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Ed Shorter: Is Neuroscience Valuable?

Discussion in 'Research' started by quert, Nov 3, 2013.

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  1. quert

    quert Guest

    Edward Shorter comes up occasionally in TMS books as, essentially the historian of TMS. Both Dr. Sarno and Dr. Schubiner refer to his book about the history of TMS in their own books. He is the Jason A. Hannah Professor in the History of Medicine at the University of Toronto.

    He's come out with a new book called "How Everyone Became Depressed" and now has a blog at Psychology Today to promote it: http://www.psychologytoday.com/blog/how-everyone-became-depressed . Since he is a professor, his book and his blog can be a little on the dry side. At the same time, because he is a professor, he sometimes talks about very important subjects and does so with the benefit of great learning.

    I was browsing his blog and came across and article that I thought is important. With advances in biomedical technology in the last 30 years, most notably MRI brain scanning technology, we are beginning to learn huge amounts in neuroscience that we didn't know before. This new knowledge about the brain is popping up in all sorts of books about various different regions of the brain, such as the amygdala, which handle fear, and the frontal cortex, which handles rational thought.

    At the same time, there is a backlash against all of these new neuroscientific writings, and Adam Gopnik, a longtime writer at the New Yorker, summarized several books that talk about the limits of neuroscience. Edward Shorter thought that he was being too critical of neuroscience and wrote the following piece: (my comments are the ones that aren't indented)

    Adam Gopnik Blots His Copybook
    There is a huge area of neuroscientific research that has made a difference
    Published on September 29, 2013 by Edward Shorter, Ph.D. in How Everyone Became Depressed

    Adam Gopnik at the New Yorker is one of my favorite writers, especially when he goes on about how wonderful Paris is. But he’s blotted his copybook recently (New Yorker, Sept 9) with a piece about “neuroscience” that pretends to be skeptical about the skeptics.​

    If you're curious, here's a link to the New Yorker article:
    http://www.newyorker.com/arts/critics/books/2013/09/09/130909crbo_books_gopnik
    I read it and actually preferred Ed's piece to the piece it was discussing. Gopnik's article wasn't without interest but was a little too academic and abstract without actually telling me much more.

    Neuroscience is hot right now. No doubt about it. The psychoanalytic explanations of behavior so popular in the 1960s and -70s have given way to explanations favoring pieces of the brain as the center of action. One early 19th century writer, riffing on phrenology, referred to this kind of cerebral localization as “bumpology,” and Gopnik leaps on the phrase with glee as a way of ridiculing both those who criticize neuroscientific explanations and those who favor them. A pox on everybody, cries Gopnik, who yearns for good-old-fashioned Humanism, and Erasmus didn’t need to know about his amygdala, thank you very much.​

    He mentions that psychoanalysis was very popular in the 60s and 70s. Perhaps that is why it showed up in Forbidden Planet.... Howard Schubiner's book, Unlearn Your Pain, is more updated, relying more heavily on recent Neuroscientific research.

    Hmmm. We have to be careful not to throw the baby out with the bathwater here. Some of the recent crop of books criticizing neuroscience are actually quite good: psychiatrist Sally Satel and psychologist Scott Lilienfeld’s recent Brainwashed: The Seductive Appeal of Mindless Neuroscience (Basic Books) warns that perps may go free because they can now blame their brains for their misdeeds rather than their characters. We see this with every new edition of the Diagnostic and Statistical Manual of the American Psychiatric Association: that some new diagnosis provides potential exculpation for criminal acts. The changes that DSM-5 makes, for example, in “Dissociative Identity Disorder” (formerly called Multiple Personality Disorder) stipulate that the existence of the various personality states within the individual may be self-reported, as opposed to reported by others. This opens a wide portal for pleas that “my personality as Jim made me rob the bank.” So, yeah, these fears that neuroscientific findings may have forensic consequences are not unrealistic.​

    But I suspect that Gopnik is not really interested in the courts. He wants to put the shiv into Sally Satel, who is a prominent conservative media intellectual based at the even more conservative American Enterprise Institute in Washington DC.​

    Yet my beef isn’t really with Gopnik’s politics. It’s that he seems unaware of a huge area where neuroscientific research really has made a difference in human welfare, and that’s psychopharmacology, the study of drugs that affect the brain and mind.​

