Brain Science Podcast discussion
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Brainwashed
2014
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BSP 109: Avoiding "Neuromania"
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I had some thoughts on the increasing trend of looking to (neuro)science for answers about why people engage in harmful behavior...My own work has pointed me to an idea of encouraging folks to look at problem solving, in essentially any area, by first asking what the (positive) goal is, and then looking for examples (data) about what factors/causes have previously produced results that are similar to the intended goal. Using the current situation as the starting point, then we can look at what factors/causes we can add to the system to get us from here to where we want to go. This would mean that in looking for ways to reduce or eliminate harmful behavior in us animals — for example addiction to drugs — we can look at what the biology (nature) is and see what combination of other factors (nurture) have allowed an individual to be healthy — not addicted to drugs — in the past. Then we can look to add those other factors to the mix and check to see how well our predictions worked.
This approach to problem solving by breaking the situation down into a starting state, goal, variables and invariables, and then looking to add the variables that have a high correlation to the goal (when added to the invariables) is very novel when it comes to making social policy, but it obviously offers a far more practical, rational, and scientific approach to solving our problems than anything else we seem to have tried.
So, when it comes to using neuroscience in courts and other social areas when we’re looking to solve our problems, we can promote looking at the what the brain does (whether you call that mind, psychology, behavior, or whatever) as a combination of the invariables of genes, basic physics, and biology all added to the variables coming into the system from the environment (inputs of solids, liquids, gases, and energy, including information, and availability of outlets for the body’s own solids, liquids, gases, and energy). That way we don’t need to get lost in semantics and cognitive biases that cause us all so much frustration, and can instead focus on getting to where we want to go as a planet as effectively as possible.
And really, that's our biggest goal, isn't it? To have a happy, healthy planet that's really living well!
There is an attempt to reduce away will power. But what is will power? It means a person wants to do something. Either we want to do something, or we don't. We can want things for self, but it's extremely difficult to want things on behalf of other people. Could it be said, it is the people who do want something, are the people who have something? I wonder why that is. I'm afraid neuroscience is not going to answer, either.When we reduce the idea of agency through neuroscience or any other type of science, we reduce ourselves as human beings. Why? Why is that? It is because "human" is an abstract idea and we live in the abstract. We are intellectual beings and not physical beings. I do not think neuroscience can successfully explain what it means to be intellectual.
I liked the last episode, by the way. It was very good. I forwarded it to several people.
I listened with interest to your recent discussion about the pitfalls of perceiving addiction as a brain disease. I work in community mental health as a counselor/therapist and I would like to assure you that, at least in my own experience, the idea of addictions as a brain disease and therefore as something that an individual has no control over is not the operating basis for addictions treatment, nor is that the model that is taught in graduate school. I would refer you to Motivational Interviewing, which is the prevailing evidence based practice for addictions treatment at least where I work. Motivational Interviewing is based on the importance of personal control and choice in recovery. This model does include relapse as a part of the addiction recovery process/cycle, but this is presented as something that is hopeful information to interested parties (the person struggling with addictions, family, friends & involved professionals) that if a person does relapse that this is part of a cycle which will eventually lead to sustained recovery. I would add that thinking of addiction as a brain disease prior to graduate school (I graduated in 2005) never made me think that an addict’s choices & behavior did not have an impact on their recovery. I feel that perhaps you and the authors may have overstated the impact of this idea on people’s thinking about addictions and in the treatment of people with addictions. I think another important piece of the addictions misperception puzzle are remnants from the “just say no/war on drugs” campaign which painted all illegal drug use as highly problematic rather than a more nuanced view of people’s use of illegal drugs. I think these ideas are still in our culture and that there is a tendency to ignore the fact that, as you pointed out, the vast majority of people who use illegal drugs do not end up horribly addicted and that most people who do become addicted are able to stop, often without professional help. Just as food for thought, regarding the story about the alcoholic who was trying to have charges dropped and who was able to refrain from drinking because he needed to be sober in court, it brought to mind the population that I work with, people with serious and persistent mental illness. I work with individuals in a residential setting whose symptoms are not well controlled and who are highly symptomatic (experiencing delusions/hallucinations etc.) most of the time. I and my co-workers have noticed that people with Schizophrenia, even when it is very poorly controlled, are able to “hold it together” if the incentive is high enough such as during a family visit. We have one individual who always denies that they have any mental illness and who is at baseline highly delusional who blurted out “I have schizophrenia!” during a phone call with Social Security when asked repeatedly why they are unable to work. You indicated that the sign of a brain disease is that a person does not have control over it, but I am not sure that Schizophrenia (one of your examples of a brain disease) falls entirely in that category. In my experience and others who work in my field there are times that individuals with this disease are able to control their behavior, at least for brief periods of time, similar to the alcoholic who refrained from getting drunk.
