When Neuroscience Becomes a Sales Pitch: Who Benefits When Brain Research Becomes Mental Health Treatment?

I have become increasingly suspicious of the way neuroscience is being used in mental health.

I do not mean neuroscience as a whole. If somebody has a stroke, epilepsy, Parkinson’s disease, dementia, a brain tumour or another identifiable physical problem affecting the nervous system, neuroscience clearly has an important role. We can look at physical changes, damaged tissue, electrical activity, blood supply and disease processes, and that knowledge can sometimes directly affect treatment.

My concern begins when we move away from physical disease and start using neuroscience to explain psychological experiences such as PTSD, anxiety, shame, grief, addiction and emotional distress. Somewhere along the way, finding something happening in the brain can become confused with understanding why a person is suffering.

Of course the brain is involved. It would be strange if it were not. Reading this page involves your brain. Remembering something painful involves your brain. Falling in love involves your brain. Feeling frightened because somebody previously hurt you involves your brain. But discovering brain activity alongside an experience does not mean we have explained the experience itself.

If I look at a photograph of somebody I love, things will happen in my brain. A researcher may be able to measure some of those changes. But those measurements cannot tell you who that person is to me, what we have been through together, what I fear losing, whether I trust them, what I regret or why that particular photograph affects me.

The brain activity is part of what is happening. It is not the whole story.

That distinction seems fairly obvious when written down. I am not convinced it remains so obvious once the word neuroscience enters mental health.

When Brain Activity Becomes an Explanation

There is something powerful about biological language. Saying that someone learned to become frightened because something terrible happened to them sounds almost ordinary. Saying their neural threat circuitry has become dysregulated sounds much more scientific.

But have we actually explained that person any better?

Sometimes I think we take a human experience, translate it into biological language and hand it back as though the translation itself has added certainty. That concerns me because neuroscience carries authority. A colourful brain image looks objective. A labelled diagram looks convincing. Terms such as amygdala, prefrontal cortex, vagus nerve, neural pathway and nervous-system regulation can make a psychological theory sound more established than it really is.

There is research suggesting that people can find an explanation more convincing simply because neuroscience information has been added to it, even when that information does little to improve the explanation. I find that particularly worrying in mental health because the person receiving the explanation may already be frightened, confused or desperate to understand themselves.

If a professional says, “Neuroscience tells us this is what is happening to you,” it takes confidence to question them. And yet questioning them may sometimes be exactly what is needed.

Functional brain imaging itself is more complicated than the finished pictures suggest. A conventional fMRI image is not simply a photograph of thoughts happening. Researchers are often working with indirect signals involving changes in blood oxygenation and blood flow, then applying statistical methods and interpretation to those measurements.

Recent research has raised further questions about how straightforwardly some of those signals relate to underlying brain metabolism. Other research has shown that different teams analysing the same brain-imaging data can reach different conclusions because reasonable analytical decisions can affect the outcome.

That does not mean brain imaging is useless. It means there are layers between what the machine measures and what somebody later says the image means.

The scanner may be a machine. The interpretation is still human.

There is also the problem of small studies. Neuroscience has a history of making surprisingly strong claims from surprisingly small groups of people. Larger research programmes have since suggested that many relationships between brain measurements and behaviour are much smaller and less stable than early studies made them appear.

That should make us more cautious, especially when research moves from describing averages across groups to explaining an individual person. A group of people diagnosed with PTSD may, on average, show a particular difference from another group. That can be scientifically interesting. It does not mean every person with PTSD has that difference, that the difference caused their PTSD, or that changing it would remove their distress.

Those are completely different questions.

How Uncertain Research Becomes Certain Mental Health Advice

Scientific papers are normally full of caution. Researchers write that something “may” be associated with a condition, that a finding needs replication, that the sample was small, or that they cannot yet know whether what they found is a cause, consequence or coincidence.

That is how science should work.

The difficulty comes when the finding starts travelling.

A university wants publicity for interesting research. A journalist wants a headline people will read. Another researcher sees an area worth studying. A grant application follows. More papers appear. Conferences discuss the subject. Books are written. Therapists hear the terminology and start using it.

The language slowly changes as it moves. “May be associated with PTSD” becomes “what PTSD does to the brain”. An association becomes a mechanism, the mechanism becomes an explanation. The explanation becomes a model for treatment. Eventually somebody sitting in front of a therapist may be told that this is what has happened inside their brain, by then, most of the uncertainty contained in the original paper may have disappeared.

