Thursday, June 27, 2013

Going to Synagogue, With a Punch Line

6/27/12. Ruth Wisse:  "Maybe Jewish humor is rooted in the incongruity of being chosen --- by God and by oppressors."

Book Review: "Brainwashed: The Seductive Appeal of Mindless Neuroscience"

6/27/13. My book review:
Satel, Sally; Lilienfeld, Scott. Brainwashed. The Seductive Appeal of Mindless Neuroscience. New York:  Basic Books, 2013.

             “Fifty Shades of Gray Matter,” was the first title Sally Satel wanted but she had to go with “Brainwashed. The Seductive Appeal of Mindless Neuroscience.”

              The book has six chapters and an epilogue:

 1.    This Is Your Brain on Ahmadinejad:  Or  What is Brain Imaging?

 2.    The Buyologist Is In:  The Rise of Neuromarketing

 3.    Addiction and the Brain-Disease Fallacy

 4.    The Telltale Brain:  Neuroscience and Deception

 5.    My Amygdala Made Me Do It:  The Trials of Neurolaw

 6.    The Future of Blame:  Neuroscience and Moral Responsibility

 Epilogue:  Mind over Gray Matter

Satel and her co-author Scott O. Lilienfeld discuss the stunning progress in neuroscience and its implications for society, especially through the development of functional magnetic resonance imaging (fMRI) that takes pictures of the brain in action.

The authors do not aim to critique  the science and technology of brain scans. Rather, Satel and Lilienfeld sound a warning bell that we are witnessing premature applications of these seductive, techno-color images of the brain that promise to help diagnose drug addicts, understand the influence of neurological damage on criminal responsibility, and predict consumers’ buying habits, to name only a few topics discussed in this concise, elegantly written book.  

Psychologists, psychiatrists, and neuroscientists are alert to this warning and know we are in danger of losing the mind to this age of  neurocentrism.  

For example, in his new book, The Spark:  The Science of Human Development, Jerome Kagan reviews in detail the many problems using blood flow measures in the brain to understand emotions:

…many events evoke a brief feeling that lasts about a second and then disappears. But there is little change in blood flow to a brain site during the initial second. The peak in the blood flow signal occurs about six seconds after the event occurred and therefore, five seconds after the feeling may have vanished. The blood flow measure reflects a cascade of phenomena that include association to the event, a possible feeling, and perhaps a private query as to why the scientist presented that particular stimulus.

The rigor of psychological studies of the mind cited in Kagan’s book often take a back seat to the fMRI scans which measure brain activity by noting associated changes in blood flow. Since cerebral blood flow and neuron activity are correlated, when an area of the brain is in use, blood flows to the region also increases. We are flooded with observations of brain parts lighting up.  There are no shortages of interpretations when certain regions of the brain glow --- even though we know that brain regions have millions of interconnections, we sometimes confuse the meaning of excitatory and inhibitory functions on brain sites, and that the better people become at a skill, the less hard the brain appears to work.   

Yet this neuromania pervades the culture, supplying consumers craving certainty the illusion of simple black-and-white answers to their many shades of gray psychic distress.

For example, the other day I watched the Dr. Oz Show, a daily television program focusing on medical issues and personal health launched by Oprah Winfrey’s Harpo Productions and Sony Pictures. Dr. Mehmet Oz is a cardiac surgeon, and Professor of Surgery at Columbia University. I watched Dr. Oz interview  child and adult psychiatrist Dr. Daniel Amen on the topic:  “Your Brain:  Up Close and Personal.”  Dr. Amen  runs the many national outlets called Amen Clinics (sounds religious) in Newport Beach, California; San Francisco, California; Bellevue, Washington; Reston, Virginia; Atlanta, Georgia; and New York, NY.

According to Satel and Lilienfeld:

…Daniel Amen, oversees an empire that includes book publishing, television shows, and a line of nutritional supplements. Single photon emission computer tomography, SPECT, a nuclear-imaging technique that measure blood flow, is the type of scan favored by Amen. His clinics charge over three thousand dollars for an assessment…he grossed over 20 million in 2011…There is near universal agreement among psychologists and psychiatrists that Amen’s scans cannot diagnose mental illness.

