Neuro: The New Brain Sciences and the Management of the Mind
by Nikolas Rose and Joelle M. Abi-Rached
352 pages. Princeton University Press, 2013.
In a typical PET (positron emission tomography) brain scan, a radioactive element attached to glucose is injected into the subject’s blood and traced as it flows into and throughout the brain, where the molecule’s decay can be measured to yield an image of the brain at work. In Neuro: The New Brain Sciences and the Management of the Mind, Nikolas Rose and Joelle M. Abi-Rached attempt an analogous procedure regarding the diffusion of a neuroscientific mode of thinking about the mind into the psychological and social sciences and practices concerned with keeping society safe and and its members sane. The image that emerges from their detailed critical look at historical and current research and practices in neuroscience, psychiatry and psychopathology reveals widespread overselling of the clinical implications of neuroscience research, a “screen and intervene” norm guiding social control, a crisis in the diagnosis of mental illness, and a lamentable lack of constructive engagement between the neuro, “psy” and social sciences. Rose (Professor of Sociology and head of the Department of Social Science, Health, and Medicine at Kings College London) and Abi-Rached (Ph.D. candidate in the history of science at Harvard University) do not share the reductionist fears of many in the humanities and social sciences or the reductionist claims of some neuroscientists. Their message is that while we have new neurobiological levers of control, we still need to figure out how these levers are related to the mental health and behavior of individuals in society, and when and how to use them. They urge the psy and social sciences to play an active role in this endeavor.
In the first three chapters of the book, the authors introduce and elaborate what they call the “neurobiological style of thought”. This style is assigned an official (if admittedly somewhat arbitrary) beginning in 1962, when MIT biophysicist Francis O. Schmitt got funding for an interdisciplinary neurosciences research program. The program initially included neurophysiology, neuroanatomy, neurochemistry, neurology, immunology, psychology, psychiatry and psychoanalysis, although the psy disciplines soon became the dog being wagged by the neuro tail. In the resulting “neurobiological reconfiguration of ways in which individual and social problems are made intelligible and amenable to intervention”, all causes of and responses to abnormality and anti-sociality (and, increasingly, wellness) pass through the brain.
The authors identify four critical features of this neurobiological vision: new knowledge of the biology, chemistry and physiology of brain components, particularly neurons and synaptic plasticity at various timescales and times in a single lifetime; new technologies for non-invasively “seeing” the cognizing brain in action; the use of bioengineered animal models of human mental function and behavior; and unprecedented pressure to link research to immediate public, hence potentially lucrative, benefits. This “translational imperative” has promoted inflated claims of benefits, selective reporting of findings, and overgeneralization of results. It also encourages reductionist claims, since discoveries at, say, the neurochemical level must be construed to be very closely linked to mind and behavior in order to be thought relevant to alleviating mental and social ills.
These problems are perhaps clearest in the use of animal models, in which researchers induce abnormal animal behavior in a laboratory environment in order to learn about the abnormal mental functioning of a human being. The conceptual and theoretical steps that link lab results to the clinic too often involve a chain of ill-defined conceptualizations of mind, behavior and relevant environment (both animal and human). A fascinating aspect of this research, explored in detail, is the role of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) in a cycle of “self- vindication”: Human mental illness is diagnosed behaviorally using the DSM; a type of mouse is developed that exhibits putatively analogous behaviors (e.g., giving up quickly on a forced swim test, which is interpreted as a kind of learned helplessness, itself a marker of depression in humans); a drug is administered to see if mouse “depression-like behavior” improves; if it does, the drug may be tried on diagnosed humans; if they improve, we look at the mouse brains to see what happened. A fundamental problem with this self-vindicating cycle is the fact that DSM-derived diagnoses are severely underconstrained, generating an unacceptably large number of false positives. As a result, what has been manipulated and what the results of these manipulations mean is not clear.
