New books on “the brain” are being published every week, it seems, with many of them purporting to explain virtually everything about human behavior, follies, and the future. But increasingly, some very informed observers are expressing some reservations about such speculation, especially where profit motives are involved.
Sherwin Nuland, MD, is one of the most renowned medical authors of our time. A longtime Yale professor of surgery, he was already a noted historian of medicine when his book How We Die won the National Book Award in 1994. His dozen books and numerous articles range widely over his professional and personal interests, with his most recent book being The Soul of Medicine. A few years ago, he “came out” regarding his own treatment with electroshock therapy as a younger man.
From the perspective of medical history, what do you think about the explosion of recent knowledge and speculation about neuroscience?
Nuland: It’s actually pretty straightforward for me — the more we have understood the structure of the brain and its biomechanics, the more we have sought causes for behavior based on organic factors. And I’m very much afraid that this might be a wild-goose chase in the long run. We’ve now reached the point where we have found certain brain cells in other species, such as whales, that are similar to certain cells in the cortex of humans; and if those cells are thought to do with emotions and feelings, then we hear that those species have similar emotions and feelings. I can’t buy a lot of this, and I think we are going through a phase that we will have to step back from within the next fifteen to twenty years.
But isn’t it natural tendency to try to ascribe behavior to biological factors?
Perhaps — it’s a recurring thread in the history of science. In the mid-eighteenth century, for example, doctors and others got the notion that if they understood the structure of the body well enough, they could understand all its function and diseases as well. This became anatomical pathology. Later we discovered that changes important to diseases were not just anatomical but physiological — which means biochemical, essentially. So science in this regard went from trying to explain everything mechanically to later realizing there’s a lot more to it than that. And I think that’s what’s happening with our notions of the brain — we’re now in this anatomical phase.
What do you think the human motivation is toward that sort of reductionism?
Well, we want to be able to explain everything! We don’t want to admit that we will need thirty or forty years to know brain chemistry better and then find specific genes. But even there, we will have to stop and remember that even genes are variable through the course of a lifetime.
Do you see any dangers to the sort of neo-Darwinian speculations of Richard Dawkins and others who attempt to link everything to genes?
It takes away from progress by focusing so much on anatomical factors that people tend to ignore physiological and other ones. And then there is this tendency, when we discover one genetic characteristic, to say this is fixed, that a child born with it will never change — that it is “hard-wired,” a term that sends shivers down my spine as I just don’t believe it. Finally, from a more sociological or demographic point of view, if you begin to find a particular genetic trait in one group more than another, you begin to generalize that this trait will always be there. But genes are not really destiny.
You’ve written about your own personal struggle with a neuroscientific malady, severe depression.
What’s interesting here is that diseases like depression and the major neuroses had been thought, thanks to Dr. Freud, to be emotional or psychodynamic and related wholly to early childhood experiences and so on. But as we’ve gotten more focused on anatomical changes in the brain and are beginning to understand physiology better, even the psychoanalysts are saying that behind many of the major neuroses and certainly the psychoses lies a biological invariance. And I have trouble with that, since I remember so well my own experiences with depression. And there is a lot more that is volitional than one might think by listening to the present-day descriptions of people, who are said to be fixed and determined to develop bipolar or other disorders.
You’ve described your own depression as being situational as well, triggered by difficult personal events.
There is no question about that. And I’ve also noticed that in recovery there comes a point where one’s own basic decisiveness to get better is a major factor. So I can’t believe that if the biological factor is so strong, the conscious decisiveness can be as important as I have found it to be.
How do you think that works? Do you think you’re actually changing your neurochemistry by decisive action?
There’s a good chance of that, yes. I think you can change your own neurochemistry. I do not believe that anything here is smoky and spiritual and shadowy, but that everything has a basis in neurophysiology — there are a lot of factors in brain anatomy we can change, so there must be many in physiology too.
You have said that the electroshock treatments you underwent “got all the jangled connections cleaned out.” What did you mean by that?
That’s what it felt like! The brain is a vast system of communication, and even though it weighs only three pounds, it has 30 billion nerve cells and at least a million billion connections or synapses within every cell. So of course connections and messages can get scrambled in patients who are emotionally ill. And thus, for all sorts of reasons, you start making the wrong choices. But again, you can address that by changing neurochemistry.
Many have observed that this is one of the functions of meditation, for example.
Oh, no question — when you’re meditating, you are essentially changing a whirlwind of stimuli into pathways that are less dangerous to one’s health.
Do you have an opinion on what the priorities for ongoing neuroscientific research should be?
Well, you can’t get anywhere without starting with the anatomy and brain structure, as people are now doing. I think that one of the most important things that is being worked on, and it probably always will be important, is how genes may change in how they’re expressed. This tells scientists that this is not a fixed response; the mere fact that you have the same genetic pattern in two individuals does not mean that they’re going to be the same in other ways. So studying how individual genes express themselves differently in people is amazingly important, as is the ongoing research on the basic chemistry of the brain. And synaptic changes have not been touched on enough, as we do know that certain synapses change over a lifetime — there is plasticity among the synapses. A simple example of this is that it is well known that people who are intellectually active into their seventies and eighties and nineties are more likely to be capable of that intellectual activity. We even know that there are certain protein factors that can affect the synapses and the amount of blood supply that goes to a particular part of the brain, or that can prevent damage to the cells themselves, as in the case of brain-derived neurotrophic factor, the name given to these substances produced in the brain that help determine the efficiency of neurotransmission.
What remains most mysterious about neuroscience to you?
I’ve been fascinated for a very long time by the question of what is this thing we call the human spirit. Is there some spiritual thing we have that is extracorporeal and doesn’t arise from our internal chemicals? If we like symphonic music, for example, and we hear some piece that we love, we can feel things swell up in our chest? What is that? And as for music, I noticed some time ago that in the music that young people have loved so much since, say, the sixties, you can almost always hear the heartbeat in the background — there’s a beat to it that you can recognize as the “lub-dub, lub-dub” of our hearts. Why is that universal, as drumming is universal in the kind of cultures we call “primitive”? There is something going on there that I think is based on brain structure and function, but I would love to see that structure and function correlated with the emotions we feel so strongly at times. Scientists are talking about “genes for emotions,” but I’m having trouble with that. I think that there are factors within us that that have been built up by experiences that may be even deeper than Freud’s unconscious. There may be something that we’re aware of on some level that arouses a sympathetic response.
In fact, the famed San Francisco band the Grateful Dead were among those who consciously tried to emulate the heartbeat at times, with their drummer even recording his unborn son’s fetal heartbeat; and they strove to evoke the Dionysian celebratory impulse in listeners.
The Greeks were constantly revisiting what they called kosmos versus chaos, and they felt there were forces in this world that want to destroy cosmos, to make things chaotic. But they also felt there were forces to keep things stable. And we know in our bodies there are also forces in every cell, and that for every destructive factor there are those that correct the damage that can be done. This is how we stay alive, by repairing the damage done by free radicals, making new cells, and so on. How did the Greeks come to this notion, which fits so well with our own physiology? I’d argue, with no support whatsoever, that within each of us there is some kind of awareness of this “chaos versus kosmos” battle, and, as with evolution, we seek out bonds and physiological changes that tend toward cosmos, or stability, or what is called homeostasis. One of the great miracles of life is the ability to correct the damage that is occurring in and around all of us.