Does brain science help us? In times past, I never doubted it. Then, last week, I attended an all-day seminar about the neuroscience and clinical management of destructive habits. Afterwards, I found myself wondering how much our massive research into the brain’s activities is really benefitting human life.
The neurophysiology of addiction has been studied in depth, and the lecturer talked a lot about it. Dopamine secreting neurons in the ventral tegmental area (VTA) send messages to the nucleus accumbens apprising it of opportunities in the environment. The accumbens integrates all of its inputs and either releases the basal ganglia (e.g., the striatum and substantia nigra) to indulge in a habitual action, or restrains them to abstain. Drugs of abuse, especially those that act directly on dopaminergic neurons (e.g., cocaine) are acutely habit forming because they trick the brain into thinking a tremendous payoff will result from their ingestion.
This brief sketch belies an enormous amount of investigative work. Countless scientists now study addiction, mental illness, and brain science in general. Pharmaceutical marketing and popular media have celebrated how this huge and costly investigative effort has yielded many advances for treating psychiatric disease, substance abuse, and neurologic problems. But has the clinical payoff really been that high?
At the seminar, when the presenter started speaking about the treatment of addiction, rather than the science of it, there was a shift in emphasis. Medium spiny neurons and dopamine physiology dropped out of the discussion. Instead, we heard how changing social groups is important, so addicts can find support for abstinence rather than peer pressure for addiction. We learned how alcoholics should clear their homes of booze. The speaker extolled healthy activities like exercise and yoga. She strongly endorsed mindfulness meditation to improve tolerance of uncomfortable emotional states.
Sure, there was a section on drugs that treat addiction, like naltrexone for alcoholism, buprenorphine for opiate dependence, and mecamylamine for nicotine cravings. But in each case we heard how the medications won’t work in isolation, and instead need to be part of larger programs of behavioral management. In other words, they aren’t miracle cures.
What are we to think when the brain science sounds so sophisticated, but the best treatments remain based on common sense (e.g., change social networks), or come from ancient wisdom traditions (e.g., meditate)? Can we conclude that brain science has resolved much mental distress? To me, it would seem premature to assert that neurophysiology has greatly helped us in day-to-day life.
I say this as someone who underwent cutting-edge psychiatric treatment for many years. A prominent Bay Area psychiatrist managed my mood issues with as many as six medications at a time. I seldom questioned her advice when she added another drug, or increased the dose of one that clearly wasn’t working. Only as side effects overwhelmed me and my productivity plummeted did I finally begin to question her strategy.
Unfortunately, it took a long time for me to realize that I’d be better off with meditation than medication. Now that I no longer use pharmaceutical support, I see that although drugs help in crisis situations, they often serve poorly as long term treatments. Don’t take my word for it. Robert Whitaker’s book, Anatomy of an Epidemic, shows clearly the many shortcomings of psychopharmaceuticals. Whether we speak of addiction management, or treatment of depression, or assisting schizophrenics, the sparkling promise of brain science remains largely unfulfilled in clinical terms.
Understand that I studied synaptic signal processing as a biophysics graduate student. In medical school I took most of my elective classes in neurology and neurosurgery. I’ve educated myself about the nervous system ever since. I’m well aware that neuroscientists have collected impressive quantities of information about the brain and its component parts. As an intellectual enterprise I continue to support this research. But we need to recognize that genuinely safe and effective treatments have not so far been forthcoming.
It frustrates me that despite this limitation, it has become difficult to say anything about human behavior without invoking the findings of neuroscience. Although meditation clearly helps people cope, and has done so for millennia, its benefits now need the imprimatur of functional MR scanning in order to be accepted. Although building positive activities into one’s lifestyle can assist with battling addiction, we apparently need to hear this common sense advice framed as neuroscience before we’ll take it seriously.
If it were just a question of objective science validating ancient wisdom, I’d have no complaint. But because of the neuroscience perspective, human behavior is now viewed as a product of computations carried out in brain tissue. Different aspects of our experience get ascribed to named nuclei in the brain. Thus, the amygdala is our ‘fear center,’ the hippocampus is a ‘memory module,’ and so on.
These descriptions are not only highly reductionistic, and therefore a bit suspect, they are also gross simplifications of exceedingly intricate and redundant neural processes. By describing people in these stark terms, we strip them of their native complexity. Perhaps this wouldn’t be a problem if something valuable were gained, but as I noted above, the best clinical treatments come from experience with people, not experiments with brains. The largest effect of neuroscience has been to persuade us to think of ourselves as computers made of flesh. Is this really an improvement over the view that humans are sacred beings of mysterious origin? Is it an accurate belief? Could it not be the case that there is more to humanity than synaptic activity?
Personally, I’d recommend a grandmother’s advice about how to achieve happiness over a neuroscientist’s. I’d embrace a yogi’s opinion about how to manage anxiety over a psychiatrist’s. And I’d endorse a saint’s ideas about the meaning of human life over a reductionist’s. Sure, let’s continue to study the brain. But until the research proves itself in the behavioral realm, let’s not grant it so much influence over how we view ourselves and our struggles.