I guess that this is one of the most difficult articles for me to review because for me it is very hard to remain objective.
It certainly has been a while since I first read this article. In the beginning I was very very sceptical as usual. Looking back I a and agreed that the scepticism is somewhat misplaced after reading extensively in the broader per referral field that helped converge on the conclusion that was drawn by Dr. Jollant.
Overall, I agree the single strongest point of this article above or under is its proposition to propose and come up with a model that further refined earlier proposition with regard to the brain and its relation to various neural cognitive process behind the pure theoretical cognitive model of suicidal behaviour. Previous reports focus heavily on the behaviour aspect without really brandishing any neurocognitive data that could substantially or remotely validate the theory and proposition of the models. See earlier article.
Dr. Jollant proposed three stage model that are related to the value attribution,emotional modulation, and facilitation of act. Despite the fact that I don’t think these three values would neatly be correlated with ventrolateral prefrontal cortex/OFC, MPFC/DMPFC, and DLPFC, I think it is certainly a great direction to take with regard to upcoming and impending recognition of brain circuitry instead of regional specialization which contributed to the symptoms.
The fact that ventrolateral free of prefrontal cortex and OFC are so prominently featured in many reports across a great variety of article suggests that it may be the focal point or a critical node that may be at the interception of all three processes instead and hence of key vulnerable point among all potential interruptions. After all, brain is plastic and any disruption within the circuitry would not necessarily guarantee the interruption of the entire function of the circuitry. However and critical nodes when it is responsible for multi-role converging on the same sets of vulnerability that contribute to the suicidal risk main results in that particular region being far more provincial and among all structural or functional alterations.
In many ways I feel the current literature of trying to come up with his sets of brain region and understanding its specific role may be flawed. Instead what we could be looking for are the interception points toward a critical nodes where value attribution emotional regulation and inhibition functions converge. Hence the interruption of these regions would greatly increase the risk asked implicates multiple cognitive process that simultaneously and synergistically contribute to the suicidal behaviour.
I’m a firm believer that brain regions specialization at a higher cognitive level is a relative myth. Just as similar as to how memory cannot be pinpointed to a specific regions, the transient networks within the brain may be responsible for our lot of the higher cognitive process that we take for granted, unlike the lower sensory or motor processes.
I think the issue is that I’ve been to fixated on finding the precise function of each regions and trying to pin them down like what Dr. Jollant did earlier. Maybe if we take a step back and look at everything as a probability event where déficits or alterations can happen anywhere within the circuitry and the mere statistical convergence of these events are the ultimate findings we conduct and comparisons. From that perspective, and adopting a vulnerability perspective where suicide is the combination of a variety of vulnerabilities such as decision-making value attribution cognitive inhibition and emotional regulation then findings of each experiment can indeed be vastly different because we are comparing deficits across multiple circuitry’s which could break anywhere that resulted in the culmination of all of the circuits being compromised. Our spatial findings using neuroimaging approach may merely shed light on the spatial convergence of the circuits that with the same amount hits (borrowing a lingo from cancer genetics here), the most vulnerable spots that could result in a phenotypic appearance of suicidal behaviour. it’s time like this that I wish I had known more about multiple hits hypothesis and the lesion studies of suicide.
(added two studies to be reviewed)
- There are certainly a lot of negative emotions that I would activate the lateral orbitofrontal cortex.
A good analogy I can think of about what exactly brain imaging is doing it’s like a measuring the heat of an engine while trying to understand where the car went.