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“The art of healing the soul” is the word that comes from the Greek and defines Psychiatry. The brain is the organ that carries the “soul,” which is the same as saying the mind, that which many still attempt to maintain can be external to the body, by leaving it and continuing to have a life of its own. However, consciousness and what we call intuition, creativity or an impulsive idea, are all the result of a large chemical equation which is also part of the matter found in our heads.
But is Psychiatry seen by all its specialists in the same way? The proof that time makes us doubt convictions grounded in the past is Bernardo Costa Neves, who came to the conclusion, during his specialisation in this area, that Psychiatry, as it stands, has no answer to many of the problems faced by the patients.
“I have always been interested in trying to understand how the brain works; to grasp how our behaviours and thoughts emerge. For many years, psychologists and philosophers wondered whether the mind was separate from the brain. These days, it is widely accepted that the mind and the brain are inseparable entities. We can use the analogy of a computer, where the mind is the information (the software) and the brain is the matter (the hardware). From early on, my interest was this: to understand the mind-brain relation.”
He reminds us that mental illnesses are also physical; in spite of this, when he first entered Med school, he had no idea he would be pursuing studies in Psychiatry. When he first came in touch with Neurosciences, he thought he would become a neurologist, or perhaps a neurosurgeon; however, after the first 3 years of theoretical studies, he got in touch with the clinical area and, while still admiring Neurology, he realised that “it focused more on the motor and sensory manifestations and less on the behavioural manifestations of brain illnesses. Still, what fascinated me most was behaviour and emotions per se, and not the brain's other functions. I was more interested in understanding, for instance, what causes someone to become emotional when they admire a painting than in understanding how the painting itself is depicted in the mind.
Looking at people and trying to interpret their behaviours led him to understand that society is not prepared to understand mental patients. “People with mental disorders suffer greatly, and in our society there is still quite a bit of prejudice in relation to Psychiatry. Everyone has been through moments of intense stress - when studying for a final exam, when preparing for a job interview or while anxiously awaiting the result of a medical examination. Some stress factors are more intense than others: the death of a relative is one of the most intense factors. The moment in life when stress factors emerge also influences the impact they will have on a person's mental health. For example, abuse and neglect in childhood are one of the leading predictors of mental disorders in adulthood. Each person's ability to withstand such factors or “resilience” varies from one individual to the next. Social relationships are one of the most important ingredients for a healthy brain. A person's genetics also provide greater susceptibility or greater protection against these environmental factors. Schizophrenia is one the mental illnesses with a greater genetic influence. If a first-degree relative has the disease, the risk of contracting it rises. If the affected relative is a monozygotic (“identical”) twin sibling, that risk is 50%. In the end, what determines whether or not a person contracts an illness is a combination of all these factors. I think all of us would be able to empathise with and show more compassion for psychiatric patients if we thought that many of these factors are beyond our control and that it could happen to anyone.”
Compassion and tolerance are features he realised were innate to him and caused sparks to fly in his brain when he met his first psychiatric patient, who suffered from schizophrenia. Since he had never been in contact with this illness, he was impressed, as “he heard voices that insulted him, and he believed that strangers in the street were threateningly staring at him and making comments about him.” Bernardo is faced with this case and wonders how the brain behaves in order to read messages that are not real, like listening to the news on television and thinking they are sending personal messages. “These patients have difficulties in correctly processing signs in social contexts. One of the difficulties involves inferring other people's emotions and intentions. For instance, during this interview I'm paying attention not only to what you say, but also to your facial expressions, your gestures, your posture and even your voice modulation. When you smile, I take that as a sign that you are pleased and that I did something that pleased you. Schizophrenia patients have difficulties in correctly processing this information: they look at a neutral face and they interpret it as an expression of rage. They have a negativity bias when it comes to recognising emotions.” This concern with societal behaviour led Bernardo Costa Neves to study more about a hormone. “We're studying the effects of a molecule that works as a hormone on the periphery and as a chemical messenger in the brain. We want to know how this molecule influences social behaviour, at several levels, one of which is recognising emotions. Several studies have already shown that oxytocin, when administered to patients with schizophrenia, helps correct this negativity bias. What we don't know is how this neurotransmitter does this and why it doesn't always work.”