I think this is one of the biggest dangers in the whole process. Research is allowed to be tentative, but treatment is experienced personally. A theory that researchers are still arguing about can become something a person is encouraged to believe about themselves, once that happens, the theory can start shaping how they interpret their own reactions.

A frightened person may stop thinking, “I learned to become frightened because of what happened,” and start thinking, “My brain has been damaged.”

Those are very different ideas to live with.

And once a theory has been repeated enough, it can become difficult to challenge because people begin mistaking familiarity for proof.

PTSD and the Limits of the Brain Story

PTSD is probably one of the clearest examples of why I am cautious.

There is a large amount of neuroscience research into PTSD. Researchers have examined the amygdala, hippocampus, prefrontal areas, memory systems, threat responses and communication between different brain regions. Some of this work may eventually prove useful.

But I think we should be very careful about what we say it currently tells us.

A brain scan cannot tell us what happened to somebody. It cannot tell us whether they were attacked, neglected, betrayed, trapped, controlled or humiliated. It cannot tell us whether the person responsible was a stranger or somebody they loved. It cannot tell us whether the danger lasted a few minutes or several years.

It cannot tell us whether anyone believed them afterwards, whether they blame themselves, whether they lost their home, family or sense of identity, or why one particular reminder brings fear while another apparently similar reminder does not.

Those things are not background details around PTSD. They are part of understanding the person.

Two people can go through experiences that look similar from the outside and come away with very different meanings, fears and ways of coping. One person may feel shame. Another may feel anger. Another may become watchful and suspicious. Someone else may carry guilt because they survived when another person did not.

You cannot find those meanings by looking for a coloured area on a scan.

Of course those experiences will have biological activity associated with them. Everything we experience does. But finding the biology that accompanies an experience is not the same as understanding the person having the experience. I worry that mental health sometimes reverses that order. Instead of the person’s story helping us understand their reactions, the brain becomes the explanation and the person becomes evidence for the brain theory, that is backwards to me.

Research Funding, Careers and the Pull of a Good Theory

This is where my suspicion becomes more jaded.

Research needs money. There is nothing wrong with that. Laboratories cost money. Researchers need salaries. Equipment is expensive. Participants need recruiting. Large studies take years.

Without grants, a great deal of useful research would never happen.

But research funding also creates incentives, and I do not think we should pretend otherwise.

A grant is funding to investigate an idea. It is not proof that the idea is right. Yet once money begins flowing into an area, that area can develop momentum. Researchers need further funding if their work is going to continue. Universities want research income and prestige. Departments build reputations around particular areas. Researchers build careers around expertise they may have spent years developing.

None of this requires anybody to be corrupt.

A researcher can genuinely believe in a theory and also want their next grant. A university can genuinely support science and still care about income and reputation. Both things can be true at the same time. The problem is that systems can reward particular directions long before anyone really knows whether those directions will prove useful.

Novel research often attracts more interest than repeating an old study to see whether it was actually right. A surprising brain finding is more exciting than a study saying the previous result could not be reproduced. New theories can generate further questions, papers and funding opportunities. Replication tends to be less glamorous, over time an entire research ecosystem can develop around an idea.

There may be dozens of papers, specialist conferences, research groups and funding streams. That creates an impression of solidity. People assume that because a field is busy, the underlying theory must be strong. I am not sure that follows as twenty studies can still share the same bad assumption and large amount of activity does not automatically produce truth.

There is also something uncomfortable about the amount of professional time spent chasing grants. Researchers can spend months preparing applications that are never funded. Universities employ staff whose careers depend partly on bringing money into institutions. Entire professional structures grow around obtaining, managing and reporting research funding.

Again, none of this means the research is dishonest.

But when we talk about financial influence in mental health, I think it is too easy to look only at pharmaceutical companies, money moves through universities, research institutions, training organisations, charities, professional bodies and therapy businesses too, the incentives may be different, but they still exist.

Psychiatry, Medication and the Convenience of a Biological Story

This becomes even more important when psychiatry and medication enter the picture.

If psychological suffering is explained as a biological malfunction, biological treatment starts to look like an obvious response. If somebody is told that something is wrong with their brain chemistry or neural functioning, medication can begin to feel like treatment for the underlying cause rather than one possible way of helping with what they are experiencing,those are not necessarily the same thing.

A medication can help without proving the theory used to explain why somebody needed it.

