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pontificatrix

pontificatrix
Bio
I am a resident in psychiatry at an academic medical center. My blog posts describe patient encounters I have had in the course of my training, both past and present. Names and identifying details have been changed. My blog conforms to the information-privacy standards detailed on http://medbloggercode.com. If you believe you have been a patient of mine and have concerns about the effects of this blog on the privacy of your medical record, please let me know and I will be happy to withdraw any offending material.

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SEPTEMBER 5, 2008 1:56PM

biology vs psychology: false dichotomy?

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I was speaking with a very intelligent and insightful patient who mentioned that he'd felt his problems (depression, some obsessional traits, a mild eating disorder) were all 'psychological' until he found a drug that significantly improved them. From that point on he was convinced they were 'biological,' and embarked upon a quest for the Magic Pill that would solve all his neuroses at a single swallow.

I see references to this sort of split all the time, and not just from patients but also from highly educated physicians and scientists. Somehow they consider that our behavior* arises from two distinct sources: one composed of neurons, synapses, and neurotransmitters, and another composed of experiences, drives, and willpower.

If you buy the biological theory of behavior at all, then it makes little sense to imagine a dividing line between 'biological' and 'non-biological' causes of behavior. Experience alters neurochemistry just as surely as medications do.

Here's a nice piece of work discussing some of the cellular-level changes that can be triggered by real-world experience (Takahashi, Svoboda and Malinow).

Evidence abounds for the utility of 'talk therapy' in psychiatry. In order to separate the 'biological' from the 'psychological,' one would have to believe that there exists an entirely separate underpinning of human behavior that operates on some ethereal plane, unrelated to the biomechanical world of synapses and neurotransmitters.

If you're going to accept that neurobiology underlies behavior, then there is no clear point at all where you can divide the biological from the psychological. If you accept that experience exerts its effects through alteration of our neuronal activity, and you accept that hearing your therapist is an experience, then there is no room for some nebulous 'non-biological' effect. Your therapist's words tickle your ear neurons, which tickle your brain neurons, which make subtle changes - sticking themselves to some of their neighbor cells, unsticking themselves from other neighbors, changing the rate at which they spit neurotransmitters at each other - and voila! You change your behavior.

That the line between biological and psychological is fuzzy to the point of nonexistence may be starting to permeate the general consciousness, at least to a degree. This usually arises in discussions of ethics, where the whole edifice of crime-and-punishment rests on an assumption of free will. This assumption is being radically challenged by evidence that our behavior is heavily determined by factors not under our direct control (genetics and medication in particular).

This opens up another can of worms, because we frequently associate 'biological' with 'beyond our control' and 'psychological' with 'within our control.'  Hence my patient (and many like him) and his Magic Pill search.

But I think the educated world at large is not yet ready to join Steven Pinker in declaring us will-less playthings of our genes and environment. Fine for now, but I'm curious to see what we'll make of coming scientific advances that will no doubt push us even closer to the will-free wall.


*I'm using "behavior" intentionally to encompass all of the workings of the human brain that are manifest to others. I'm doing this very deliberately because the question of whether mind is biological at all is a very sticky wicket and not something I can afford to get into in this limited space.

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"This assumption [of free will] is being radically challenged by evidence that our behavior is heavily determined by factors not under our direct control"

The issue of free will is interesting to me. If our biological experiences alters behavior, then it remains true that we usually choose the experiences (talk therapy, medication) that have the effect. Yes, then it could be said some other experience is influencing that choice, and the choice before that, and so on back to being a very small child without any real choices at all. Still, I don't think free will means that we have a choice uninfluenced by brain chemistry or previous experiences/choices.

Our experience as humans is biological, and in a sense, limited. We cannot sprout wings or stomp through Duluth like Godzilla. Free will does not mean access to those options, it means the ability to exercise the options we have. But we can imagine those options, dream about those and other choices, and in doing so perhaps create an internal experience that changes our behavior.
OK, but where's the space between "my choice is influenced by my brain chemistry" and "my choice is caused by my brain chemistry"?

We can imagine and dream about our options, but is there any meaningful sense in which those very imaginings, dreams, and choices could have been otherwise?
Well, I'm a know-nothing lay person, but it seems to me that there are, at least sometimes, hard divisions between biological and experiential effects. As an obvious example, talk therapy has substantive effects with depression, but is not terribly effective with schizophrenia.