Finally, I was excited to hear that you are exploring hospice/palliative care. I used to volunteer at a hospice facility and found it very rewarding. When people are dying there is an opportunity for such profound connection with those around them that is not available at any other time, and being with these people and their loved ones during this time is a privilege. If you have not already listened to it, you might want to listen to the recent This American Life podcast ( I believe it was titled “Death and Taxes”) which profiled a hospice facility.
Good luck to you!
Yeah, Kathy, I think it's important to remember that having a disease (nature) doesn't mean that changing things that can be changed ("nurture") can't improve (or make worse) one's ability to live a rewarding and enjoyable life.Also, addiction can be called a disease in the same way that type II diabetes can (since both are caused by things that can be changed), and we can still work to improve the health and well-being of those who have diseases.
I feel the concept of disease is overused. I agree things need to be labeled or identified allowing everyone to talk about the same subject or issue, but the concept of disease seems to lack dynamic characteristics. With regard to addiction and possibly some other mental health issues, if a person does work to effect change in self, for whatever reason, is that person not changed? If the person had a disease, is the disease not gone? That doesn't line up well with the concept of disease. The same holds true for type II diabetes, such that if a person changes diet and begins regular exercise, the diabetes may go away. In future that person may have less tolerance with regard to food, but maybe that person was eating way to many sugars to begin with. This is all in flux and dynamic. The problem with a disease categorization is it locks people into a definition averse to dynamic characteristics and hope for change. The way things used to be defined was good, to the extent there was nothing at all before that. Now we can define things better that do not lock people into malady so much.
I emailed this to Dr. Campbell and she encouraged me to post it, so for what it's worth:The first part of your podcast was superb! I agreed entirely with everything you had to say about the technology involved in analyzing the brain. However, in the second part beginning with your discourse on addiction, I feel you really don't understand real addiction. It's one thing to treat people who are addicts and even if you see them for as long as 30 days of detox, you still can't get a really good foundation. I know this because I have had to deal with them for the last 8.5 years in my work. Let me say up front, I am not a councilor or degreed in any form of social work. I am a computer technician with an educational background in microbiology.
Up until the beginning of this year, I was employed by a small non-profit corporation called "The H.O.U.S.E., Inc" here in Joplin, Missouri. It is a residential facility for recovering alcoholics and addicts. It has 9 properties with a total capacity of just under 200 men and women. It also included an outpatient facility. The company is more than a residential holding facility for recuperating addicts, it has a minimum 1 year program that includes 13 in-house group meetings, counseling staff, an in-house GED program, a continuing educational program for both vocation and college advising and assistance, a VA program and VA contract, and receives funding for the support and rehabilitation of addicted parolees. As the result of the 1 year length in the program, it gives a person the chance to get to know the addicts well and watch them go through stages in recovery. I've watched several hundred people in long term and I know quite a lot about addiction as the result.
Like you, I have always had a problem with the notion that addiction is a disease. To me, disease is cause by a vector of some sort. Addiction, from my view, is a disorder with a genetic foundation. It would be hard to argue against the predisposition we see in those who become addicts vs those who don't. One common theme among the people who become addicts or alcoholics is that they will say (in meetings) that they never felt normal. The people who become addicts are people who are always trying to get out from under and want to drop-out - even for just a while. Unfortunately, they are also the people who are most likely to become addicted. They are always feeling a sense of anxiousness. The dopamine reward tends to restore a state of homeostasis, a release from tension and blissful state of relaxation. It may be that the addicts and alcoholics have a deficiency of dopaminergic neurons or insufficient synapsis with the limbic system to provide a degree of homeostasis that they can cope with 24 hours a day, 7 days a week, 365 days a year. As the founder of The H.O.U.S.E., Inc. used to say in meetings, the first year is a gift and while the clients remain is a structured environment with a support system, they do all right. However, you are quite wrong when you say that 40% recover. Relapse is more like 80-85% nationally. You have to ask yourself. what constitutes recovery? A month, a year, 5 years, 10 years? Much of the problem in recovery is that the addict or alcoholic is walking a fine line between recovery and relapse all the time. As I used to try and explain to the clients, while here at the House, this is your opportunity to find a new way of living that satisfies you personal needs for life apart from the House. They do well while they are hear, but the moment they move out and are on their own, they've left their program, there social contacts, their way of life for the past year. They get bored, lonely, and frustrated. The kind of life they have led for the last year is ABNORMAL FOR THEM. The bulk of their personal history is interacting with other addicts and using. They have isolated themselves and the pull of their past life and the activities they used to get involved in pulls strongly out of decades of habituation. So, I would try and encourage them to engage in all sorts of social activities in the local community to find activities in safe environments that would fulfill their need for a social life. Few do it.
