Thursday, March 8, 2007

Solomon: Imaging

From: Andrew Solomon
Date: Thu, 8 Mar 2007 15:54:36 -0500

I would add this from where my writing about art (The Irony Tower: Soviet Artists in a Time of Glasnost was my first book) and my writing about psychiatry (The Noonday Demon: An Atlas of Depression was my last book) intersect: that while we may look at images as an inspiration for art and appreciate their visual beauty, we should also be aware that they are in many senses created and imagined, and that how they are created has an enormous effect on public policy. Brain scans (fMRI) are numbers, thousands of numbers, which a computer then constructs into a photo-type image. It's not a photo, and is not made through the exposure of any sensitive medium to light. Imaging is probably the most promising area in psychiatry today. When I am asked what lies ahead, my first answer is always that while new medications would be great, the real progress will occur with imaging. With better imaging, we can work out subtypes of depression and schizophrenia, both multifarious disease entities. We might be able to see who will respond to which medications or treatments. Helen Mayberg, working at Emory, has used imaging to locate a previously unrecognized brain area that is disregulated in severely depressed patients, and has initiated a new surgical procedure, based on the deep brain stimulation used in Parkinson's, in which an electrode is inserted into this area, and this seems to regulate other areas of the brain that we have long known to be implicated in depression. She has achieved astonishing results: at least 60% of her patients show significant remission. Given that she works only with people who have failed on medication and ECT and who have no further options, and who have been classed as permanently disabled by mental illness, this is amazing. What's really amazing in relation to this symposium, however, is that it has all come out of images and is explained to patients and media through images, and those images are at once incredibly specific and wholly artificial.

Part of the struggle of the mental illness rights movement has been the quest for parity, to get government bodies and insurance companies to provide the same coverage for mental illnesses that they would for "physical" illnesses. Talk about why this is fair and just was largely fruitless, and then came imaging. Someone cleverly thought to code areas of brain activation in warm colors and areas of non-activation in cool colors. A whole vocabulary emerged that included phrases such as "lights up" to describe an activated brain area. As soon as you show someone a picture of a depressed brain, with those sinister expanses of blue where there should be pink or orange, the population accepts that these are physical illnesses. So every popular magazine article about depression or bipolar illness or schizophrenia or borderline personality disorder now shows brain scans, and lobbyist in the mental health movement take scans along when they meet with legislators. A picture seems to be worth a hundred thousand words in this enterprise.

There are dangers attached to the practice. We will ultimately be able to image criminal brains as well and see what is activated and inactivated. If seeing the brains of depressives has liberated them from culpability and entitled them to treatment, what effect will such imaging have in the context of justice? And what happens when we can image the brains of people and show that they are physiologically (because personality is all reflected in brain physiology and activity) obnoxious or overbearing or nasty? The images contain truth, but they perpetuate the idea that there is a separation between physical and psychic reality. Physicality is an alternative vocabulary for psychodynamic processes, which are always brain-based. The images serve a political purpose admirably, but they are still a fiction; your brain is grey, and not pink and orange and blue, and these beautiful pictures are designed manifestations of numerical data. Like all tools of politics, these richly imagined pictures are powerful, and can be used for good purposes or ill.

Andrew Solomon

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1 comment:

Dolores Hangan Steinman said...

As scientists in the field of blood flow imaging and working on computer visualizations we are confronted regularly with challenges responsibilities at the interface of art and science. Due to the medical profession’s increasing interest in developing less invasive visualization techniques, as well as a growing familiarity among the general public with digital representations, simulating real-life radiographs or angiograms is becoming commonplace. We were able to provide such images due to the continuous development of the technology (sometimes we question the “competition” between scientific curiosity and technological progress). We try to supplement the sensory perception, and use the computer in replacing the recorded image by a man-and-machine creation. This process of generating computer models is therefore an interpretation of reality through the creation of easily accessible images following the cultural trend in place.
The difficult task, we find, is that of generating images that are at once accurate and clear, are following established conventions and are aesthetically pleasing. We are struggling to make concepts understood and accepted by both medical experts and the public at large while keeping the compass straight and being continuously aware of the ways in which this process can be manipulated to alter the perception of reality.