We have already seen how dangerous oversimplified biological stories can become, the idea that depression was simply caused by a chemical imbalance became part of public understanding for years, many people still repeat it as though it were established fact. Yet the evidence never justified the certainty with which that explanation was sometimes presented.

That does not mean antidepressants never help. Some people find them extremely useful. Others do not. Some experience difficult side effects or withdrawal. Those questions need to be considered on their own terms, a drug working does not prove that the illness was caused by a shortage of whatever the drug affects, a painkiller may help a headache. That does not mean the headache was caused by a lack of painkillers.

The commercial side makes this more uncomfortable because pharmaceutical companies are businesses. They exist to make money. They can also develop medicines that genuinely improve or save lives. I do not see a contradiction in saying both.

What would be naive, in my view, is pretending that large amounts of money have no influence on what gets researched, how treatments are promoted, which results receive the most notice or what stories become familiar to doctors and the public. There is a long history of pharmaceutical research producing more favourable results when funded by manufacturers, of negative findings receiving less publicity, and of benefits being emphasised more strongly than harms.

That does not mean every drug trial is corrupted. It means commercial interests are real enough that they deserve permanent scrutiny. When an uncertain biological explanation points towards a profitable biological treatment, I think our level of questioning should increase rather than decrease.

Therapy Has Its Own Industry

Therapists should not imagine that this problem belongs only to psychiatry.

Therapy has become an industry too.

There is money in training therapists, selling courses, running conferences, writing books, providing supervision, creating accreditation programmes and developing branded therapeutic approaches. Specialisation can also be commercially valuable. Being a therapist is one thing. Being an expert in a fashionable area of neuroscience-informed trauma treatment can sound like something else entirely.

Neuroscience can be very attractive in that environment because it gives psychological ideas an appearance of medical precision, instead of saying, “This exercise may help you feel safer,” somebody can say, “This regulates your nervous system.”

• Instead of saying, “You learned to become watchful after something frightening happened,” somebody may talk about trauma rewiring the brain.
• Instead of saying, “Some people find breathing slowly calming,” we can attach an explanation involving vagal tone, neural regulation and autonomic states.

Some of those biological ideas may contain truth. My concern is not that therapists should never talk about biology. My concern is the jump from possibility to certainty.

• How much of what the client is being told is established?
• How much is a reasonable theory?
• How much is metaphor being presented as science?

And how much has simply been repeated so often within therapy culture that nobody remembers where it originally came from?

Once a therapist has paid thousands of pounds to train in a particular method, built their practice around it and perhaps begun teaching it to others, questioning the underlying theory can become personally difficult.That does not make the therapist dishonest, it makes them human.

If your income, reputation and professional identity are tied to a model, evidence against that model asks more of you than changing your mind about an interesting paper you read last week, this is why I think treatment systems can survive long after the evidence beneath them starts wobbling. Science may move on faster than the industry built around yesterday’s science.

What Does “Evidence-Based” Really Mean?

I am also increasingly cautious about the phrase “evidence-based” when it is used as though it ends the discussion.

Evidence matters. Of course it does.

But evidence is not one solid thing.

Research can be strong or weak. Studies can have tiny samples. Researchers can choose inappropriate measures. Outcomes can be selected in ways that flatter a treatment. People who drop out may disappear from the final story. Negative effects may not be measured properly. A statistically significant result may make very little difference in someone’s actual life.

A treatment can also perform well on average while being wrong for a particular person.

That is important because mental health deals with individuals, not averages.

If a trial finds that a particular therapy helps 55 per cent of people compared with 40 per cent in another condition, that may be useful information. It does not mean the person sitting in front of you has a 55 per cent personality.

They still have a history, preferences, fears, relationships, beliefs and choices that the trial cannot contain.

I sometimes think “evidence-based” becomes another authority word, rather like “neuroscience”. Instead of opening a conversation about the quality and limits of the evidence, it can close the conversation down.

The person asks why they should do something and is told, “Because it is evidence-based.”

That is not really an explanation.

We should be able to ask what evidence, how strong it is, who was studied, what harms were measured, how many people did not benefit and whether other reasonable options exist.

If a treatment cannot tolerate those questions, I would worry about the treatment rather than the person asking them.

Where Are the People Who Were Harmed?

One of the things that troubles me most about therapy research is how much easier it has traditionally been to talk about benefit than harm.

Therapy can help people. I have no difficulty saying that.

Therapy can also harm people.

