Journal of Bioethical Inquiry

, Volume 8, Issue 1, pp 15–25 | Cite as

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

  • Emily Borgelt
  • Daniel Z. Buchman
  • Judy Illes


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.


Neuroethics Mental health Psychiatry Neuroimaging 



Supported by NIH/NIMH 9RO1MH84282, the Canadian Institutes for Health Research, Institutes for Neuroscience, Mental Health and Addiction (CIHR-INMHA) CNE #85117, the British Columbia Knowledge Development Fund (BCKDF), the Canadian Foundation for Innovation (CFI), and the Vancouver Coastal Health Research Institute. Special thanks to Dr. Allan H. Young and members of the Institute of Mental Health, Department of Psychiatry, University of British Columbia, and to the anonymous reviewer for thoughtful remarks.


  1. Abi-Rached, J.M., and N. Rose. 2010. The birth of the neuromolecular gaze. History of the Human Sciences 23(1): 11–36.PubMedCrossRefGoogle Scholar
  2. Angermeyer, M.C., and H. Matschinger. 2005. Labeling—stereotype—discrimination: an investigation of the stigma process. Social Psychiary and Epidemiology 40(5): 391–405.CrossRefGoogle Scholar
  3. Bennett, M.R., and P.M.S. Hacker. 2003. Philosophical foundations of neuroscience. Oxford: Blackwell.Google Scholar
  4. Bloch, S., P. Chodoff, and S.A. Green. 1999. Psychiatric ethics, 3rd ed. New York: Oxford University Press.Google Scholar
  5. Boeije, H. 2002. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality and Quantity 36(4): 391–409.CrossRefGoogle Scholar
  6. Buchman, D.Z., and J. Illes. 2010. Imaging genetics for our neurogenetic future. Minnesota Journal of Law, Science, & Technology 11(1): 79–97.Google Scholar
  7. Campbell, P. 2010. A decade for psychiatric disorders. Nature 463(7277): 9.CrossRefGoogle Scholar
  8. Cheung, E.H. 2009. A new ethics of psychiatry: neuroethics, neuroscience, and technology. Journal of Psychiatric Practice 15(5): 391–401.PubMedCrossRefGoogle Scholar
  9. Corrigan, P.W., S.A. Kuwabara, and J. O’Shaughnessy. 2009. The public stigma of mental illness and drug addiction: findings from a stratified random sample. Journal of Social Work 9(2): 139–147.CrossRefGoogle Scholar
  10. Davis, L.J. 2010. The bioethics of diagnosis: a biocultural critique of certainty. Bioethical Inquiry 7(2): 227–235.CrossRefGoogle Scholar
  11. Dumit, J. 2000. When explanations rest: “Good Enough” brain science and the new socio-medical disorders. In: M. Lock, A. Young and A. Cambrosio (Eds.). In Living and working with the new medical technologies: Intersections of inquiry, 209–232. Cambridge: Cambridge University Press.Google Scholar
  12. Edwards, J., P. Harvey, and P. Wade. 2010. Technologized images, technologized bodies. In Technologized images, technologized bodies, ed. J. Edwards, P. Harvey, and P. Wade, 1–36. New York: Berghahn.Google Scholar
  13. Farmer, R.L. 2008. Neuroscience and social work practice: the missing link. Newbury Park: Sage.Google Scholar
  14. Finnell, D.S. 2000. The case for teaching patients about the neurobiological basis of addictions. Journal of Addictions Nursing 12(3/4): 149–158.CrossRefGoogle Scholar
  15. Foucault, M. 1963/2010. The birth of the clinic: an archeology of medical perception. London: Routledge.Google Scholar
  16. Fry, C. 2009. A descriptive social neuroethics is needed to reveal lived identities. The American Journal of Bioethics-Neuroscience 9(9): 16–17.CrossRefGoogle Scholar
  17. Gillett, G. 2009. The subjective brain, identity, and neuroethics. The American Journal of Bioethics-Neuroscience 9(9): 5–13.CrossRefGoogle Scholar
  18. Gillett, G. 2010. The multiaxial, multi-layered reality that is mental disorder. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 17(1):
  19. Giovanni, F., and S. Anker. 2009. Neuroculture. Nature Reviews Neuroscience 10: 815–821.Google Scholar