It's also my lay take that in many instances it's not neuronal changes so much as maleable sub-conscious thought, sometimes to the point of obsession. Convince the uncritical sub-conscious mind to stop focusing on something, and clear conscious, behavioral benefits can be observed.

Experience and talk therapy have a great deal of influence on what our sub-conscious minds attempt to act on, as it uncritically doesn't "think" about things so much as try to enact instructions from the conscious mind that it sees on a TV screen. And that attempt by the sub-conscious to get our bodies to obey the instructions sent in turn affects our conscious selves, both psychologically and behaviorally.

With regard to a simple behavior illustration, a person can walk back and forth on a 6" wide board all day long with nary a mis-step so long as that board is lying on the ground. Suspend it between two tall buildings, and the patient would be hard-pressed to make it across. Why? Because the analytical conscious mind sends a different message to the non-analytical sub-conscious when the board is raised into the air ("Uh, oh! I might fall off!"), and the sub-conscious uncritically attempts to make this mental image sent from the conscious mind into reality. I.e., the sub-conscious interprets the vision of falling off as an instruction from the conscious mind.

Is this kind of involuntary behavior alteration a "neuronal change" that blurs the line between psychological and biological? Clearly not. Yet, I would say that the phenomenon is analagous to the kinds of things you are writing about. The effects extend well into psychology and disorders. Sometimes we don't see or understand all the subtle and myriad neuronal activity that we can presently only dimly or generally perceive.

This seems to me to be entirely separate from the difficult behavioral challenges associated with schizophrenia and other serious diseases, which to my lay mind are solidly in the neurobiological camp, and no amount of experiential influences are going to substantially alter that condition.

I'm sure this is entirely stupid, though, so feel free to delete this comment.
This assumption [of free will] is being radically challenged by evidence that our behavior is heavily determined by factors not under our direct control (genetics and medication in particular).

I don't have quite the technical background to understand the details, but I think another interesting direction from which our understanding of free will is coming under attack is basic neuroscience. I'm thinking of the work that Daniel Wegner cites in The Illusion of Conscious Will (though I haven't read the original studies), in particular Libet's "readiness potential". Ask subjects to report the instant (my wording) that they decide to take some action, like raising their hand, while you're monitoring their brain activity, and you can see a characteristic pattern about half a second before subjects make their report. So what's causing what becomes a bit unclear. I'd have to reread Wegner for more details, but if you know this stuff, pontificatrix, I'd be interested in your thoughts.

Because the analytical conscious mind sends a different message to the non-analytical sub-conscious when the board is raised into the air ("Uh, oh! I might fall off!"), and the sub-conscious uncritically attempts to make this mental image sent from the conscious mind into reality.

Actually, Dana, though pontificatrix probably knows this area better than I do, there's Gibson and Walk's "visual cliff" experiments which I think were pretty suggestive that the "fear" of falling is something that happens below the analytical, conscious level. (One point they raise is that some animals that rely heavily on vision behave the same way humans do.)
Okay, hang on. These are all really good comments and I want to get through all your points.

Dana says:
"talk therapy has substantive effects with depression, but is not terribly effective with schizophrenia"

Actually this is not true. Cognitive-behavioral therapy has been found effective in schizophrenia, both as an adjunct to meds and as independent therapy.

http://www.ncbi.nlm.nih.gov/pubmed/18212600
http://www.ncbi.nlm.nih.gov/pubmed/18230197

"it's not neuronal changes so much as maleable sub-conscious thought"
But are you saying that neuronal changes are not involved in 'subconscious thought'? Does 'subconscious thought' have no biological substrate?

"Is this kind of involuntary behavior alteration a "neuronal change" that blurs the line between psychological and biological? Clearly not."
Why not? How else do you change your behavior besides by changing your neurons?

Rob says:
"another interesting direction from which our understanding of free will is coming under attack is basic neuroscience. I'm thinking of the work that Daniel Wegner cites in The Illusion of Conscious Will (though I haven't read the original studies), in particular Libet's "readiness potential". "

Well, Libet's basic finding is that your brain starts getting you ready to do stuff before you think of doing it yourself. I think his take-home message is that conscious choice acts really slowly, much more slowly than we are capable of acting. Therefore we've got other mechanisms that make our behavior happen on a rapid timescale. Then we convince ourselves after the fact that our conscious choice was involved.