He was then faced with parts of History of Philosophy and Phenomenology which he regarded as outdated, as they did not meet new explanations that are currently accepted, and which aroused his interest. This discussion between the past and the outlook for the future caused him to look at Neurosciences and seek new articles dealing with pioneering research. However, even Psychiatry set up obstacles to his critical sense, as explaining emotions is not palpable; “this leads Psychiatry to face added difficulties when it comes to medical diagnosis. Compared to other specialities, Psychiatry is still not very technological and relies mainly on the physician's subjective assessment. At the moment, there are no validated tools to support Psychiatrists in their diagnostic decision; however, scientific and technological progress is moving in that direction.” He maintains that the brain should be observed differently and so he joined the Diana Prata Lab, which is coordinated by Neurobiologist Diana Prata.
He discussed with Diana Prata his research interests and understood that they lined up with the laboratory project, and, although his initial proposal involved bipolar patients, he ended up adapting his focus to the topic of schizophrenia, which was broadly addressed by Diana Prata from her days at King’s College, in London.
After meeting with his mentor, he ended up applying for a scholarship with a project integrated into the laboratory. Initially, he did his internship at the laboratory, while giving appointments at the Júlio de Matos Hospital and working emergency shifts at the São José Hospital. Time seemed to slip through his fingers, but it was the period when he felt happier, because he had his patients close to him and he could contrast theory and practice and open up new horizons with his doubts.
However, he ended up temporarily suspending his clinical practice at Júlio de Matos when he earned his Ph.D Scholarship from the FCT, given the scholarship's exclusive basis. Still, nothing along his pathway was in vain, as he is now studying neurobiology of social cognition, that is, the way the brain processes information in the social world. He had already found out about the main player at the Diana Prata laboratory, oxytocin, that hormone he had yet to know up close and personal. The multidisciplinary nature of the project was one of the things that most fascinated him, as “one of the limitations of scientific research is the fragmentation of knowledge. Every person specialises in a very specific sphere of knowledge. The problem occurs when we try to understand a phenomenon as a whole and we are only focused on one part, very often without realizing it. That's why there needs to be communication among experts from different areas. The laboratory has a multidisciplinary team comprising psychologists, engineers, physicians and biologists united in their efforts toward a common purpose, just as an orchestra with various musicians and instruments playing in harmony.”
The treatments that are currently available are still failing to look at problems involving social integration, which are ubiquitous in psychiatric disorders. Patients “become increasingly isolated, because they are constantly engaging in negative interpretations of other people's intentions and emotions. They are unable to maintain wholesome relationships, or to have the motivation to do so.” For the time being, we are unable to improve their social motivation and the desire for interaction, but this laboratory's work aims to advance knowledge with that purpose.
Bernardo Costa Neves has 4 years to show proof of his doubts. In the meantime, he is bringing researchers at the iMM and physicians at the Júlio de Matos Hospital closer, leading them to debate new ideas and experiences and to expand their visions with regard to different clinical approaches to patients, but also to research works that may one day lead to effective treatments.
Looking at the future, he is hopeful about helping to build a pathway that allows “these patients to live better, to have a better quality of life.” This is the great reward he earns as a result of the pathway he has chosen.
When I wanted to meet Bernardo it was to understand what makes a Medical student choose one area and not another. To understand one's motivations when choosing Psychiatry, as was the case. And I think I understood it. Bernardo chose to be a Psychiatrist for the people, for the sake of the people who are unable to explain themselves on their own. But, above all, because he understands that he can contribute toward expanding Science in the area of brain research, along with medical intuition, with technological research and understanding the extent to which we can add contents to Psychiatry manuals for the next generation of students and young physicians.
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Joana Sousa
Editorial Team