The publicly most obvious of the four features is the visual one, and in particular the development of functional magnetic resonance imaging (fMRI) and the ubiquitous and persuasive images of “lit up” brains. Rose and Abi-Rached correctly point out the “attribution of false concreteness [to these images] by researchers, policymakers, and popular interpreters”. Unfortunately, their sociological perspective on this problematic aspect of neuroimaging misses the basic problem. For it is hotly debated, not “undoubtedly true”, that “such images provide powerful support for particular theories of brain functioning, by purporting to allow researchers to actually observe the mind/brain seeing, hearing, smelling, thinking, desiring, emoting, willing, or hallucinating.” The images are statistical maps that display brain-activity data the way maps of the United States with states colored red or blue display voting-behavior data. Their objective- seeming allure would not be an issue if the data from which the images are derived really did provide powerful evidential support for theories of mental processing. The reason they don’t (mentioned briefly on p. 80) is because most brain areas are active in many different cognitive processes and because inactivity or subthreshold activity might be just as critical. So just because an area “lights up” in a new experiment, it cannot be reliably inferred that a particular cognitive function involving that area in previous experiments is involved in the new one. (New whole-brain or network analyses are being used to derive better inferences, but such developments are not yet part of the neurobiological vision.)
But the authors also make clear that the neurobiological style of intelligibility and intervention has diffused so quickly in part because the psy and social sciences have not been providing either intelligibility or effective intervention. Consistent with their assessment of the crisis of legitimacy in psychiatry is the fact that in late April the National Institutes of Mental Health withdrew its support for the 5th edition of the DSM (http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml) as a sufficient diagnostic tool even though we don’t yet have reliable neurobiological markers to add. At the moment, psychiatry now exhibits what Allen Frances, chair of the DSM-IV task force, calls “an unhappy combination of wildly false-positive set of criteria coupled with potentially dangerous interventions”. Moreover, many in the social sciences (and humanities) hold an entrenched conviction that individuality, improvisation and other behaviors and traits that manifest dynamic responsiveness to the environment belong to humans alone. This conviction may hinder the social sciences’ ability to contribute to improving the conceptualization of animal models mentioned above.
In the final chapters of the book, the authors focus on how the neurobiological vision is reconfiguring how we understand and respond to mental illness, cognitive capacities most relevant to social behavior, anti-social behavior, and the self. Social neuroscience in particular comes in for critique from both sides: “social” behavior is often modeled in the lab using highly unrealistic experimental paradigms, but few sociologists think social neuroscience models have implications for “their often unarticulated conception of human beings as sense making creatures …. shaped by institutions that owe nothing substantial to biology.” (This makes Rose one of the “lonely voices” (p. 160) in his field calling for engagement.) The authors also draw non-standard conclusions regarding the vision’s relation to the law and the self. They see the main impact of neuroimaging and other neurobiological evidence taking place outside of the courtroom, in criminal justice policy regarding such procedures as crime prevention, risky person identification, and processes leading up to and following trial. They also argue that despite dramatic and often conceptually confused pronouncements of the “you are your synapses” variety, the neurobiological vision of the self has only led us to add a neurobiological dimension to self-understanding and processes of self-management.
In summary, Rose and Abi-Rached provide is a rich and provocative look at how neuroscience has permeated thinking about ourselves and society, and how the psy and social sciences should respond. Neuroscience hasn’t lived up to promises in understanding mental illness, consciousness, or the link between mind and brain, but gone are brute (and brutish) brain interventions such as lobotomy, and gene-for-disease approaches have given way to genetic-based vulnerabilities to environmental insult. Everyone still agrees social factors are important in shaping people into productive members of society. We still need to create environments that make it easier for us to make the right decisions. What’s missing are psy and social science contributions to the neurobiological vision: better concepts of the social, the abnormal, and the normal that can help neuroscientists develop better experimental designs and mental and behavioral constructs and make more reliable inferences from lab results to real-world practices.
Carrie Figdor is Associate Professor in the Department of Philosophy and the Interdisciplinary Graduate Program in Neuroscience at the University of Iowa. Her research involves theoretical issues in cognitive neuroscience and neuroethics.
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