    I know, I know. Some aspects of psychopharm have been seized by the pharmaceutical industry and converted into pseudoscience as a way of selling drugs. The whole neurotransmitter play, for example, claims that too little serotonin makes you depressed but the remedy is Prozac. Nobody in neuroscience believes this anymore, but it’s what doctors tell their patients every day (because they feel they have to tell them something).​

    I think that Shorter is right on the mark here. Many well designed studies have shown that anti-depressants work well to relieve depression. Many of these studies are double blind randomized controlled trials, so they rule out the placebo affect. However, with their antidepressant medical affect documented, they can be prescribed by doctors, which makes them even more powerful, because anything which is given to you by a doctor who says that it will heal you is even more effective. So these antidepressant pills benefit from both powerful medical action and a powerful placebo response.

    ... But that doesn't mean that depression is just "too little serotonin." Yes, Prozac does operate by making serotonin more available in the synapse, but that doesn't mean that depression is just an imbalance of serotonin. The brain is much more complicated than that and I am glad that medical science is making that clear.

    But on the whole the historic record of psychopharmacology, including convulsive therapy, is stunning. The suicides prevented by the timely prescription of tricyclic antidepressants such as imipramine; the patients lifted from the depths of despair by electroconvulsive therapy; the manic agitation stabilized by lithium; the back wards of the old asylums emptied out by the first antipsychotic drug chlorpromazine: These are accomplishments comparable to the introduction of penicillin in internal medicine. And they have given rise to modern neuroscience. Neuroscience set out to explain how these drugs worked, and soared from there.​

    This is where I think Shorter really shines. Some medical remedies have been shown to be very helpful with some very serious conditions such as bipolar, psychosis, and depression. Some of these studies have been done with the highest levels of rigor and then replicated by multiple teams. They really help people, and that is very important. Neuroscience was part of this and he is right to defend it.

    I am not faulting Gopnik because he failed to write about imipramine. The problem is that he acts as though current neuroscience is mainly focused on the localization of things within the brain. But localization is secondary to the discovery of mechanisms. Because once we discover the brain mechanism of something like melancholia we can treat it more effectively. And much of the research in neuroimaging, neuropsychopharmacology, and the rest of it aims to do just that.​

    What’s the problem here, Adam? It’s like criticizing the Atomic Table or Boyle’s Law: This is mainline science, man. It’s not scientism (phony science), and it’s not an assault on your precious Humanism. No one wants to do away with the classics, and figuring out exactly why Shakespeare appeals seems pointless.​

    But why melancholic patients kill themselves: That’s not so pointless.​

    Bottom line: neuroscience can save lives, and that is worth defending.
     
  2. Ellen

    Ellen Beloved Grand Eagle

    Thank you, quert, for posting this. It's an interesting topic worthy of debate.
     
  3. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    This very interesting but I need to do some research on neuroscience before I can reply adequately.
    I'm not a doctor or a psychologist, just a freelance writer having gotten over TMS pain.

    But if neuroscience can save lives, I'd say it's valuable.
     
  4. plum

    plum Beloved Grand Eagle

    Thank you for posting this quert. It's important to the evolution of tms theory that we keep an eye cocked on the bigger picture. I'm not particularly concerned with how and why people hop on bandwagons, twas ever thus. Of more interest is how neuroscience is contributing to our understanding of one of the big three unanswered questions - how do we do this thing that we do? What is consciousness? Mankind has circled this for an age and many people will be familiar with Dualism, Theories of Mind, Ghosts in Machines...

    But your post rests less on philosophy and more on utility. Is neuroscience valuable? As a woman caring for a man with Parkinsons, I say hell yes. Essentially neuroscience is the study of the brain and nervous system, that is the focus. It is simply a discipline. People must pick up the knowledge and run with it, that some run in the wrong direction is par for the course. It certainly doesn't render an entire field redundant.

    Back to tms, I think it behooves us all to develop some rudimentary understanding of neuroscience. A while ago at tmshelp we had a series of discussions on what is the unconscious?

