Here’s the question:
To what extent are the findings of neuroscience useful to psychology?
Here are some of thoughts about that, triggered by the report of research that found an association between dopamine transmission and the ability to work hard. The researchers assumed that it was the dopamine transmission that was the important variable. People with “good” dopamine transmission were able to work hard.
Like all research on the relationship between physiological variables and psychological variables these findings can be interpreted in various ways. Two of the most important interpretations are as follows:
Interpretation 1: The location and dynamics of dopamine transmission in the central nervous system of a human being has significant influence over how hard s/he is able and willing to work.
Interpretation 2: The ability and willingness of a human being to work hard is essentially a function of how s/he uses her mind and emotions and is merely mediated by dopamine transmission. The dynamics of dopamine transmission are a result, not the cause of the ability and willingness of a human being to work hard.
In the first case we are ascribing to dopamine transmission a major influence over how hard humans are able and willing to work. In the second case we are saying merely that, when humans are able and willing to work hard, that intention and capacity is facilitated by dopamine transmission.
We don’t have the ability at this point to scientifically determine which of these interpretations is more correct or valid. But the interpretations lead to very different conceptions of how humans operate, what is fundamentally true about humans and how they can be helped to change whatever they want to change.
If you subscribe to Interpretation 1 you believe that the ability and willingness to work hard is either randomly distributed in humans or is a function of genetic dynamics. You believe that in some mysterious way, some humans just happen to be blessed with dopamine dynamics that enable them to work hard and some, unfortunately aren’t. Or you believe that certain humans have genes that enable them to work hard. Of course, knowing what we know now about genetic expression, that notion becomes very complicated.
According to the findings of epigenetics, whether or not certain genes are expressed and how strongly they are expressed is largely influenced by the experience of human beings. So it is impossible to tease out the extent to which the ability to work hard is a function of the genes one is born with or what has happened to him or her in his or her life. And we have no idea about how genes actually control the differences in dopamine transmission in the brain.
If you subscribe to interpretation 2 you believe that the ability and willingness to work hard is a function of how a person has been raised and the person’s experience during the first 18 years of life. If a person has a very difficult first three or four years in which there is deficient support, affirmation, nurturance, care, etc., it is very unlikely that s/he will be able to work hard. S/he will be too anxious, too easily distracted, too caught up in concerns about whether or not s/he will be safe in the world, will be able to connect with others, will be able to do what s/he wants to do (remember Erik Erikson’s findings of the importance of safety, autonomy and initiative in the first six years of life) to be able to work hard and stick to a task.
If you subscribe to interpretation 1, your effort to help a person learn how to work hard will focus on introducing dopamine into their central nervous systems or, through the use of psychotropic drugs, altering the receptor dynamics so that there is more dopamine present in their central nervous systems. Of course, given the state of our ability to do this, you won’t be able to do this with any precision. You won’t be able to determine where in the central nervous system, the increased dopamine will be located or what will happen to it after you introduce it. And given the fact that using synthetic dopamine to treat Parkinson’s patients is only minimally effective, even if you had a way of targeting the increased dopamine transmission in certain areas of the brain, it wouldn’t be very effective. And given our present state of the art the patient would be subject to significant withdrawal effects because increasing the dopamine throughout the brain would lead the brain to shut down receptors and decrease the density of receptors so when you stopped giving the patient the psychotropic drugs, s/he would experience very difficult withdrawal effects. And s/he would be subject to the kind or relapse that plagues patients who take psychotropic drugs. For the damage that is done by psychotropic drugs and their lack of effectiveness read Anatomy of an Epidemic by Robert Whitaker
If you subscribe to interpretation 2, your effort to help a person learn how to work hard would involve helping them learn how to manage their thoughts; experience, process and use their feelings; become more able to manage beliefs, assumptions, attitudes and habits that lie beneath the surface of their consciousness; become more clear about what they want and what they will have to do to get it. It would involve helping them discharge some of the energy locked in them from traumatic experiences, learn how to manage anxiety, loosen and break up obstacles to them using their energy effectively through helping them discharge some of the blocked emotions that lie inside them. It would involve helping them become clearer about what is true about themselves and more accepting of those truths. It would involve helping them learn how to quiet down and reduce their internal noise level so they can receive the important and helpful messages from inside that have been blocked by all that noise. In other words, it would involve using the many methods of psychotherapy that have been developed and proven to be safe and effective over the years.
Which of these interpretations and methods of helping you use is crucially important. They don’t mix well. Psychotropic drugs will make it much harder for the person you are working with to benefit from the methods associated with interpretation 2. The drugs impair the very faculties that humans need in order to benefit from psychotherapy. They are extremely damaging in many ways and are associated with high relapse rates.
Interpretation 1 assumes a very cynical view of human beings and leads to a very poor approach to helping a person become more able to work hard. It is cynical because it assumes that human beings are essentially bundles of neurons, glial cells, neurotransmitters and synapses who don’t have the ability to do anything to change their behavior beyond taking drugs or submitting to psychosurgery. It is poor treatment because it deprives the person of the opportunity to learn how to work harder through learning how to manage her or his thoughts, emotions, intentions, perceptions, reactions and behavior. It is also poor treatment because the drugs and psychosurgery will impair the ability of the person to use and process thoughts, emotions, intentions and perceptions with acuity and sensitivity. The use of drugs and psychosurgery with subject the person to difficult and painful withdrawal effects and will subject the person to high relapse rates once the drugs are withdrawn.