A poor therapist can increase shame, dependency, confusion or fear. A person can be encouraged to interpret themselves through a theory that does not fit them. They can become dependent on the therapist’s explanation rather than developing trust in their own judgement. Boundaries can be crossed. Power can be abused.

Even without obvious misconduct, a treatment can still make somebody worse.

If mental health really wants to behave like a mature healthcare field, it has to be as interested in deterioration as improvement.

We should want to know who became worse, who dropped out, who felt pressured, who became frightened by what they were told, who experienced medication harms, and who spent years following an explanation that eventually turned out not to fit them.

Those people should not be treated as inconvenient exceptions.

They are part of the evidence too.

There is a particularly difficult form of harm that can happen when professionals tell people that their brain or nervous system has been changed or damaged by trauma. Even when the professional believes they are providing validation, the person may hear something much darker.

They may hear that they are permanently altered.

They may begin monitoring themselves for signs that their brain is malfunctioning. Ordinary fear becomes evidence of damage. A bad day becomes proof that their nervous system is still broken. Recovery starts to look like repairing defective machinery rather than understanding and changing a human response that developed for reasons.

I do not think we should underestimate the power of the stories professionals give people about themselves.

The Person at the Bottom of the System

This is where all of this comes back to the person seeking help. They may be frightened, grieving, ashamed, confused or simply desperate to understand why they are reacting the way they do. Yet they are often the person with the least power in the whole process. The researcher has specialist knowledge, the university has authority, the psychiatrist has medical status, the therapist has professional authority, the trainer may claim expertise and the company has marketing. The person seeking help mainly has their own experience, and even that can begin to feel less trustworthy once enough professionals tell them that neuroscience has explained what is happening.

If everybody around you appears to agree that a particular explanation is scientifically established, asking whether they might be wrong takes confidence. It is particularly difficult when you are already vulnerable and looking to those people for help. Yet I think “Are you sure?” is one of the most important questions we can keep alive in mental health. Professionals can be wrong, research can be wrong and treatments can be wrong. More importantly, whole systems can continue operating around an idea for years before enough evidence accumulates, or enough people are prepared, to seriously question it.

I do not think this requires a conspiracy. In some ways, that would be easier to understand. What worries me more is the ordinary interaction between good intentions, professional ambition, money, status and human reluctance to admit that something we have invested in may not be as solid as we believed.

A researcher wants their work to succeed. A university wants funding. A therapist wants to believe their training is useful. A pharmaceutical company wants to sell medication. A trainer wants people to buy the next course. A professional body wants its standards and preferred approaches to retain authority.

Nobody has to arrange the whole thing.

The incentives can do a lot of the work themselves.

Money does not always need to buy dishonesty. Sometimes it only needs to reward certain questions, certain answers and certain ways of seeing people.

Science Can Correct Itself, but People Live Through the Mistakes

I am not arguing that neuroscience should stop researching psychological distress. Research should continue because we may learn useful things from it. My concern is what happens when research stops being presented as research and begins being presented as an explanation of an individual person before the evidence justifies that certainty.

There is a large difference between saying, “We have found something interesting in this group of people and we need to understand it better,” and telling somebody, “This is what is happening inside your brain.” Somewhere between those two statements, uncertainty can disappear. Once that happens, the theory may begin shaping treatment, professional training and the person’s understanding of themselves long before we know whether the original finding was as important as people believed.

That is why I think there should be a much stronger barrier between exploratory neuroscience and treatment systems built around it. Science is allowed to be uncertain and to change its mind. The person receiving treatment, however, has to live with whatever we tell them while we are still finding out whether we were right.

If research into a distant galaxy turns out to be wrong, another paper eventually corrects it and most of us carry on with our lives. If we are wrong about a frightened person and build a treatment around that mistake, the person lives through the consequences while science catches up.

You cannot give those years back.

That is why I have become suspicious. Not because I think every neuroscientist is dishonest, every psychiatrist is corrupt, every therapist is misguided or every medication is harmful. I am suspicious because I do not think professional status, good intentions or scientific language should ever be enough to remove the need for questioning.

History gives us very little reason to believe that powerful systems automatically correct themselves quickly simply because the people within them mean well.

Sometimes excellent science produces better treatment.

Sometimes uncertain science produces an interesting theory.

And sometimes an uncertain theory attracts enough money, authority and professional investment that it becomes a treatment system before we have properly established whether it was right.

When the subject is someone’s mental health, I would rather we were suspicious too early than apologising too late.