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Imaging the brain: visualising “pathological entities”? Searching for reliable protocols within psychiatry and their impact on the understanding of psychiatric diseases

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Poiesis & Praxis

Abstract

Given that visualisations via medical imaging have tremendously increased over the last decades, the overall presence of colour-coded brain slices generated on the basis of functional imaging, i.e. neuroimaging techniques, have led to the assumption of so-called “kinds” of brains or cognitive profiles that might be especially related to “non-healthy” humans affected by neurological, neuropsychological or psychiatric syndromes or disorders. In clinical contexts especially, one must consider that visualisations through medical imaging are suggestive in a twofold way. Imaging data not only visually render pathological entities, but also tend to represent objective and concrete evidence for these psychophysical states in question. This article aims to identify key issues in visually rendering psychiatric disorders via functional approaches of imaging within the neurosciences from an epistemological point of view.

Zusammenfassung

In den vergangenen Jahrzehnten hat die Zahl der Visualisierungen im Rahmen medizinischer Bildgebung nicht nur deutlich zugenommen, die allgemeine Präsenz farbkodierter Schnittbilder des Gehirns, die auf der Basis funktioneller Bildgebung, namentlich des Neuroimagings erzeugt wurden, hat auch zur Ansicht beigetragen, man könne von kognitiven Profilen (“kinds” of brains) auf erkrankte Individuen schließen, die von neurologischen, neuropsychologischen oder psychiatrischen Syndromen oder Störungen betroffen sind. Innerhalb des klinischen Kontexts gilt es freilich zu berücksichtigen, dass Visualisierungen in Rahmen medizinischer Bildgebung in zweifacher Hinsicht suggestiv sind. Bildgebende Datensätze scheinen nicht nur pathologische Entitäten als solche zu visualisieren, sondern diese psychophysischen Zustände objektiv und anschaulich zu repräsentieren. Der Artikel zeigt Kernthemen der Visualisierung psychiatrischer Krankheitsbilder auf, die auf der Basis verschiedener Verfahren der funktionellen Bildgebung den Neurowissenschaften erstellt werden. Dies geschieht mit dem Schwerpunkt auf epistemologische Frage- und Problemstellungen.

Résumé

Face à l’augmentation nette des visualisations qui se base sur l’imagerie médicale ces derniers décennies, la présence des coupes du cerveau codé en couleur qui ont générées sur des applications fonctionelles a contribué à la supposition de pouvoir extrapoler si un individu est affecté par un syndrome neurologique, neuropsychologique ou psychiatrique des profils cognitives (“kinds” of brains). Dans le contexte clinique, il est notamment indispensable de remarquer que des visualisations qui se base sur l’imagerie médicale sont suggestive à plus d’un point de vue. Les enregistrements de l’imagerie médicale ne seulement visualisent des entités pathologiques, mais aussi représentent les états psychophysiques d’une manière objective et concrète. D’une vue epistemologique, cet article débat des aspects clé des visualisations qui se base sur des applications fonctionelles des neurosciences.

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Notes

  1. See Dumit for fieldwork material: “Digital brain images are often represented as automatic, computed, and objective illustrations demonstrating insanity and incompetency. PET images thus seem to have a persuasive power that is out of proportion to the data they are presenting. The scans become visual truths, presenting themselves as facts about people and the world such that even their own producers cannot refute them” (Dumit 2004, 17). Dumit especially highlights the impact of brain images on the understanding patients have of their own body or “objective self” (Dumit 1997, 2003).

  2. As Anne Beaulieu puts it, this could be regarded as a “negative definition of normality—that is to say, subjects are normal if they are untraumatized, unmedicated, unaddicted, non-diabetic, non-pregnant, and not having had any neurosurgery, psychiatric or neurological disorder“ (Beaulieu 2001, 646). In other words, the relation of normality to pathology that is supposed upon logical causes is “reversed”—see especially Georges Canguilhem: “Le normal c’est l’effet obtenu par l’exécution du projet normatif, c’est la norme exhibée dans le fait. Sous le rapport du fait, il y a donc entre le normal et l’anormal un rapport d’exclusion. Mais cette négation est subordonnée à l’opération de négation, à la correction appelée par l’anormalité. Il n’y a donc aucun paradoxe à dire que l’anormale, logiquement second, est existentiellement premier” (Canguilhem 2006/1966:180).

  3. Referring to the endeavour of the natural sciences to transfer phenomena of the lived world via operationalisation into the realm of, for example, neuroscientific research. Therefore, these phenomena cannot be regarded as “natural objects” in a proper sense, but must be considered as “naturalised” ones (Keil 2005; Janich 2006; Sturma 2006). This immediately has an impact on anthropological issues, that is to say, “how we take facts about ourselves (…) and incorporate them into our lives” (Dumit 1997, 89; Huber 2008).

  4. With regard to the specific problems arising in psychiatric studies misusing PET with regard to the scientific practice of selecting “extreme images” – for instance in creating a “brainset of schizophrenia itself” (Dumit 2004, 95 et sqq. and 86).

  5. Commonly, paradigms within psychiatric research are dealing with motoric or visual stimuli, working and episodic memory, attention, and language processing (Kalus et al. 2007; Schneider and Fink 2007).

  6. See Jeannerod: “Un des objectifs de cette méthode serait, une fois identifiée la fonction altérée, de re-qualifier le symptôme en question et de l’intégrer dans un cadre nosologique différent de son cadre initial.” (Jeannerod 2004: URL: http://www.sens-public.org/spip.php?article107 (31 March 2008).

  7. The development of probability maps and other digital resources, that is to say, informatics tools and resources for neuroscience is supported by the Human Brain Project (HBP), a still on-going US-based research project that was initiated in 1993 to support neuroinformatics: Hence, the International Consortium for Brain Mapping, based at the University of California, Los Angeles (UCLA) could be formed. One in four core research sites is the German Institute of Medicine at the research centre Jülich: URL: http://www.fz-juelich.de/inb/inb-3/ime_probability_maps/ (30 May 2008).

  8. See also Michael Hagner:”Das Aufschreiben von Kurven auf Papier bedeutete gleichzeitig ein Einschreiben von bestimmten, ganz neuen Eigenschaften in die Organsysteme. Anders gesagt: Mit der graphischen Stabilisierung des im Körper Verborgenen war unweigerlich eine Umdeutung der körperlichen Funktionssysteme selbst verbunden“(Hagner 2006:169).

  9. For further details see also Rheinberger, Bettina Wahrig-Schmidt and Hagner:”Und die molekulare Wende in der Biologie (…) scheint zu implizieren, daß hier vielleicht das traditionelle Verhältnis von Repräsentation und Referenz geradezu umgestülpt wird, indem die molekulare Schrift selbst gar nicht mehr als Darstellung von etwas gedacht werden kann, sondern zu dem primordialen Vorgang wird, der Repräsentation überhaupt erst erzeugt“ (Rheinberger et al. 1997, 9).

  10. See Beaulieu for further expertise including fieldwork material: “The data are measurements of phenomena, and they define complex phenomena in a way that imaging, as a pictorial strategy, could not achieve“(Beaulieu 2002, 60: et sqq.).

  11. Daston and Galison have distinguished three basic modes of objectivity: the ideal, the characteristic, and the individual type (Daston and Galison 1992, 2007).

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Huber, L. Imaging the brain: visualising “pathological entities”? Searching for reliable protocols within psychiatry and their impact on the understanding of psychiatric diseases. Poiesis Prax 6, 27–41 (2009). https://doi.org/10.1007/s10202-008-0055-1

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