Once psychiatric neuroscience integrates the blossoming research in the various fields studying the effects of experience on CNS structure and function, there will be greater emphasis placed back upon experience, particularly relational and social experience. I like to think of my research as relational neurobiology (which includes epigenetic factors and neuroplasticty, including self-directed neuroplasticty). We are continuously learning about the impact relational experience has on the developing person, including the CNS. There is research emerging demonstrating that fetal cells could transform into neurons, astrocytes, oligodendrocytes, and macrophages -- crossing the maternal blood brain barrier and responding to molecular distress signals if the mother's brain is injured. The mother's brain regulates to a significant degree, e.g., through the maternal- placental-fetal neuroendocrine system, the developing fetal brain, creating long-term predispositions towards stress reactivity (e.g., placental corticotropin releasing hormone/factor). Social pain, e.g., social exclusion, is equivalent neurobiologically, i.e., activation of the dorsal anterior cingulate cortex (dACC), to actual physical pain -- words and social isolation are painful. Social status influences the actual structure of certain neural regions, e.g., the hippocampus.

The principle of giving equal weighting to subjective experience and objective neuroscience research has a long history in psychiatry: I think of George Engel’s biopsychosocial model, Leon Eisenberg’s caution to steer between a mindless and brainless psychiatry and his quip that the human brain is all biological and all social, John Strauss and Larry Davidson’s emphasis on the interaction between person/identity processes and disorder, Yrjö Alanen’s pointing out that an important starting point for all integrated psychobiological psychiatry is the insight that interactionality with other people is part of human biology, etc. Kenneth Kendler, psychiatric geneticist, in delineating a philosophical structure for psychiatry, underscored the importance of attending to subjective, first-person experiences. He noted that the goal of psychiatry is the alleviation of the human suffering that arises from dysfunctional alterations in particular domains of subjective experience. Kendler cautioned us not to take advantage of the advances in molecular biology and neuroscience at the expense of abandoning our grounding in the realm of human experience and suffering.

Boydell et al (2004) have identified the following broad categories in which social factors have been implicated in the initiation and course of the schizophrenias: family factors (mother-child relationship, unwantedness, family communication deviance, dysfunctional family environment, communal upbringing, early parental loss, expressed emotion, childhood abuse, etc.); an urban effect (city birth, city upbringing, etc.); social isolation (during childhood, moving schools in adolescence, in young adult life, at time of onset); migration and ethnic minority status, discrimination, unemployment, etc.; life events (socioeconomic factors, deprivation, inequality, etc.); interaction between social and other etiological factors (gene-environment interaction, social factors and cognitive processing, social causation versus social selection, etc.).

Boydell et al (2004) concluded:

“It is now clear, however, that, in order to understand the causes of schizophrenia, the role of the social environment cannot be continued to be ignored. In saying this, we are not proposing an oppositional social instead of biological approach, which we consider as futile as arguing whether poverty or mycobacteria cause tuberculosis! Rather, we suggest that both social and biological factors need to be studied as well as their interaction.

We need to recognize that (i) social factors can impact on brain development, (ii) some social factors give rise to psychological vulnerabilities, and (iii) many social factors act over the life course, creating developmental liabilities...It is possible that the social environment creates psychological vulnerabilities that act additively to the risk function in combination with genetic or non-genetic neurodevelopmental impairments...

I am very proud to belong to an organization that continues to place great emphasis on relational, subjective, and cultural factors in the onset, course and outcome of psychotic disorders.

References/Citations available on request

Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
brian_koehler@psychoanalysis.net
212.533.5687