    Here is a link to one. Shrug off the personalities involved and consider the relevance of the brain structures involved. They do not explain away Sarno's ideas but help lift them out of a nebulous state.

    http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=8223&SearchTerms=plum,unconscious

    This is an incredible time to be alive. We've learned more about the brain in the last twenty years than ever before. As much as I will always defer to mystery and metaphor because I am more artist than scientist at heart, I consider neuroscience to be one of, if not the most valuable field of research today. It would be easy to fall into reductionistic thinking but this is not so bleak, it is not black or white. I have always believed in the soul and now in the late summer/early autumn of my life, I gather the wisdom it yields ever closer. Life is rich with marvellous paradox.
     
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  5. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    Dummy me, I had to look up neuroscience to be sure I knew what it meant.

    Here's what Wikipedia says about it:

    Neuroscience is the scientific study of the nervous system.[1] Traditionally, neuroscience has been seen as a branch of biology. However, it is currently an interdisciplinary science that collaborates with other fields such as chemistry, computer science, engineering, linguistics, mathematics, medicine and allied disciplines, philosophy, physics, and psychology. It also exerts influence on other fields, such as neuroeducation[2] and neurolaw.

    The term neurobiology is usually used interchangeably with the term neuroscience, although the former refers specifically to the biology of the nervous system, whereas the latter refers to the entire science of the nervous system.

    The scope of neuroscience has broadened to include different approaches used to study the molecular, cellular, developmental, structural, functional, evolutionary, computational, and medical aspects of the nervous system. The techniques used by neuroscientists have also expanded enormously, from molecular and cellular studies of individual nerve cells to imaging of sensory and motor tasks in the brain. Recent theoretical advances in neuroscience have also been aided by the study of neural networks.

    Because of the increasing number of scientists who study the nervous system, several prominent neuroscience organizations have been formed to provide a forum to all neuroscientists and educators. For example, the International Brain Research Organization was founded in 1960,[3] the International Society for Neurochemistry in 1963,[4] the European Brain and Behaviour Society in 1968,[5] and the Society for Neuroscience in 1969.[6]

    Forest loaned me the book, WHAT FREUD DIDN'T KNOW, by Timothy B. Stokes, PhD, a 3-Step Practice for Emotional Well-Being through Neuroscience and Psychology. I thought it might be too deep (academic) for me, but it looks like I will be able to understand it. He likes my way of writing short, simple summaries of sometimes complex articles or books. It's on my schedule to read and then write about. It looks like the book covers a lot of subjects in TMS healing that I've read about in Dr. Sarno's Healing Back Pain, and in Steve Ozanich's The Great Pain Deception, and Scott Brady, MD, Pain Free for Life.

    It just had the term "neuroscience" with which I was unfamiliar. Now I know what it refers to.

    So just from knowing what it is and that it covers a lot of TMS healing techniques, I can say that neuroscience is valuable in TMS healing, although I'm not a doctor, just someone who has healed because of TMS techniques. Several helped me, such as meditation, mindfulness, but the best was journaling, discovering my repressed emotions.
     
  6. plum

    plum Beloved Grand Eagle

    Walt, you are a dear. I honestly believe most folk with tms know more about neuroscience from the inside-out, and therefore the names and labels don't mean so much. Neuropsychology is a truly fascinating branch and falls well within the tms/healing ball park. Some of the best writers in the crop embrace neuropsych and mindfulness. My favourite is a Buddhist neuropsychologist called Rick Hansen. He is best known for co-authoring The Buddhas Brain but has also recorded a handful of audiobooks available from Sounds True. His wisdom is compassionate, timeless and practical. I wholeheartedly recommend it.
     
  7. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    Thanks, Plum.
    I was a reporter for the Chicago Tribune and the very first day the editor said not to use 50 cent words in writing,
    not even 25. He said most people who read newspapers only have a 5-cent vocabulary, so I began to write using
    everyday words. Not Dick and Jane, but words most people understand.

    You're right that most TMS people, me included, know more about neuroscience from the inside-out.
    Now I know its one dollar word.
     
  8. plum

    plum Beloved Grand Eagle

    Ok. I'm no tech wiz but these links should take anyone intetested to two free sessions with Rick Hansen.

    http://www.soundstrue.com/weeklywis...1&category=IATE&version=full&loc=weeklywisdom
    http://www.soundstrue.com/weeklywis...7&category=IATE&version=full&loc=weeklywisdom

    Sounds True feature a weekly podcast and I regularly download them from itunes. I've not had chance to listen to these two yet (as my ironing pile attests to), but all his other stuff really hits the spot for me. Jargon lite and heavy on the how to's with plenty of guided meditations.
     