So instead of my deciding 'I will raise my hand NOW' and starting a chain of events that leads to hand-raising, the chain of events starts before my decision. That makes my decision seem like it might actually be irrelevant - except that Libet argues the conscious choice acts more as a gatekeeper, with veto power to stop the action.

That actually goes a bit further than what I'm trying to say here (which is just that mind and biology are not separate). It's really interesting and Libet's findings should be more well known than they are. I may blog a Cliff's-notes Libet in the future if there's interest.
and Rob, if you're interested, Libet wrote a book called "Mind Time" that is intended for an educated lay audience. I highly recommend it.
Cool! Thanks, pontificatrix, for both the discussion and the recommendation. I'll definitely look up the latter.
I guess I'm coming at this from a more philosophical point of view. Have you read any of the Churchlands' work (Patricia and Paul)? She and her husband are some fascinating people. David Chalmers, too, writes extensively on the philosophy of the mind.

At any rate, in thinking about free will and choices, I think about freedom itself. Is a person in a prison free? You might not think so, but it depends entirely on that person's perception. Several political prisoners, as an example, have expressed a sense of freedom when allowed the full utility of their mind, even though their movement was restricted.

I don't think a "choice being caused by" brain chemistry versus "choice influenced by" brain chemistry is necessarily relevant, because what a person experiences as free will is subjective. If a person perceives that she is free, or that she has free will, then that is so. If that perception is not there, neither is free will.
Alexandria: Yes, we have the subjective perception of free will. (Or I do at least, and I'll take your word for it that you do as well.)

And if I consistently perceive something to be true, it *is* true.

So yeah, when thinking about it that way, I agree with you.

That's a very different narrative from the neurobiological one where we try to figure out how our brains make our behavior happen. That's the narrative in which I would say there's not really any room for a phenomenon called free will.

But there's a prevailing belief among the scientifically inclined that the second narrative - the brain-behavior narrative - is the 'real' one (whatever that means). Nevertheless, people who stick to the brain-behavior narrative often aren't consistent enough to admit that the free-will narrative doesn't belong there.
Whenever I think about the question of free will or read conversations about it, I begin (a tiny bit) to understand what Wittgenstein was up to....

There is the tendency to confuse grammer with experience and experience with knowledge. My experience is that the sun moves around the earth. And so I know that.

My experience is that there is a "me" latched into this body, peering through it and making choices that are highly influenced and constrained by all sorts of internal and external factors. The fact of a "me" might even be as obvious as the fact of the sun's movement around the earth.

Science gives us no reason to believe that a mysterious "me" exists at all- let alone that it serves as the justification of all of our moral outrage and righteousness. There is much more evidence for things like telepathy and reincarnation (and even this is awful in terms of the scientific ideal) than for the existence of something in my brain that stands outside of natures intricate and awe inspiring complexity. Most of us know that evolution is a highly complicated and mysterious phenomena, but that doesn't lead us to suppose a taller ME must have built the human body to look like it.

But the science can be cast aside because the most significant thing that happens when we talk about free-will is we FEEL it must be true. We imagine that taking away the idea of free will means we won't get out of bed in the morning, or we will no longer care about making the world more fair.

The idea of free-will SEEMS to justify the foundation of our moral impulses. It must have been a bit like how the "fact" that the Sun spun around the Earth SEEMED to prove our relevance in the universe.

But the really cool thing- to me- is that absolutely everybody actually believes in free-will 99% of the time.

Sure, you can find those academics (or couch potatoes like me) who follow the course of natural science to its natural conclusion and naturally conclude that as much as it feels so nice to be a "me"...there is no evidence that "I" am one. But follow those folks around for about two hours and you'll see that they are just as convinced as anyone else that they have a "me" that is cut off and separated and that deserves a certain kind of treatment and respect. They are absolutely in line with the notion that things could have happened differently and very often SHOULD have happened differently. The lecture about one thing and live another.

I don't think they (we) have choice.
Well, I'd say that the fact that I feel there is a 'me' is the same as there actually being a 'me.' Goes all the way back to Descartes and his old cogito chestnut.

I don't agree that subjective experience = free will though. After all, I could have the subjective experience of *not* feeling free, theoretically.
pontificatrix, I remember having to write yet another paper on the topic of nature vs. nurture. It suddenly dawned upon me that my genes are easily as much of my environment as my parents. I have to deal with both (along with my organs, state, teachers and the content of my blood). It was such a relief to finally draw the line this way, to finally let go of this odd distinction between my genes and the air I am breathing, to just let the obvious fact that each and every factor you can point to is one that I have to deal with.

