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Healing the Brain Recently, Ann Silver posed the question of the brain’s capacity to restore itself concomitant to, and following, good environmental (internal as well as external) conditions. Can we say that less stressful conditions reverse harmful, but adaptive, neural changes secondary to chronic and profound stress? I would like to spontaneously, off-the-cuff, respond to this excellent question without initially quoting exact references in the research literature - solely relying on my decades of immersion in this research literature - which have been quite fruitful to me in demonstrating the vast overlap in the mental disorders. As I pointed out yesterday at our NYU conference on psychoanalysis and psychosis, Daniel Weinberger, of the Clinical Brain Disorders Branch of NIMH, noted that all of the neuroscience findings in schizophrenia research are non-specific. This fits nicely with the theories I have been proposing for many years - i.e., the human brain is vastly dynamic and complex, not to be defined by static DSM categories, and that the neuroscience of severe mental illness is largely the neuroscience of fear/anxiety, social isolation/defeat and disuse. From basic science research, we know that psychosocial stress can result in many significant neural changes, e.g., atrophy of apical dendrites in the hippocampal subfields, which reverse once the stressor is terminated. Sapolsky, of Stanford University, pointed out that reversibility of neural changes is contingent on the degree and temporal parameters of stress-one can reach a point of cell death. However, we now know that neurogenesis takes place in the human hippocampus (probably the prefrontal region as well) and that stress interferes with neurogenesis - with less stress being facilitative of neurogenesis. Enriched environments (including in-depth psychotherapy?) facilitate neurogenesis and deprived environments interferes with the latter. The life we lead shapes our brains (the latter are in a real sense custom-made for each of us). Neuroimaging outcome studies demonstrate reversal of ventriculomegaly subsequent to good treatment/outcome-implying reversibility of tissue atrophy surrounding the ventricles. I have seen patients in long-term psychotherapy make great strides in neurocognitive functioning (without specific cognitive remediation, as also pointed out by Luc Ciompi in his research at Soteria Berne in Switzerland), e.g., significant improvements in working memory, reasoning, judgment, etc., presumably as a function of lowered terror and fear as well as the establishment of a background sense of safety in relationships. Structural (sMRI) and functional changes (fMRI, PET) have been observed in persons with severe mental illness as a result of psychotherapeutic interventions. The question is not if this happens, but rather, studying the varying conditions (including various psychosocial interventions, relationships, diet, exercise, hydration, stable living conditions, and the myriad of variables known to be facilitative of good health) which are facilitative of reversibility as well as neural compensation. Brian Koehler |