“This is Why you’ve Been Suffering”: Reflections of Providers on Neuroimaging in Mental Health Care

Abstract

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers' perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, and allied mental health. Our results suggest that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway.

Narrative Devices: Neurotechnologies, Information, and Self-Constitution

“…I do not wish to imply that the possible impacts of users' access to information generated by neurotechnologies on their self-conceptions have been wholly neglected in neuroethical debates. Potential identity effects have been discussed in relation to neuro-related wearables and in empirical studies of clinical applications of fMRI and implantable BCIs (see, for example, [9,[35][36][37][38]). Some of these studies are discussed further below.…”

Defining Ourselves: Personal Bioinformation as a Tool of Narrative Self-Conception

“…However, receiving (reliable) information about one’s increased risk of psychiatric illness could, as well as heralding this threat, also be seen as offering a number of ways of countering the feared loss of self. It might provide the opportunity and encouragement to undertake protective measures such as behaviour changes or early interventions (where available and effective) (Borgelt, Buchman, and Illes 2011 ; Buchman et al 2013 ; Gilbody, Sheldon, and House 2008 ; Marshall and Rathbone 2011 ). Just because these measures aim at improved health outcomes does not mean that the ends thus served are solely health-related.…”

“…These indications of the potentially constructive role of bioinformation in narrative development notwithstanding, it is important to recognize that the same kind of information could instead be detrimental to the recipient’s sense of self. For example, one group of practitioners asked about the hypothetical clinical use of predictive neuroimaging expressed concern that this could disturb rather than empower patients’ sense of identity if they came to equate a disordered brain with a disordered self (Borgelt, Buchman, and Illes 2011 ). Indeed, we might heed warnings from research that found that simply informing participants that they carried a gene associated with increased risk of Alzheimer’s disease impacted negatively on both their own assessment of their memory and performance in memory tests (Lineweaver et al 2013 ).…”

Symposium: Neuroethics and Mental Health—Old Wine in New Bottles or a Legitimate New Field of Bioethical Inquiry

“…The paper by Borgelt et al (2011) provides the analysis of a qualitative study of the manner in which knowledge of mental illness and its treatment is constructed by professionals and patients, in the presumed neuroscientific episteme of mental health.…”