Some time ago, a professor of geropsychiatry related to me the following story (although I have searched, I have no outside collaboration of or verification for the story - only the fact that the professor was a student of history). Freud and Alzheimer were contemporaries who disagreed as to the source of mental illness. Freud took the position that environmental influences were the major source; Alzheimer took the opposing view, that biological factors were at the root of mental illness. Freud went off to Vienna to explore his theory; Alzheimer stayed in Germany and continued his biological experiments. The professor concluded that Freud won the argument in that he was more influential for the first two thirds of the 20th century, but that in the future Alzheimer's theory may be considered more useful.
Now, almost a century after Freud and Alzheimer disagreed, it looks as though the view of Alzheimer is supported almost exclusively. There is, however, probably an interaction effect (discussed below) that neither of these scientists could predict (given the state of their science), and which supports portions of both of their theories. It is little wonder that the theories of Alzheimer and Freud were so opposite, for the state of their science - even in the first half of the twentieth century - was very short on means of verification. In a sense, this paucity of verification was also responsible for the development of behaviorist theory. Many early behaviorists, frustrated over the unceasing arguments as to causes of behavior, proposed a "black box" view. The brain was seen as an unknown quantity - a "black box" - in which function and structure were totally obscured. They concluded that behavior alone, its existence or extinction, was the needed focus of scientists. Although the views of Freud and the behaviorists are still helpful today, these approaches must be examined in terms of today's neurologic findings.
Today, with new neuroimaging techniques, as well as with genetic science, there are means to closely examine and modify theories of the causes and treatment of various behaviors. The importance of these recent advances in the explication of brain structure and function has led scientists to designate 1990-2000 as the Decade of the Brain. A government publication, Maximizing Human Potential: Decade of the Brain 1990-2000 (Subcommittee on Brain and Behavioral Sciences, 1991), describes the present state of neuroscience and the possibilities that this developing science holds. The information found in this report has implications for the mental health of the elderly.
The report describes some of the newer, noninvasive neuroimaging techniques and their applications: PET (positron emission tomography), MRI (magnetic resonance imaging), and MEG (magnetoencephalography) in particular. PET can be used to study metabolic activity or function of the brain in various diseases such as schizophrenia, depression, Parkinson's and Alzheimer's diseases (AD) as well as various drug addictions. MRI addresses the magnetic fields - or, in a sense, the structure of the brain - ocoirring in various diseases. MEG measures the nerve cells' magnetic discharges or, basically, the brain's magnetic fields, and is also used to study various brain diseases. There are several large cross-national genetically focused studies described. For example, the nature of AD in families with a history of the disease has been studied, and it was found that those developing AD before age 65 had a defect on chromosome 21; those developing the disease after this age did not demonstrate this defect.
In terms of addictions, receptor sites and related glucose activity can be studied for indications of the presence of various substances such as nicotine, alcohol, and cocaine. These studies are being linked to studies of genetic and familial differences. In terms of schizophrenia, investigations of brain abnormalities are being examined. The report describes how PET facilitates the study of dopamine receptors and their interaction with various neuroleptic drugs. One study is described in which pairs of identical twins (one with schizophrenia and the other without) were studied and abnormalities in brain structure and function were found. The report suggests that environmental and developmental factors affecting the twins made the difference, since the genetic material was identical. This latter finding demonstrates the interplay between environment and biology, which Freud and Alzheimer were not able to study (and therefore appreciate) in the same way as present-day scientists.
Depression, a condition affecting many elders, is also described as demonstrating an interplay between environmental and genetic factors. Again, studies of identical twins are one source of data. The report goes on to describe similar studies under way for the study of manic-depression. It offers a fascinating section on the advances in treating spinal cord injury. Included are findings that indicate that intensive treatment (eg, with antiinflammatory drugs) immediately after injury - while the neurons are damaged but still alive - can salvage a certain amount of motor function. Research continues on the insertion of cultured neurons, on drugs that promote survival of the neurons in spinal cord injury, and on refinement of neural prosthetic devices that stimulate the nervous system to work where damage has occurred.
It may seem that the topic of spinal cord injury is far removed from the topic of elder mental health, but the topics are actually associated. For example, if neurons can be stimulated to grow, cultured neurons inserted, or computer-assisted devices used to simulate spinal cord neuritic activity, then within the brain of AD victims there is some possibility that these techniques might also be helpful. This is true of other mental health conditions affecting the aged, such as benign senile forgetfulness, depression in aging, elder suicide, and the "terminal drop" in mental functions which appears a year or so before death. With the availability of these new neuroimaging and genetic techniques, it would seem that multiple advances in treatment for neural-based conditions affecting the elderly will be formcoming; at least the technology is being developed.
And now to temper this enthusiasm with some thoughts on potential dangers. If, in a "brave new world" type of scenario, genetic weaknesses and familial tendencies are used to create some type of a second class citizenry, then the application of these advances may harm more than help the elderly. Similarly, if dehumanization occurs through the classification of persons - especially the elderly - by their biological potential, then there is much about which to worry. Insurance implications for some of the genetic work need to be addressed early on also to avoid unintended consequences. All of these concerns can and must be addressed in a timely manner. The Decade of the Brain holds much promise for the elderly; this is especially true if the interplay between environmental influences and illness comes to be better understood, and if effective treatment of dehumanizing conditions such as AD are identified.
- Subcommittee on Brain and Behavioral Sciences. Maximizing human potential: Decade of the brain 1990-2000. Bethesda, MD: Office of Scientific and Health Reports, 1991 (NTIS No. PB91-133769).