  20. Glannon, W. 2007. Bioethics and the brain. New York: Oxford University Press.Google Scholar
  21. Glannon, W. 2009. Our brains are not us. Bioethics 23(6): 321–329.PubMedCrossRefGoogle Scholar
  22. Glaser, B.G. 1965. The constant comparative method of qualitative analysis. Social Problms 12(4): 436–445.CrossRefGoogle Scholar
  23. Guze, S.B. 1992. Why psychiatry is a branch of medicine. Oxford: Oxford University Press.Google Scholar
  24. Hacking, I. 2004. Historical ontology, 99–114. Cambridge: Harvard University Press.Google Scholar
  25. Hoop, J.G., and R. Spellecy. 2009. Philosophical and ethical issues at the forefront of neuroscience and genetics: an overview for psychiatrists. Psychiatric Clinics of North America 32(2): 437–439.PubMedCrossRefGoogle Scholar
  26. Huber, L. 2009. Imaging the brain: visualising “pathological entities”? Searching for reliable protocols within psychiatry and their impact on the understanding of psychiatric disease. Poiesis praxis 6(1–2): 27–41.CrossRefGoogle Scholar
  27. Hyman, S.E. 2007. Can neuroscience be integrated into the DSM-V? Nature Reviews Neuroscience 8(9): 725–732.PubMedCrossRefGoogle Scholar
  28. Illes, J., S. Lombera, J. Rosenberg, and B. Arnow. 2008. In the mind’s eye: provider and patient attitudes on functional brain imaging. Journal of Psychiatric Research 43(2): 107–114.PubMedCrossRefGoogle Scholar
  29. Insel, T.R., and P.S. Wang. 2010. Rethinking mental illness. Journal of the American Medical Association 303(19): 1970–1971.PubMedCrossRefGoogle Scholar
  30. Jacobs, D.H. 2009. Is a correct psychiatric diagnosis possible? Major depressive disorder as a case in point. Ethical Human Psychology and Psychiatry 11(2): 83–96.CrossRefGoogle Scholar
  31. Kandel, E. 1998. A new intellectual framework for psychiatry. American Journal of Psychiatry 155: 457–469.PubMedGoogle Scholar
  32. Kendell, R.E. 2000. The next 25 years. British Journal of Psychiatry 176: 6–9.PubMedCrossRefGoogle Scholar
  33. Klitzman, R. 2006. Clinicians, patients, and the brain. In Neuroethics: defining the issues in theory, practice, and policy, ed. J. Illes, 229–241. New York: Oxford University Press.Google Scholar
  34. Lennox, B.R. 2009. The clinical experience and potential of brain imaging in patients with mental illness. Frontiers in Human Neuroscience 3: 46.PubMedCrossRefGoogle Scholar
  35. Levy, N., and S. Clarke. 2008. Neuroethics and psychiatry. Current Opinion in Psychiatry 21(6): 568–571.PubMedCrossRefGoogle Scholar
  36. MacQueen, G.M. 2009. Magnetic resonance imaging and prediction of outcome in patients with major depressive disorder. Journal of Psychiatry and Neuroscience 34(5): 343–349.PubMedGoogle Scholar
  37. Mashour, G.A., E.E. Walker, and R.L. Martuza. 2005. Psychosurgery: past, present, and future. Brain Research Reviews 48: 409–419.PubMedCrossRefGoogle Scholar
  38. Matto, H.C., and J. Strolin-Goltzman. 2010. Integrating social neuroscience and social work: innovations for advancing practice-based research. Social Work 55(2): 147–156.PubMedGoogle Scholar
  39. Merton, R.K. 1976. Sociological ambivalence and other essays. New York: Free.Google Scholar
  40. Murphy, E.R., and J. Illes. 2007. Neuroethics and psychiatry: new collaborations for emerging challenges. Psychiatric Annals 37(12): 398–804.Google Scholar
  41. Novas, C., and N. Rose. 2000. Genetic risk and the birth of the somatic individual. Economy and Society 29(4): 485–513.CrossRefGoogle Scholar
  42. Pardo, M.S., and D. Patterson. 2010. Minds, brains, and norms. Neuroethics. doi: 10.1007/s12152-010-9082-4.Google Scholar
  43. Pescosolido, B.A., J.K. Martin, J.S. Long, T.R. Medina, J.C. Phelan, and B.G. Link. 2010. “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry. doi: 10.1176/appi.ajp.2010.09121743.