In another chapter, Satel and Lilienfeld focus on neuromarketing --- a field with a long history. Using consumer motivational research, depth psychology and subliminal tactics to manipulate expectations and induce desire for products was the theme of Vance Packard’s (I read it in high school) classic book on advertising,  “The Hidden Persuaders,” published in 1957. Now, enter the fMRI and marketing. Some neuromarketers sell the idea that focus groups are not a reliable means to find out what consumers like or what they are going to buy. Instead of asking people about their buying preferences, neuromarketers bypass the conscious mind and go straight to analyzing fMRI’s of consumers to determine both their unconscious desires and decision making processes.

Satel’s specialty is treating drug addicts. She is frustrated with the accepted definition of addiction as a chronic and relapsing brain disease. To treat drug addicts, Satel reminds us, we must help them change their behavior and cravings for drugs. To do this, we appeal to their desire and motivation for change. To call something a disease implies there is a medication to stop the disease process. There is no such medication for drug addicts --- and for many other mental maladies. Drug addicts sometimes respond to incentives to change. People with disease are not able to reverse their disease voluntarily. To treat drug addicts, we have to understand minds.

In their last chapter, Satel and Lilienfeld turn their attention to neuroscience and moral responsibility. They wonder if advances in neuroscience bring us closer to solving the age-old dilemma of how much of our behavior is determined and how much is the result of our free will.  As Satel and Lilienfeld note, the proper use of reason is to recognize reason’s limitations. Neuroscience does not bring us closer to understanding this predicament.

We do have a choice about learning from neuroscience and accepting the limits of our new technology, without throwing out our minds with the brain water. We remain mystified  about how the water of the brain becomes the wine of self-consciousness. Our limits spring from the mystery of the generation of consciousness, the basic experience of humans on which our social and personal relationships rest. We do not understand how consciousness is produced, nor do we understand its full potential.

I believe I made a free choice to read Satel and Lilienfield’s superb book, but maybe the writer Issac Bashevis Singer is on to something when he says:

We have to believe in free will. We’ve got no choice.


 (1)   Kagan, Jerome. The Human Spark. The Science of Human Development. New York:  Basic Books, 2013. 

 (2) The authors dedicate their book to James Q. Wilson, a brilliant social scientist. Please type James Q. Wilson into the search box for this site and some of his articles will be available for you to read.




Tuesday, June 18, 2013

"A Nation of Kids on Speed"

6/18/13. Drs. Cohen (physician) and Rasmussen (historian) tell us about the history of stimulant use --- as a weight loss drug, and as an antidepressant. It is obvious that these doctors have not worked in a clinical setting, diagnosing and treating people who need help.

These doctors know not what they are talking about. After 35 years of treating children, adolescents, and adults, I know that stimulant medication saves lives of those properly diagnosed with ADHD and associated disorders.

The relentless attacks on psychiatric medication never let up. People are down on things they are not up on.

My response:

           Regarding Drs. Pieter Cohen’s and Nicolas Rasmussen’s article, “A Nation of Kids on Speed,” these authors make evident that attention-deficit/hyperactivity disorder is a well-known disorder that is not known well.

 What is not known well:

·       There is a wealth of scientific data on the clinical description, epidemiology, developmental course, prognosis, etiology, evaluation, co-existing disorders, differential diagnosis, and treatments for ADHD.

·       There are some excellent long-term studies about the positive effects of stimulant medication for ADHD.

·       The psychostimulants methylphenidate (Ritalin) and amphetamine (Adderall) are the oldest and most established pharmacological agents in child mental health.

·       The benefits of stimulant medication for ADHD have been studied over more than 50 years.

·       Medications are underused in some regions and are prescribed too freely in others.

·       There is strong evidence that ADHD is a genetic disorder.

·       Most people who suffer from ADHD never get diagnosed or take medication.

·       People who have undiagnosed ADHD are at risk for substance abuse, depression, anxieties, and suicide.

·       These medications work for the vast majority of people who are properly diagnosed.

          The authors correctly note that psychological diagnosis is based on symptoms --- and as many recent criticisms of the DSM-V have pointed out, we have a psychiatric diagnostic manual that is more reliable (consistent) than  valid (the disorder exists). We rely on symptoms to treat such disorders as ADHD because we have no valid biological tests to diagnose ADHD or any psychological disorder. Our psychiatric diagnoses are significantly handicapped because we have no idea how the water of the brain generates the wine of consciousness.

