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 BOOK REVIEWS

Brainwashed: The Seductive Appeal of Mindless Neuroscience

Richard Balon, MD

Wayne State University, Detroit, Michigan, USA

By Sally Satel and Scott O. Lilienfeld. New York, NY: Basic Books; 2013; ISBN 978-0-465-01877-2; pp 256; $26.99 (hardcover).

Neuroscience—or neurosciences—has been a magic formula that is going to provide answers to, if not to all then, most problems of present-day psychiatry and even beyond. As the authors of Brainwashed: The Seductive Appeal of Mindless Neuroscience Sally Satel and Scott Lilienfeld write, there are new areas of study, such as neurolaw, neuroeconomy, and neuromarketing. They point out that “brains are hot”… and …“never before has the brain been so vigorously engaged in public imagination” (p x). According to Drs. Satel and Lilienfeld, “The prime impetus behind this enthusiasm is a form of brain imaging called functional magnetic resonance imaging (fMRI), an instrument that came of age a mere 2 decades ago, which measures brain activity and converts it into the now-iconic vibrant images one sees in the science pages of the daily newspaper” (p x). Yet, as the authors later say, “Brain imaging, the iconic tool of neuroscience, finds itself at the eye of a perfect storm of seduction” (p 149). However, as Satel, Lilienfeld, and many others agree, the focus on brain and its biochemistry and metabolism is a problem. It creates mindless neuroscience, which is not—and should not be—neuroscience itself.

Drs. Satel and Lilienfeld decided “to bring some perspective to the bold speculations surrounding the promise of neuroscience” (p xx) in this slight volume with a sexy name: Brainwashed: The Seductive Appeal of Mindless Neuroscience. In the first chapter the authors review basic principles of brain imaging, specifically fMRI, computed tomography, and positron emission tomography. They point out that fMRI “is the most recent chapter in the centuries-long quest to map and comprehend the connection between the brain and the mind” (p 7). Drs. Satel and Lilienfeld make 6 important caveats about the limitations of brain imaging to be aware of: 1) brain scans rarely allow one to conclude that structure X “causes” function Y, they only provide correlations; 2) the subtraction techniques used in most fMRIs experiments are not necessarily well suited to the questions being asked; 3) the brain is not a repository of discrete modules that control distinct capacities to think and feel… it is rather “an ever-changing ecosystem crackling with electrochemical energy from which our thoughts, emotions, and intentions arise” (p 16); 4) the importance of experimental design when interpreting the brain scans; 5) fMRI is an indirect method (eg, there is a delay of at least 2 to 5 seconds between activation of neurons and the increase in oxygen-rich blood flowing to them); and 6) before the final data “reach” the voxel, an analyst must deploy statistical approaches to extract meaningful information from the noise, which could lead to inadvertent mischief. These 6 points clearly outline the limitations of fMRI and other brain imaging methods for any interpretation claimed by some. The chapter ends with further warning. Although Thomas Insel, director of the National Institute of Mental Health, is cited saying that “there is no evidence that the past two decades of advances in neuroscience have born witness to decreases in mental disorders’ prevalence or to an impact on patient life span” (p 23), there are clinics (Amen Clinics) promising patients that they can diagnose and treat mental disorders using brain scans.

The next 3 chapters focus on areas of big hype—neuromarketing, biology of pathological desire (namely addiction), and brain-based deception detection. Many big companies hire “neuromarketers” to help them sell their products better. These companies are seduced by claims that they can “mine your brain so they can blow your mind with product you deeply desire” (p 26). The problem is that the claims about successful brain mining are exaggerated. “At its worst, neuromarketing succumbs to the kinds of errors in interpretation, such as reverse inference, neurocentrismus, and neuroredundancy—using brain science to demonstrate what we could find out more simply by asking people directly” (p 28). The future of neuromarketing is unclear; there are limits to influencing human behavior and so far there is no evidence that neuromarketers can get solid information from brain scans to influence people to buy what they do not need.