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  9. BruceMC

    BruceMC Beloved Grand Eagle

    It seems as though there is a reductionist, version of neuroscience based on brain geography and another version of neuroscience in the making based on system theory and the interaction of different areas of gray matter. The old neuroscience seems to be saying that this area of the brain is responsible for this particular behavior or emotion; the new neuroscience is more interested in how the various areas interact in a self-referential, self-correcting way to produce an infinite variety of behaviors and emotions. Understanding how TMS healing works will involve using system theory to understand how those interactions occur.
     
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  10. Becca

    Becca Well known member

    Wow, quert, this was a fascinating post and a fascinating (and persuasively written, I must add) article. I agree with you: neuroscience can, and does, save lives. It's not just worth defending, it's worth championing.

    That being said: perhaps a reason neuroscience receives such criticism is that it appears to ignore the "nurture" influence, of nature vs nurture. (Note that I wrote appears as I do not think the field of neuroscience ignores it so much as focuses on one part of the equation, leaving the nurture part to another field.) Neuroscience focuses on the biological aspects of disorders (bipolar disorder, schizophrenia, anxiety, depression, etc) to make headway in pharmaceutical drugs that absolutely, positively, 110% save lives. I should know: I'm one of those saved lives. But, there's a whole other side to us that is based not on genetics, or brain scans, or biology at all, and that is our life experience. I strongly, strongly, strongly believe our life experiences shape us far more than our biological makeup does.

    Of course, the advances in neuroscience that this article and quert were talking about don't technically need to know about our own life experiences. But that's technically . Understanding how the brain works is different than understanding about how your brain works. Treating anxiety is not quite the same as treating your anxiety. Medications that save lives also have serious, serious side effects that sometimes have to be countered with more medications.

    I'm not backing off of my opinion of neuroscience: I still think it is a field that is essential and highly, highly valuable. A field worth funding, promoting, advancing. But I also think we need to fund, promote, and advance the fields and areas that help individualize treatment as much as possible. We are not just groups of people -- people with anxiety, people with depression, people with TMS. We're our own person, with unique experiences, and should be treated as such.
     
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  11. Becca

    Becca Well known member

    ...I am aware that the above was a highly idealistic argument...but I wanted to say it anyway :)
     
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  12. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    I agree we are all individuals and should be treated as such.

    My dog Annie would definitely agree. She is really individual.
    A friend said he's never seen a dog with such "presence."
    She doesn't say a word but talks with her eyes.
     
  13. BruceMC

    BruceMC Beloved Grand Eagle

    I don't think anyone objects to neuroscience per se. Anti-depressants and anti-psychotics have a role to play in treatment. I think what some psychotherapists do object to is the use of those drugs as an end in themselves without addressing and dealing with the underlying causes for depressive symptoms. I've heard that if you wall-paper over depression with a drug without changing the underlying reason for the depression in the the first place, it will manifest as other symptoms following a process similar to Dr. Sarno's oft-cited "symptom substitution". I know an AP reporter in Pakistan who described to me how her grandmother had been diagnosed with depression and given Prozac to mitigate the effects of that condition. However, the reporter also remembers how her grandmother would beat her with a stick with an insane happy grin on her old face. There was obviously still something going on beneath the surface that the Prozac couldn't eliminate or mask.
     
  14. quert

    quert Guest

    I agree. It is so small minded when people rely only on drugs and don't use psychotherapies that have also been shown to be very effective and which, as you mention, will continue to be helpful long after the patient has left therapy. It's like that old saying: give someone a fish and they eat for a day, but teach someone to fish and they eat for a lifetime.

