grasp the complexities of human behaviour with radiology, we must work in conjunction with psychiatry to develop a deeper picture of the patient, irrespective of the crime committed. The future of medicine is constantly and consistently being pushed by bioengineering, and its limits may know no horizons as the human mind continues to generate elegant solutions to previously unsolvable problems. Yet, it is important for all domains of medicine to remain humble and respectful of each specialty, and work in synergy to produce a concrete image of the entire human being on trial.
Ayden Jacob, Executive Director, A.M.E.B.I.