The parents I was born with are as unalterable as the odd shape of my left thumb. The genes I started my life off with are as inexorable as my elementary school art teacher's grabbing me by the shoulders and yelling, "That's not the way you draw a lion!!!"

The pressure in the fields of psychology and psychiatry to have a dividing line that matters may very well be simply another expression of the pressure that comes with the presumption of an isolatedly "free" moral agent.
ponti said:

"Well, I'd say that the fact that I feel there is a 'me' is the same as there actually being a 'me.'"

I agree. The fact that I can watch the sun move around the Earth is just that. But we no longer lose sight that this "fact" has life only in the watching. When it comes to free-will we still get red in the face when John Doe was clearly suppose to not do what he did, as if there is reason to believe a part of his nervous system caused a behavior less natural than it was suppose to be.

With the movement of the sun we no longer ignore the watching as we do with those events that have us shaking our fists at the universe's constant "errors".

My clients are the best reminders that I LOVE shaking that fist! I work with individuals and families.
Well, okay. This is getting hairy. You'll see that I put a disclaimer in my initial post, stating that I was only going to talk about behavior and not about mind/subjectivity. That's because there's really no way that we can tie biology to subjectivity, because we haven't much experience with our own biology and we haven't any experience with anyone else's subjectivity.

People seem really interested in the subjectivity thing though, so maybe I'll do another post on that specifically. It would probably end up being really long and boring though.
Alright everybody! Time for an experiment. Line up, and remove your skins, sinew, bone. That's right, take off your bodies. Yes, your whole body. No, you won't be naked, at least, not exactly.

Now step over here to Nurse Alix's trusty soul scale. No, it won't measure the cake you ate last night. Where did it come from? I won it in a game of chance with an Egyptian priestess...
Oh.......ponti........

ok, you were speaking of the false distinction between bio and psyche and I just brought that back to its daddy. I shouldn't have assumed that you applied it there as well. I don't know how to keep them apart. I tend to think that most of the confusion is due to people using the same words to accomplish very different tasks. I look forward to your next post.
I know, it's really hard. We need some new vocabulary words. Kant made up a whole bunch of new ones when he needed to talk about this stuff, with the result that nobody understood him and his points got buried in an avalanche of weak crappy critique-and-analysis.

I've been trying to use 'mind, subjectivity' for inside-looking-out and 'behavior' for outside-looking-in but a) that isn't really right and b) I actually forget a lot and return to using the terms in the same old haphazard ways.
This discussion is wonderful and of course, kicking my ass. I will venture to say that there is an enormous amount about the mind/body experience we just don't know yet. Especially in terms of knowledge of the biological components. Let's face it. We're still flying blind a lot of the time there.

Free will is tricky. We might have free will and at the same time, have parameters which bind us. How is this possible you ask? I have no idea. I can only say that I theorize that it is.

For example, I'm short. I didn't have much choice about that. Half of my family are depressives. Not much choice there either. But I can choose how I experience all these things. Whether I choose to wear stilts or take medicines, for example.

Then again, the concept of free will is very ... philosophical in nature. Freedom is a relative term, as was pointed out perfectly by the fabulous Ms. Dubkowski. Perhaps it is our ability to even perceive that such a thing as free will might exist is that which makes our situations unique. Brains do re-wire themselves all the time, although the process isn't easy. Try going on a diet, for example or starting to exercise regularly. It can be done, but damn, it's difficult. We can change our parameters; we can also choose to change our actions in certain situations.

Are those abilities chemistry, too? We don't know yet. Maybe. To me, what we're dancing around here is the concept of the soul. Is there a soul, like a little homunculus, pulling levers?
This is challenging reading, in a good way. Thanks.
I want the blue pill, a high colonic and a vodka martini. Double. That should work just fine. Oh, skip the enema.
Grrr

I'm sorry, but this sort of thing always sets me off. I don't understand why the academe are so narrow minded. I suppose it's just a bias built into your educational institutions.

The questions your posting jabs at are not novel,.The most intelligent of our species have been discussing these matters for the last few hundred years. What does it imply about human accomplishment, that you'd just shoot from the hip on this topic. Like no human being has ever devoted time to this before, like there is not already a body of knowledge -thousands of years old - with which to grapple.

You can't reference Dostoyevsky if you have not read him. Don't be so quick to assume the mantle of authority. There is a reason doctors have referred to their life's work as 'practice' . . .

