As many of you know, I’ve been busy interviewing for medical residency programs in psychiatry. It’s been wonderful. I love meeting students, residents, and faculty who are passionate about mental health. And the interviews have actually been really fun! I haven’t had anyone really grill me or try to be intentionally difficult. I’ve found that the questions I’ve been asked stretch my intellect and help me to understand my chosen profession better.
One question that keeps coming up is whether I’m looking for a program that is more biological or psychological. I’m not a huge fan of this dichotomy. My understanding of neuroscience is that everything that happens to the brain has a root in biology*, just as everything that happens to a computer is the result of the flow of electrons through physical components. So whether you treat the brain with so-called “biological” or “psychological” interventions, you are absolutely working through biological processes. I like to say that psychotherapy uses the brain’s public API**, while psychopharmacology accesses a lower-level, private API. It’s not a perfect analogy, but I think it’s a nice start.
Beyond the philosophical point that the brain is an inherently biological organ, the fact is that both drugs and therapy have a profound impact on the biology of the brain. Some mental illnesses are treated equally well with medications or psychotherapy (and in many cases, people do better when they receive both). Studies are even beginning to show that either form of intervention can alter the gross structure of the brain. And why shouldn’t they? We don’t have a model for the way that the brain processes and records information that isn’t physical.
I’m a pragmatist. I will use whatever technique I need to to help my patients get better. Ideology matters much less to me than proven effectiveness.
* There is always the possibility that we can’t explain everything about the brain with biological principles. Many people (including me) believe that there is a spirit, soul, energy, or force that at least partially defines who we are. However, that doesn’t mean that we should toss away what we know about the physical world. I once had a brilliant and deeply religious neuroscience professor explain it by saying “I don’t know if the brain is everything, but it seems to be almost everything.” Take that for what it’s worth.
** API means application programming interface. It’s a term that software developers use to describe how one program interacts with another.
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