Review of John Horgan’s “The Undiscovered Mind”
The Undiscovered Mind: How the Human Brain Defies Replication, Medication and Explanation, by John Horgan The Free Press, New York, 1999, ISBN 0-684-85075-3; $25.00; 326 pages
Review by Nathaniel Lehrman:
“The emperor is naked.” That’s John Horgan’s conclusion after meticulously examining the new and striking “advances” in understanding mental illness, consciousness and the mind with which the media regularly regale us. One of the very few science writers who sees through the hype constantly issued by the National Institute of Mental Health (NIMH), the drug companies and academia, he points out that the astonishing discoveries of how the brain operates – such as the vivid pictures of brain areas lighting up as we think – fail utterly to explain how the mind works.
Horgan, author of The End of Science: Facing the Limits of Knowledge in the Twilight of the Scientific Age, wrote this book to correct the current intellectual imbalance about mind-science because books about it, “whether by researchers or journalists, are written in a celebratory rather than a critical mode.” (p. 12) He therefore set himself the task of examining “scientists’ efforts to explain the properties of the mind, including consciousness,” their “attempts to medicate or otherwise treat minds afflicted with mental illness,” and their struggle “to replicate the mind’s properties in machines.” (p. 5) In none of these areas did success occur.
Neuroscience’s Explanatory Gap
Horgan contrasts the “relatively weak grip on reality” of “mind-science” with real sciences – physics, astronomy and biology – whose knowledge “is not provisional but permanent and absolute – as much so as the fact that the earth is round and not flat.” (p. 13) With “mind-science,” “theories of human nature never really die. They just go in and out of fashion. Often old ideas are simply repackaged in more palatable forms. Phrenology is reincarnated as cognitive modularism. Sociobiology mutates into evolutionary psychology. Eugenics, stripped (for the most part) of its unsavory political tenets, evolves into behavioral genetics. Old treatments linger too. [And] one paradigm that has demonstrated a Rasputin-like persistence is psychoanalysis, which Freud invented a century ago.” (p. 7)
“The puzzling inability of physiological theories to account for psychological phenomena” has been called the “explanatory gap.” (p. 16) “Neuroscience remains peculiarly disconnected with higher-level approaches to the mind, such as psychiatry. Physiology has not enough to offer about the brain in relation to the mind to lend the psychiatrist much help.” (p. 36) And with researchers constantly learning more about the brain, Horgan finds it increasingly difficult to imagine how all this data can be organized into a cohesive, coherent whole.
He describes a widely publicized 1990 MRI study at the NIMH as typical of neuroscience’s “frustratingly ambiguous results.” Researchers there compared the brains of 15 schizophrenics to the brains of their non-schizophrenic identical twins, and found that “all but one of the schizophrenics had larger ventricles – fluid filled cavities in the center of the brain – than the non-schizophrenics.” Although NIMH director Dr. Lewis Judd hailed the study as a “landmark” providing “irrefutable evidence that schizophrenia is a brain disorder,” the researchers could not establish whether the enlarged ventricles were a cause or an effect of schizophrenia – or of the drugs used to treat it. Follow-up studies also showed that many normal people have relatively large ventricles and many schizophrenics do not.” (p. 37)
Why Freud Isn’t Dead
The many shortcomings pervading Freud’s theories, such as his 1924 claim that World War I soldiers suffering from “battle fatigue” (then called “shell-shock”) were “narcissists, driven mad during war by the threat to their primary love object, themselves,” (p. 52) lead Horgan to call psychoanalysis “a profoundly flawed paradigm.” (p. 74) But he also notes its influence “even among hard-nosed scientists” such as Floyd Bloom, editor-in-chief of the journal, Science ; Nobelist immunologist Gerald Edelman who has now shifted to neuroscience; Oxford University neuroscientist Susan Greenfield, director of England’s Royal Institution; Eric Kandel, pioneer Columbia University researcher in the physiology of memory; and biologist Robert Pollack, also at Columbia (whom Horgan does not mention), author of the brilliant “Missing Moment” which was reviewed earlier on the Meta Lists.
Horgan asked Frederick Crews, the Berkeley English professor whose blistering 1993 and 1994 New York Review of Books articles reopened the most recent attack on Freud, how these scientists could still support Freud. “Likening psychoanalysis to a religious cult that excels at nothing so much as self-perpetuation,” Crews “speculated that they had been brainwashed by undergoing psychoanalysis themselves.” (p. 56) But Crews denigrates the understandable loyalty which successful analysands feel toward an analyst and a method they believe helped them significantly. The doctor-patient relationship in psychoanalysis is more intense than in any other form of psychiatric, and perhaps even medical, treatment, and according to Dr. Kerr L. White, former deputy director of research for the Rockefeller Foundation, that relationship provides approximately half the therapeutic impact of any medical treatment. Understanding these scientists’ allegiance to psychoanalysis requires separating its useful aspects – particularly its sensitivity to the therapeutic relationship – from its many glaring errors.