Another thing that holds them back in their self image. If the public at large, family and friends look down on them, it's nothing compared to their own view of themselves - a sense of worthlessness. You mentioned a moral foundation as being a criteria for their inability to stay in recovery. Well, for most of the addicts I've know and dealt with, when they are clean, they have all the same beliefs, mores, and folkways that any mainstream American has. One of the things specified in the VA contract is a series of educational seminars for the vets. They are next to useless. If knowing the problems associated with addiction could have made a difference, they would have. Most all knew the possibility that they could become addicts before they ever engaged in the activity but did it anyway. Knowing doesn't make a difference. Once an addict and using, nothing makes a difference - not even prison or death. Everyone here at the House are hardcore addicts - no light weights ever show up on our doorstep. Everyone has burned every bridge, and like Hubbs used to say, we were the "Last House on the Block between them and The Grave." One of the major keys to recovery is to Keep On Trying. In that vein, unlike most other recovery facilities (including the VA), if a client relapses, then goes through detox for a minimum of 3 days, we will re-admit them to take another shot. Better the devil you know than the one you don't. If they get caught cheating, they are put back on restriction - of course, they can walk away any time they please, but most don't.
Probably the one thing that makes the biggest difference in who will recover and who won't is AGE. Those over 45 years old have a chance. Younger than that and they bounce back too easily from all the health problems related to substance abuse. Still, it's not a guarantee.
Where does the problem originate? In the mind, brain, and genome, no doubt about it! Genetically, they are predisposed by the luck of the draw. That draw specifies the construction of that brain which determines the personality. You can argue all you like about the impact of nurture vs nature, but in the end, nurture on serves to inform you of all the alternatives from which you can select a response, by nature decides which one you'll pick because it keeps pushing you in that direction all of your life. The edge older clients have in recovery is due to genes turning on and off with maturity and aging. A drop in sex hormone production goes a long way towards getting a handle on your impulses. The biggest difference between the addict and the recreational user is that the recreational user is far more able to intermittently stop using. The addict, once started, can't stop and will drink until passed out or use until they run out or overdose.
One of the other things that Hubbs was fond of asking in meetings, "how much did it cost you to get here to the House Inc." Hundreds of thousands of dollars! There ain't nothing rational about squandering everything you ever acquired on getting high. Immoral people harm others and although drug addicts frequently causes harm to others, they harm themselves far more and continuously. Others are just collateral damage in the wake of their journey through a disastrous life. Hubbs used to also take a pole in meetings every once in a while asking, "How many of you have considered or tried to commit suicide?" Almost every hand in a crowd that numbered over 100 would get raised. The true addict and alcoholics life is truly miserable.
I hope this will give you some insight that you may not have had.
That was a good perspective, Dalton, contrasting rehab time to what the normal life of an addict is and what they're familiar with. I haven't heard it expressed in that context before.
Hi Ginger!Hi everyone,
I'm a young physiotherapist working in rural NSW, Australia. I've got a real interest in chronic pain and as you can imagine I have devolved a concurrent interest in neuroscience. This has become quite the interest, as a result I was very keen to listen to the "neuromania" podcast as I could certainly describe myself as a bit of a neuro maniac.
I'd like to offer my impression of that episode and in particular how I think it relates to the treatment of chronic pain.
The main point I got from the podcast was that it can be counterproductive to only look at complex issues such as addiction as diseases of the brain. Social factors, attitudes, beliefs etc also clearly play huge roles. The problem with having a neurogenic approach seems to be that it places the burden of responsibility away from the patient. Which potentially becomes an abhorrent belief and a barrier to conceptual change- and therefore neurophysiological change, which after all is the real goal.
My thoughts are that the social factors, culture etc are still emergent properties of the brain and that the real issue is ensuring that the patient sees themselves as having a capacity for change.
Modern neuroscience models of chronic pain potentially portray ongoing pain as being the result of disease to the brain. This does gives the impression of something degenerative, and certainly something which should be managed passively. I feel this is quite similar to older models which put peripheral structure at the centre of the pain model.
For me what is important is that the patient recognises a capacity for change and that they will be the biggest contributor to that change. In my opinion a neurocentric model, if presented well can offer this.
Once again thank you for creating such a fantastic recourse for people to discover, learn and reflect!
Kind regards from down under.
Jack Murphy
show notes for BSP 109
BSP 109 audio mp3