  44. Phelan, J.C. 2005. Geneticization of deviant behaivour and consequences for stigma: the case of mental illness. Journal of Health and Social Behavior 46(4): 307–322.PubMedCrossRefGoogle Scholar
  45. Phelan, J.C., R. Cruz-Rojas, and M. Reiff. 2002. Genes and stigma: the connection between perceived genetic etiology and attitudes and beliefs about mental illness. American Journal of Psychiatric Rehabilitation 6(2): 159–185.Google Scholar
  46. Racine, E., O. Bar-Ilan, and J. Illes. 2005. fMRI in the public eye. Nature Reviews Neuroscience 6(2): 159–164.PubMedCrossRefGoogle Scholar
  47. Read, J. 2007. Why promoting a biological ideology increases prejudice against people labelled “schizophrenic. Australian Psychologist 42(2): 118–128.CrossRefGoogle Scholar
  48. Reiner, P.B. 2011. The rise of neuroessentialsim. In The Oxford handbook of neuroethics, ed. J. Illes and B. Sahakian. Oxford: Oxford University Press.Google Scholar
  49. Reynolds, C.F., D.A. Lewis, T. Detre, A.F. Schatzberg, and D.J. Kupfer. 2009. The future of psychiatry as clinical neuroscience. Academic Medicine 84(4): 446–50.PubMedCrossRefGoogle Scholar
  50. Rose, N. 2003. The neurochemical self and its anomalies. In Risk and morality, ed. R. Ericson and A. Doyle, 407–437. Toronto: University of Toronto Press.Google Scholar
  51. Rose, N. 2007. The politics of life itself: biomedicine, power and subjectivity in the twenty-first century. Princeton: Princeton University Press.Google Scholar
  52. Schleim, S., and J. P. Roiser. 2009. fMRI in translation: The challenges facing real-world applications. Frontiers in Human Neuroscience 3: doi:10.3389/neuro.09.063.2009.
  53. Schnittker, J. 2008. An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance. Social Science & Medicine 67(9): 1370–1381.CrossRefGoogle Scholar
  54. Rosenberg, C.E. 2006. Contested boundaries: psychiatry, disease, and diagnosis. Perspectives in Biology and Medicine 49(3): 407–424.PubMedCrossRefGoogle Scholar
  55. Singh, I., and N. Rose. 2009. Biomarkers in psychiatry. Nature 460(7252): 202–207.PubMedCrossRefGoogle Scholar
  56. The International Schizophrenia Consortium. 2009. Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature 460: 748–752.Google Scholar
  57. Valenstein, E.S. 1986. Great and desperate cures: the rise and decline of pyschosurgery and other radical treatments for mental illness. New York: Basic Books.Google Scholar
  58. Vidal, F. 2009. Brainhood: anthropological figure of modernity. History of the Human Sciences 22(1): 5–36.PubMedCrossRefGoogle Scholar
  59. Vos, R., and D.L. Willems. 2000. Technology in medicine: ontology, epistemology, ethics and social philosophy at the crossroads. Theoretical Medicine and Bioethics 21(1): 1–7.PubMedCrossRefGoogle Scholar
  60. Vul, E., C. Harris, P. Winkielman, and H. Pashler. 2009. Puzzingly high correlations in fMRI studies of emotion, personality, and social cognition. Perspectives on Psychological Science 4(3): 274–290.CrossRefGoogle Scholar
  61. Whooley, O. 2010. Diagnostic ambivalence: psychiatric workarounds and the diagnostic and statistical manual of mental disorders. Sociology of Health & Illness 32(3): 452–469.CrossRefGoogle Scholar
  62. Wittgenstein, L. 1953. Philosophical investigations. Oxford: Basil Blackwell. Trans. G. E. M. Anscombe.Google Scholar
  63. Young, A. 1995. The harmony of illusions. Princeton: Princeton University Press.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Emily Borgelt
    • 1
  • Daniel Z. Buchman
    • 1
  • Judy Illes
    • 1
    • 2
  1. 1.National Core for NeuroethicsUniversity of British ColumbiaVancouverCanada
  2. 2.Canada Research Chair in Neuroethics, Division of NeurologyUniversity of British ColumbiaVancouverCanada

Personalised recommendations