Psychotherapy and the Dodo Hypothesis
Psychotherapy is a big business in America. Nearly 300,000 American psychotherapists provide some 450 forms of talk therapy, with these practitioners having obtained for mental illness (and thus for themselves) the same insurance coverage given for physical ailments like cancer and heart disease. Nevertheless, most efforts to prove psychotherapy’s value statistically have failed. Those studies which have found it useful also discovered that treatment outcome was unrelated to either its duration or the therapist’s training.
The “Dodo hypothesis” then emerged. This is based on the Dodo in Alice in Wonderland, who insisted, after a race, that “everybody has won and all must have prizes.” Here that means that all psychotherapies are equally effective. In examining the various types, Horgan points out that all have a non-specific, placebo effect, criticizes the emphasis on childhood experience of “psychodynamic” psychotherapy – which he calls “psychoanalysis lite” – and hesitantly describes a here-and-now orientation, such as that of cognitive therapy, as possibly of value. While recognizing the non-specific encouragement/placebo aspect of psychotherapy, he fails to differentiate adequately between the two main approaches to the causes of current difficulties: within childhood, as the psychodynamic therapies do, or within the present, as the cognitive therapies do (and which, in my own experience, is all that most patients need). And he also fails to recognize that the absence of statistical value in many studies of psychotherapy can be explained by the counterbalancing of its helpful and harmful effects.
A vivid description of drug company domination of an American Psychiatric Association Annual Meeting – and thus of control over the Association itself – opens this chapter. Noting how “the history of modern psychiatry can be viewed as a contest between psychological therapies, notably psychoanalysis, and physiological ones, notably drugs,” (p. 105) Horgan examines some of the latter approach’s horrors – the fever cure, the sleep cure, insulin coma treatment, electroconvulsive therapy, emetic treatment and lobotomies, some 40,000 of which were performed in the United States alone by the mid-1960’s. He then questions the value of psychiatric drugs for either depression or schizophrenia.
Concerning depression, Horgan points out that the placebo effect in treating it is so important (but little recognized) that Dr. Walter A. Brown, a Brown University psychiatrist and authority on placebos, suggested that they should be the initial treatment in many cases of depression. This of course horrified the psychopharmacologists. Horgan also shows how the effectiveness of Prozac – “one of the great success stories of modern pharmacology – and modern marketing” (pp. 111- 112) – is insignificantly greater than that of the older anti-depressants, and that a large fraction of patients are not helped by any of them. Indeed, the frequent failure of drug treatment of depression has resulted in a resurrection of electroshock, which sometimes helps profoundly depressed patients while incontestibly damaging their brains.
Horgan unfortunately accepts the specialty’s notion that depression is a disorder, like diabetes, rather than a symptom, like fever. The anti-depressants, which may make patients feel better, can thus be compared to aspirin. If, however, a psychiatrist listens to his patients rather than leaping to label them with diagnoses, he will always find a series of frustrating events and problems which present-oriented psychotherapy can usually help. But if depression is indeed a symptom rather than a disorder or disease, comparative studies of various pharmacological treatments may be worthless since they ignore what has been done, or not done, about its real causes: personal frustrations and other causes of hopelessness.
Horgan points out that drugs are also far less effective for schizophrenia than penicillin is for infections. He cites a leading textbook that some “20 to 30 percent” of those taking medication “are able to lead relatively normal lives, 20 to 30 percent continue to experience moderate symptoms, and 40 to 60 percent remain significantly impaired for life.”(pp. 123 – 124) But he fails to recognize that these long-term results with medications, which also produce the harmful side-effects he describes, are worse than without drugs, such as those reported by Karon (The General Psychologist, 1999): 30% recovered fully and 60 to 70% became self-sufficient.
Genes, Darwin and Artificial Inelligence (AI)
Genetics and evolutionary biology as alleged causes of behavior and mental illness are the subjects of the next two chapters. Both these approaches also turn out to be blind alleys. Changes in people’s thinking and behavior, and in the nature of mental illness, occur far too quickly for slow-moving genetics or biological evolution to have any significance.
Despite the success of chess-playing computers, attempts to create a more general artificial intelligence (AI) as effective as the human brain – or even the brain of an animal or child – have also failed utterly. Disdain for emotion, which is “crucial to human cognition and creativity,” is one important reason for the failure of these efforts.