Of course our reliance on symptoms does not mean we know nothing about psychiatric disorders. Even Drs. Cohen and Rasmussen insert one sentence in their half-page article that, “Stimulants can certainly benefit some young children with truly disabling ADHD.” They go on to claim, “history has already taught us that overprescribing stimulant to millions of Americans leads to dependence, addiction, and overdose.”

History may have taught this to Drs. Cohen and Rasmussen, but the clinical experience of many psychologists and psychiatrists informed by  rigorous, peer-reviewed scientific research on ADHD, has shown that many children, adolescents, and adults find stimulant medication like glasses-for-the-mind, enhancing focus, organization, planning, and effective self-monitoring. 
Do some people abuse stimulants – of course. People with substance abuse problems abuse stimulants --- and  some vulnerable people may be use stimulants to “self-medicate” to “treat” undiagnosed psychiatric problems, or use stimulants to stay up all night, or whatever people do who are impulsive, have faulty judgment and try to cope with psychic despair.
Psychiatric medications such as stimulants sometimes offer life-enhancing measures to improve the faulty “hard drive” improving mood stability, the ability to filter out external distractions, or improve self-control. Psychological therapies, often helpful with people with ADHD, do much to repair “software,” providing supportive settings to promote hope, reroute faulty “instructions” and teach people how to live better.
Until we have a medical test to identify ADHD, no amount of scientific knowledge, clinical experience, or testimonials from parents and youngsters will convince Drs. Cohen and Rasmusssen of the importance of treating  ADHD across the life-span.

I hope that Drs. Cohen’s and Rasmussen’s efforts to protect us from the dangers of the misuse of medication for ADHD does not generate the side-effects of growing-up with untreated ADHD --- side-effects such as school failure, depression, delinquency, and suicide.

Steven J. Ceresnie, Ph.D.
Independent Practice
Plymouth, Michigan

WSJ Letters to the Editor:

Saturday, June 15, 2013

Pathological Altruism


We don't think we'd ever heard of Oakland University, a second-tier institution in suburban Rochester, Mich., but Barbara Oakley, an associate professor in engineering, may help put the place on the map. Earlier this week Oakland's Oakley published a fascinating paper, "Concepts and Implications of Altruism Bias and Pathological Altruism," in the Proceedings of the National Academy of Sciences.

The paper is a concise summary of an innovative idea that informed Oakley's two recent books: "Cold-Blooded Kindness: Neuroquirks of a Codependent Killer, or Just Give Me a Shot at Loving You, Dear, and Other Reflections on Helping That Hurts" (Prometheus, 2011) and "Pathological Altruism" (Oxford University Press, 2012). The former has been described as a true-crime thriller; the latter is a dense, 496-page collection of 31 academic papers, edited by Oakley and three other scholars...

Thursday, June 13, 2013

Laughter and the Brain


Dr. Richard Restak:

"In my neuropsychiatric practice, I often use cartoons and jokes to measure a patient’s neurologic and psychiatric well-being. I start off with a standard illustration called “The Cookie Theft.” It depicts a boy, precariously balanced on a stool, pilfering cookies from a kitchen cabinet as his sister eggs him on, while their absentminded mother stands drying a plate, oblivious to the water overflowing from the sink onto the floor.  Though not really a cartoon—in that nothing terribly funny is taking place—it allows me to begin assessing various things: abstraction ability, empathy, powers of observation and description, as well as sense of humor. I am especially curious to see how patients process the image, whether they perceive only a portion of it or take it in as a whole. Some people notice only the boy, others only the mother..."

Monday, June 10, 2013

On Antidepressants in Bipolar Disorder

6/10/13. Interview with psychiatrist Nassir Ghaemi. His new book, "On Depression," is a welcome addition to a muddled field. Dr. Ghaemi draws on his knowledge of psychiatric history, philosophy, medicine, clinical experience, and research to widen our understanding of the diagnosis and treatment of mood disorders.

The Attachment Debate

6/10/13. Jerome Kagan, professor emeritus at Harvard University, writes his first blog and the controversies about the development of love.