Loebel Lectures and Workshop, Michaelmas Term 2015, Lecture 1 of 3: Neurobiological materialism collides with the experience of being human
The 2015 Loebel Lectures in Psychiatry and Philosophy were delivered by Professor Steven E. Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard as well as Harvard University Distinguished Service Professor of Stem Cell and Regenerative Biology. Both the lecture series and the one-day workshop proved popular and were well-attended.
From 2001 to 2011, Hyman served as provost of Harvard University, the University’s chief academic officer. As provost, he had a special focus on developing collaborative scientific initiatives that span multiple disciplines and institutions. In that role he helped shape the Broad Institute and Harvard’s Wyss Institute for Biologically Inspired Engineering. From 1996 to 2001, he served as director of the U.S. National Institute of Mental Health (NIMH), where he emphasized investment in neuroscience and emerging genetic technologies, as well as the establishment of DNA collections to facilitate genetic studies at large scale. He also initiated a series of large clinical trials with the goal of informing practice.
Hyman is president-elect of the Society for Neuroscience, editor of the Annual Review of Neuroscience, and was founding president of the International Neuroethics Society. He is a member of the Institute of Medicine of the U.S. National Academies where he serves on the Governing Council and Board of Health Science Policy, and chairs the Forum on Neuroscience and Nervous System Disorders, which brings together industry, government, academia, and voluntary organizations. He is a fellow of the American Academy of Arts and Sciences, a fellow of the American Association for the Advancement of Science, a fellow of the American College of Neuropsychopharmacology, and a Distinguished Life Fellow of the American Psychiatric Association.
Hyman received his B.A. summa cum laude from Yale College, a B.A. and M.A. from the University of Cambridge, which he attended as a Mellon fellow, and an M.D. cum laude from Harvard Medical School.
i. The mechanistic explanations of neuroscience pose, in a new form, an age-old challenge to our ineluctable experience of the freedom of our ideas and intentions and their causal efficacy.
a. This is not simply an academic debate
b. This collision plays out with real consequences in systems of criminal justice and in psychiatry.
i. Courts have resisted expansion of mechanistic explanations because Western justice is based on a concept of moral agency that requires freedom of choice and action.
ii. Nonetheless, increasingly sophisticated mechanistic understandings are slowly gaining traction
ii. Psychiatry poses a more complex case: Mechanistic explanations of thought, emotion, and behavior have been both welcomed and reviled.
a. Mechanistic explanations have been seen as a path to better understanding and treatments and as freeing the mentally ill from unfair attributions of moral weakness.
b. Others see the same explanations as dehumanizing.
c. By offering new views on strange and frightening behaviors neurobiology has been seen as destigmatizing. Conversely neurobiology has been seen to create a picture of a hopelessly different brain, thus contributing to new forms of stigma.
d. Proponents and antagonists of neurobiology in psychiatry give very different answers to the central questions of how a person came to be a certain way and what can be done to make things better.
iii. Psychiatrists are not immune to the cognitive distortions invited by intuitive Cartesian dualism.
a. Too often conditions that are simplistically attributed to genetic or other strong biological causes are falsely seen through a filter of determinism and hopelessness: “you can’t change your genes”. Conditions attributed simplistically to lived experience are seen, often falsely, as more malleable.
b. Conditions ascribed to biological causes are often wrongly thought to be treated best with medicines or neuromodulation. Conditions ascribed to lived experience are often thought to be treated best with psychotherapy.
iv. The credibility of psychiatry has been damaged by premature claims of mechanistic understandings and by closed minded resistance to the implications of genetic and neurobiological discoveries.
a. Unyielding theoretical stances put patients at risk of poor clinical decision-making
b. The use of patients as theoretical cudgels was illustrated by some notorious cases and, in the U.S., law suits during the 1970’s and 1980’s.
v. Currently clinical pragmatism has become increasingly dominant in psychiatry, to the benefit of clinical care.
a. However, emerging science is significantly disconnected from the clinic.
b. Moreover, the theoretical underpinnings of psychiatry remain weak, dealing poorly with the intersection of mechanistic views with human intuitions and experience. I will address this weaknesses in the third lecture.