No matter how sophisticated the neuroscientists become, no matter how advanced their findings about how the brain works, the use of drugs and psychosurgery will never be as safe or effective as psychotherapy. If you want to change brain chemistry or physiology, it will always be better to do it through psychotherapy. It will always be more effective to help people learn how to manage their thoughts, feelings, intentions, behavior. And, of course, as they become better at doing that, their brains and central nervous systems will change, will become healthier. That will always be a more safe, humane and life-enhancing approach than giving them drugs or using psychosurgery.
Therefore, the findings of neuroscience are not useful to psychology and it’s questionable if they ever will be.
So it may be interesting to learn of the findings of neuroscience. It may be fascinating to learn how the brain works. But as William Uttal, a neuroscientist, argues in his book Mind and Brain: A Critical Appraisal of Neuroscience, the neuroscientists don’t have an adequate theory of how the brain creates the mind and they never will have. The mind is so vastly more complicated, powerful, facile and rich than neuroscientists are able to explain that they are in the dark ages about how the brain is related to the mind. And, in order to effectively study the brain, they have to simplify it or reduce it to the point at which what they are studying is not an accurate or complete representation of the brain and certainly not an adequate explanation of the mind.
So the findings of neuroscience may be useful to mainstream psychiatry with its focus on the use of drugs and psychosurgery but they will never be useful to psychology.
I can hear the mainstream psychologist saying “Well, this is why we recommend a combination of drugs and psychotherapy. Since we can’t tease out the causal relationships, we use both.” I think that is wrong-headed. I don’t think you can have it both ways. Either you think human beings are essentially bundles of neurons, neurotransmitters and synapses or you think they are meaning-making, fine-tuned organisms with strong desires to love the way they want to love, work (express themselves) the way they want to work and enjoy life the way they want to enjoy life and who get upset, agitated, afraid and concerned when they can’t do that.
Let me put it another way. Even if you throw up your hands and say I just don’t know what the causal relationship is and we don’t have a scientific way to determine it, in order to be an effective psychologist you have to decide what you think is important.
Are the neurons, neurotransmitters, synapses and brain chemistry important or is how the person is living his or her life and reacting to it important? What is important? How you answer that question will determine how you work with the person.
You can’t have it both ways. Because using drugs and psychosurgery is inimical to effective psychotherapy. I’ve already given you some reasons why. Here are some others. Using drugs tells the patient that s/he doesn’t really have much control over her thoughts, emotional processing, intentions, reactions or behavior. She is essentially at the mercy of her genetic dynamics and brain chemistry and function. That kind of thinking gets in the way of effective psychotherapy.
I can hear the neuroscientist saying, “well, yes, I understand that human beings have powerful desires and intentions and that they get frustrated when they are unable to live the way they want to live but we can’t measure that with any precision, we can’t quantify it, we can’t put it under a microscope. Oh, we can use magnetic resonance imaging and PET scans to get some crude measures of brain structure and function but we don’t know the difference between what goes on in the brain when a human being is planning a trip, making an important decision, trying to understand something or just imagining a vision of the future. We can’t study that stuff scientifically.”
True. But we can study it phenomenologically. We all know what it is like to experience the process of quieting down, relaxing, going into a calm state and allowing new thoughts to come into our head. We know the experience of being able to count to ten and allow the first rush of anger to dissipate giving us an opportunity to respond to the threat in a more measured and useful way. We all know the experience of being able to work hard at something even though we don’t know if our work is going to pay off or not. Or at least we can imagine what that experience is like.
And we can use empirical approaches to study the impact of psychotherapy on mental and emotional functioning and on behavior. We can measure the differences in what happens to two randomly chosen groups of people when we provide some kind of psychotherapy to one group and a different kind of psychotherapy to the other.
Empirical approaches and phenomenological approaches are scientifically valid. They may not meet the neuroscientist’s test but they can enable us to learn the truth about human beings and what makes them tick.
This question of the relative importance of psychological variables and physiological variables and the causal relationship between them is important. It determines how we spend the precious resources that are available to help people who are going through hard times. One of the tragedies in our world is the fact that the National Institute of Mental Health spends 90 percent of the $900 million it spends each year on brain research and research having to do with psychotropic drugs. None of that is going to help anyone, at least not in the short run. Medicaid spends billions of dollars on drugs but not a penny on a Soteria House which would actually help a person recover from early psychotic break.
Here is the argument in a nutshell:
- Believing that mental disorders are caused by chemical imbalances, genetic dynamics and neurological disorders is inimical to good treatment. It gives patients the erroneous and cynical message that they are just a bunch of neurons, neurotransmitters and synapses, that they are at the mercy of random forces over which they have no control and that there isn’t much they can do about it except take drugs.
- Believing that mental disorders are reactions to life situations, are how people are avoiding pain, protecting themselves, feeling more adequate, reconstituting themselves, having the illusion of control, is associated with good treatment. It gives people the message that their symptoms are understandable, meaningful and potentially useful, that they can use them to learn about themselves, develop some compassion for themselves and learn how to manage their thoughts, emotions, intentions, perceptions and behavior in a way that will enable them to live more the way they want to live.
- It will always be better to believe that mental disorders are reactions to life situations, etc. and to use psychotherapy as the approach to treatment.
- Therefore, the findings of neuroscience are not useful to mental health professionals and whether or not they ever will be is open to question.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.