The Consciousness Conundrum
Efforts to understand human consciousness solely on the basis of brain physiology and other natural science approaches have been equally unsuccessful. They include attempts to reason by analogy: since quantum mechanics and consciousness are both mysterious, for example, they must therefore be related. Horgan, with his characteristically sound way of seeing situations, supports “the neural approach to consciousness,” and hopes it “may one day be validated by experiments on both humans and animals.” He also wonders whether “the key to consciousness might be some relatively simple neural mechanism,” such as the brain’s 40-per second oscillations. (p 244 – 245)
The Future of Mind-Science
“Mind scientists have their creeds, just as religious believers do,” Horgan points out. Reductionism is widespread among them. According to the reductionist vision of DNA Nobelist Francis Crick, “‘You,’ your joys and your sorrows, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules.” Or, as Crick suggests Lewis Carroll’s Alice might have phrased it, “You’re nothing but a pack of neurons.” (p. 258)
Physics Nobelist Philip Anderson refutes this reductionism. He explains how knowledge of the basic laws governing the physical realm provides little illumination into many phenomena. Particle physics cannot predict the behavior of water, let alone the behavior of humans. Reality has a hierarchical structure, with each level independent, to some degree, of the levels above and below. “At each stage, entirely new laws, concepts and generalizations are necessary. Psychology is not applied biology, nor is biology applied chemistry.” To Horgan, “if there is any feature of nature that has proved to be more than the sum of its parts, it is human nature.” (p. 259)
While wondering whether “the key to consciousness might be some relatively simple neural mechanism,” he believes creating a unified theory of mind requires coping with “an astronomical number of findings, many of them with contradictory implications.” (p. 261) The key to human consciouness may indeed be simple – but psychosocial rather than neural: the “shoulds” by which we live. Since natural science deals solely with the “is” and ignores the “shoulds,” it alone can never define human consciousness.
Toward a Unified Theory of Mind
If consciousness is defined as “the subjective aspect of making motor choices” (as was done in this reviewer’s 1960 “Creativity, Consciousness and Revelation” and 1961 “Pleasure, Pain, and Human Relations”), emotion can be seen as the essence of animal consciousness. Pain can then be seen as associated with an animal’s movement away from a stimulus and pleasure with movement toward it. In humans, emotions also serve as shorthand signals tending to evoke rapid positive or negative responses.
A new dimension above and beyond emotion is, however, part of human consciousness: our unique possession of speech and language. These makes possible the “shoulds quot; and the moral-social codes defining them. Religion has been both a major source of these codes, and an instrument for passing them from one generation to the next, with God often credited with formulating them.
Doing what we should – beginning with an infant’s trying to please its mother – is the basis of all human civilization. These “shoulds” – the requirements of social role – underlie all human behavior and thinking. Defined by current codes of ideal and forbidden behavior (and thinking), their evolution can be understood by the study of history. An important, early example is the key Hebrew concept of mitzvah – obedience to God’s commandments. This can not only bring personal pleasure (as from the marital mitzvah, which commands spouses to make love regularly) but, it is hoped, consequent personal and societal benefit. But we all also possess the capacity, the urge even, for defiance; this the Jews call “the evil inclination.” Behavior and thinking congruent with the “shoulds” tend to make one happy. Without such congruence, emotional conflict manifested by anxiety, depression or disorganization – mental illness – may occur.
The social codes underlying human thinking and behavior often conflict, thus requiring choice between or among them. Alphonse Daudet’s fictional Tartarin of Tarascon faced one such choice: when awakened at 3 am one cold morning to go lion hunting, intense struggle occurred within his mind between two competing imperatives – “Tartarin, cover yourself with glory!” and “Tartarin, cover yourself with flannel.”
Such competing imperatives can help explain “free will” and emotional conflict, including mental illness. Since many of these imperatives and ideals come from religion, they can be better clarified, and the conflicts among them reduced, by defining them more clearly and by deeper study of their origins and consequences. This author has been particularly interested since the 1960’s in the conflicting sexual ideals of the western world, and their religious and scientific origins. With abortion, homosexuality and promiscuity now such important causes of political friction, this subject deserves much more attention than it has thus far received.
John Horgan’s brilliant, exhaustive investigation of “brain sciences” – neurophysiology, neuroscience, psychoanalysis, psychopharmacology and others – has led him to conclude that the methods of natural science alone can never explain consciousness, mental illness or the basic nature of the human mind. But such explanations might be more attainable if we also took into account the “shoulds” we live by – made possible by humanity’s unique possession of speech and often credited to God.