The chapter dealing with “addiction and the brain-disease fallacy” brings up some important points. During the last 2 decades, addiction has been promoted strictly as a “brain” disease. The authors write that it may be good public relations, but that it is bad public education and bad science. This all goes to the heart of the old debate about whether addiction is a defect of the will or the body (p 51). Drs. Satel and Lilienfeld make a good argument against addiction being considered purely a brain disease. They cite Bob Schuster, former director of the National Institute on Drug Abuse, who did not think of addiction as a disease but was “happy for it to be conceptualized that way for pragmatic reasons … for selling it to Congress” (p 57). They also remind us of a study conducted after the Vietnam War—most soldiers stopped using narcotics, including heroin, after coming home. Therefore the truism, “once an addict, always an addict” was overturned. Yet, those lessons and observations have been forgotten. Neuroscience, with its brain-disease model and misplaced emphasis on biology, “leads us down a narrow clinical path,” diverting “attention from promising behavioral therapies that challenge the inevitability of relapse by holding patients accountable for their choices” (p 69). Yet the brain-disease model contains some truth, that there is some genetic influence on alcoholism and other addictions, and prolonged substance abuse may alter brain structures and function. However, “it’s the minds of addicts that contain the stories of how addiction happens, why people continue to use drugs, and, if they decide to stop, how they manage to do so. This deeply personal history can’t be understood exclusively by inspecting neural circuitry” (p 70). Maybe neuroscience will help us obtain some useful information about neural mechanisms associated with desire, compulsion, and self-control, which then could be used clinically, but clearly we are not there yet. This chapter’s debate is the most interesting and thought-provoking of the entire book.

The chapter on deception detection contains a lot of interesting information about deception and lying. For instance, people admit to lying in about 1 out of every 5 social interactions lasting >10 minutes; the English language contains 112 nuanced words for deception; and there are spontaneous lies and rehearsed or memorized lies. However, the chapter is mostly demonstrating that there is no way to use brain scans to detect lies. “No brain region uniquely changes activity when a person lies; each type of lie requires its own set of neural processes” (p 91). There also is no single signature for a guilty brain (p 96). Again, neuroscience clearly does not contribute to the detection of deception, no matter what some may claim.

Chapter 5—aptly named “My amygdala made me do it”—focuses on neurolaw, “a discipline that sits at the intersection of brain science, legal theory, and moral philosophy.” The assumption of this discipline is that “brain function, and the brain images more specifically, can help explain the defendant’s behavior” (p 101). However, as the authors point out, it is not clear what the relationship between brain function, as represented by brain images, and criminal behavior is (p 101). Other problematic issues are that by the time the scan is obtained, the deed has been done, and showing that brain abnormalities predate the crime is more easily said than done (although possible) (p 107). As forensic psychiatrist Phillip Resnick said, “You need to understand why… And you can’t see why on an fMRI” (p 121). The authors warn us about the implications of concluding that our conduct is caused by brain function. That could mean that we do not truly “choose” our actions and therefore cannot be held morally responsible for any wrongdoing. That would throw havoc into our legal and moral value system. The next chapter continues with this line of thinking, debating neuroscience and moral responsibility. Again and again, the authors argue that neuroscience does not hold the key to answering these questions, though some neuroscientists may claim and believe so.

Finally, in the Epilogue, Drs. Satel and Lilienfeld emphasize that they do not critique neuroscience or brain images; rather, they are trying to expose mindless neuroscience—the oversimplification, interpretive license, and premature application of brain science in the legal, commercial, clinical, and philosophical domains (p 149). They definitely succeeded here. They also warn of the trap of neurocentrism, and suggest that neuroliteracy will become important in the future.

This is a thoughtful and thought-provoking book, definitely worth reading by all those interested in neuroscience and brain imaging and their implications for clinical psychiatry and other disciplines. Mindless neuroscience clearly is a problem for clinicians, because it does not provide answers for clinical issues. The reader will better understand what the present day neuroscience is, and what it can or cannot deliver. This book definitely is good bedtime reading.