Dr. Martin Paulus is the Scientific Director and President of Laureate Institute of Brain Research which is an institute focused on pragmatic academic psychiatry, i.e. that is how to use neuroscience-based measurements to identify modifiable treatment targets and to generate predictions that can be useful for clinicians. He is also a member of the Adolescent Brain Cognitive Development study which is working towards determining how the brain changes during those years. We have this opportunity for an interview with him.
Dr. Paulus please tell us about your views on how much of mental illness is related to a difficult childhood.
Childhood trauma, e.g. neglect, physical, emotional and sexual abuse, has a profound effect on the development of mental health problems.
Childhood trauma, e.g. neglect, physical, emotional and sexual abuse, has a profound effect on the development of mental health problems at a later point in time. There is good evidence that childhood trauma results in increased rates of depression, post-traumatic stress disorder and other mental health conditions. Moreover, individuals who have experienced childhood trauma typically have a more severe course of mental health problems.
As you have said, a number of mental healthcare providers still use guesswork and intuition to treat patients. Could you please elaborate on this?
The main problem is that we do not have a good understanding of the biological underpinnings of mental health condition. Unlike diabetes, where we know that there is a dysfunction in how sugars are metabolized in the body, we do not know what metabolic or other process is dysfunctional in disorders such as depression or anxiety. As a consequence it is difficult to develop a biological test for psychiatric conditions. Moreover, this makes it difficult to determine what type of intervention will work with what type of patient. In medicine we have a better understanding of some of the basic processes that contribute to conditions such as high blood pressure. As a consequence, physicians are able to select particular type of medications that are best able to treat a particular patient. In psychiatry we are still a ways away from this situation.
What role does technology play in narrowing down the treatment and making it accurate so that it doesn’t remain guesswork and intuition?
One way that technology might be able to help psychiatry to better characterize psychiatric conditions is to obtain better daily measurements of what people actually do instead of what they remember and what they tell the physicians what they do. This is important because it provides a more objective way of quantifying how people are engaging with their environment. In a recent study, investigators were able to associate levels of activity measured by devices such as “FitBit” to levels of depression and anxiety. This is an important step forward and will help us to potentially measure how people are feeling even if we don’t ask them all the time.
At the same time would you say that intuition does play an important role even in the average person’s decision making.
This question is unclear to me. If you mean the intuition of a treatment provider then I would say that individual assessments of patients is very important and is related to the training and experience of a provider. In that way the provider’s intuition, which is a consequence of experience and training plays an important but hard to quantify role in the assessment of a patient.
Which are the critical years when changes happen in a human’s brain?
The brain is ALWAYS changing and developing.
We used to think that brain development happens during the first decade of life. Now we know that some parts of the brain develop even into the third decade of life. However, it is emerging that even the aging brain keeps changing as a consequence of the experiences that a person is having. Therefore, I would say that the brain is ALWAYS changing and developing and there really is no time when the brain is static. Nevertheless, early years are very important to lay the foundation for learning, for processing new experiences etc.
Do alternative forms such as mindfulness and meditation help as a combination while treating patients with mental conditions?
There is good evidence now that mindfulness type interventions are able to positively affect the brain and mental health conditions similar to standard interventions. Therefore, I would say that these approaches are very useful for a variety of different mental health problems ranging from anxiety, depression and PTSD.
The empathy you show towards human beings is entirely evident. Observing so much suffering, are you able to switch off while not at work?
Empathy is different from sympathy in that one gradually learns to appreciate the suffering in other people without necessarily having a sense of responsibility or guilt or despair. Over the years I have been able to refocus my efforts to find ways of helping people when they are suffering and realize that my own involvement would only stand in the way. Nevertheless, when I feel affected by the difficult experiences that others have it helps me when I exercise (I ride my bike regularly).
Please tell us about your growing up years and what motivated you into the area of mental illness.
I was always fascinated by people’s thoughts and feelings and the complicated consequences.
It is hard to say whether there was a particular event that got me interested in studying psychiatry, but I was always fascinated by people’s thoughts and feelings and the complicated consequences that these can have for people’s daily life. Initially, I was very much interested in psychoanalysis but I later realized that while it provided a good narrative for what people were experiencing it did not provide a way of explicitly testing some of the observations or interpretations. I was fortunate to be at a university where the Department of Psychiatry was interested in the biology underlying mental health conditions. This opened my eyes and I saw tremendous opportunities in studying the brain to understand how people feel and think.
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Photos: Shutterstock, Personal archive of Dr. Martin Paulus
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