Normally, us Reasonable Pagans ain't so confrontational. But you got my blood up, so I have to believe this was for the best.
"Reasonable" Pagan:

1) Obviously this is not a new question. There is nothing new under the sun. Pretty much all philosophically interesting topics have been covered in the past and will be covered in the future. I'm not going to link to the entire Western canon every time I make a blog post. If that bugs you I suggest you renounce all reading and discussion henceforth.

2) However, as science advances, certain things become clearer while new questions are raised. I think the Malinow paper I linked is representative of a body of evidence that makes it ever harder to continue to posit a mind-body divide. This sort of evidence was not available to, e.g., sixteenth-century philosophers.

3) I've been thinking, reading, and writing about various topics in philosophy of mind for many years. I've got a BA in philosophy and a PhD in neurobiology. The last thing I'm doing is shooting from the hip.

4) And what's up with that jab about the 'mantle of authority'? I'm not telling anyone what to do, I'm posting my thoughts on a weblog. If you have concerns or reactions relating to what I've posted, I'm happy to hear them. Unfounded and uninformed personal attacks are not a useful contribution.
This is a highly interesting topic, obviously. Nice post.

Free will? A magic pill? I thought as I read your post that perhaps this is best seen in simple terms at this juncture. We are all born with genetic directions, some of which are distinct and specific while others are potentialities that may or may not be realized. There seem to be particular mental elements that are not within an individual's control.

I've read that even schizophrenia is, in some cases, a “potentiality” whose realization the environment can help determine. A person may possess the potentiality for developing schizophrenia, but it may require certain environmental factors for it to manifest.

Clinical depression is caused by a chemical imbalance in the brain, and talk therapy is not especially helpful alone, but can be very beneficial in conjunction with medication.

There are some behavioral elements that are not controlled, but rather predetermined. Case in point would be when one touches a hot burner and immediately pulls his hand away before even feeling the true impact of the burning sensation that will surely follow shortly. Yet, there are those who are able, through some willful force I do not understand, to remain in contact with something hot regardless of the pain, and that is a conscious effort, “free will” if you choose to call it such.

In terms of potentiality, I might have been born with a genetic predisposition that make me respond favorably to vanilla ice cream, which I cannot control, but I can choose whether or not to eat it in a given situation, even if I cannot control how much I WANT to eat it. However, that potential favorable response will never become a factor if I'm not exposed to vanilla ice cream. That seems to be the best we can do with our understanding of “free will” at this point – some things we can control; others we cannot. Biology and environmental factors combine to create our personal realities, and there are certain aspects we can control and some we can't.

One last thought I had: I don't think Pinker has said we are “will-less playthings of our genes and environment.” That would seem to be a misreading of his presentations, unless you include in your definition of “environment” the learned cultural elements that each of us incorporates into our conscious responses. Pinker says, “Except for a few neurological disorders, no behavioral trait is determined with 100 percent probability by the genome, or anything else...” Even two individuals raised in the same environment will likely perceive, and react to, the same event differently.
Dick comment on my part. I'm the one who went off half-cocked. If we could delete comments on Open Salon, that one would have been up for about ninety seconds.

I'm trying hard to overcome my prejudice against psychology.

I was out of line. Mea Culpa. Not at all 'reasonable.'
RP: Thanks for the reconsideration. I'm open to all kinds of commentary so if there are specific statements in my post with which you disagree, or which you feel aren't well supported, I'm happy to engage in a dialogue about them. It can only improve my future offerings.
I have come to think of almost everything as organic. Personality is organic; behavior is a function of personality. I suppose it's reductive, but the longer I live, the more obvious it seems to me that we all default to certain behavior patterns unless we actively transcend them, which lasts only as long as we can sustain that focus. As for free will, I'm not even sure we're choosing to transcend at those moments (seen by some as "taking responsibility for our weaknesses" or something) as much as some more than others are "self-help-oriented" to begin with. Back to nature and no free will.

I have read quite a bit on some of the newer sociobiological concepts like attachment theory, that really intertwine the neural pathways and early experience. I'm way out of my league here, but I have this inchoate and just-out-of-reach grasp of what all we're talking about. At any rate, it's of everlasting interest to me, and I would love to see an extension of this in another post.

Meantime, Carol and ponti, go look at my post on chess. It's deceptively benign, but I think it speaks to mortality issues. Really, I think it all comes back to this innate need to feel special and in control.