    I agree with Becca that perception and appearance are important to distinguish from reality in all of this. One of the hottest areas of neuro-science recently seems to be brain-plasticity, the idea that our brains are constantly remolding themselves. If one believes, as most scientists do, that thinking happens in the brain then whenever we learn something or grow, that needs to be reflected in the brain somehow. That simple idea is really all that brain plasticity is. From this simple idea it must follow that because therapy changes us and helps us grow, it must change our brains. There is actually a whole book devoted to the neuroscience of therapy and how it relates to brain plasticity. It's is called "The Neuroscience of Psychotherapy: Healing the Social Brain," and it is already in its second edition, by Norton. I'd love to read it, but my stack of books to read is already too tall. The following is from the publisher's description:

    How the brain's architecture is related to the problems, passions, and aspirations of human beings.
    In contrast to [the view that the brain is completely fixed and unchanging], recent theoretical advances in brain imaging have revealed that the brain is an organ continually built and re-built by one's experience. We are now beginning to learn that many forms of psychotherapy, developed in the absence of any scientific understanding of the brain, are supported by neuroscientific findings. In fact, it could be argued that to be an effective psychotherapist these days it is essential to have some basic understanding of neuroscience. Louis Cozolino's The Neuroscience of Psychotherapy, Second Edition is the perfect place to start.

    In a beautifully written and accessible synthesis, Cozolino illustrates how the brain's architecture is related to the problems, passions, and aspirations of human beings. As the book so elegantly argues, all forms of psychotherapy--from psychoanalysis to behavioral interventions--are successful to the extent to which they enhance change in relevant neural circuits.​

    Those links that you shared, plum, look terrific. I'll give them a listen. I think you got it exactly right when you said that neuroscience doesn't explain away Sarno's ideas but help lift them out of a nebulous state.
     
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  15. plum

    plum Beloved Grand Eagle

    We are hardwired to survive, and not just physically. It is the frailty and ideosyncrasies that make us beautiful. Viriditas, my darling Becca, as most especially favoured by Hildegard von Bingen. Each of us embodies that *zazoom* of life. Screw politics and paradigms and paranoia, it is those that ARE themselves, who are feasts of BEING, who gift life in odd and magnificent ways. I love your idealism. We are shot to shit without it.
     
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  16. BruceMC

    BruceMC Beloved Grand Eagle

    Yes, quert, I'm not a psychiatrist or a neuroscientist, but it seems to me that meds can stop the gross symptoms of mania and depression, but traditional psychotherapy does have an important role to play encouraging the brain's innate capacity to self-heal, what the brain science doyens call "endoplasticity". Otherwise you get yourself an insanely "happy" manic depressive grandmother who runs around the house beating the kids with a stick.
     
  17. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    That poor woman, the grandmother. She must be full of TMS. I bet her "Picture of Dorian Gray" is really a sight.
    You know the movie of the Oscar Wilde novel about a young man who makes a pact with the Devil not to age,
    but his deeds and personality change a portrait of himself that shows how he really is.

    The grandmother may be having problems with her mortality. That's a tough one for many. I'm wrestling with it myself.
    As Woody Allen says, it's so unfair. But I just trust that God knows why he gave us birth and then the other thing.
    He wants us to do something with our life. We don't have to be Popes or movie stars or great doctors. Just working at
    anything to pass the years, and spreading some happiness around may be all that is expected of us.

    If that grandmother knew of TMS she could probably live her remaining years more happily and spread it to the kids she torments.
     
  18. Ellen

    Ellen Beloved Grand Eagle

    How our divided brain loves dualism--this vs that. It's all part of the whole, the oneness of being.

    My new avatar is turning me into a Buddhist, it seems :)
     
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  19. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    Sounds like Spinoza knew about TMS, just didn't call it that.
     
  20. Forest

    Forest Beloved Grand Eagle

    I was just leafing through The Divided Mind and in the introduction I found a brilliant quote (one of many) that I thought was very relevant to this discussion.
    It sounds like he is saying that a great deal of TMS is explained as arising from a division between two different parts of the brain - the neocortex and an older, more primitive part of the brain. The neocortex is associated with higher functions, like rational thought, whereas the older part of the brain include traits "we consider the most troublesome, like childishness, dependency, or the capacity for savage behavior." I tend to associate the ego with the neocortex and the id with the older part of the brain. Thus, neuroscience and understanding brain regions can be used to understand the divided mind that is at the heart of TMS theory.

    I love the quote because it captures what I think is the best way to think about the relationship between psychology and neuroscience. Neuroscience is there to explain and provide functions for what we already know from TMS theory and psychology. In my experience, it can also add nuance and deeper understanding. For example, I've been reading about the older parts of the brain that Dr. Sarno references for a while now and I've found what I've learned to be very helpful in understanding my own unconscious.

    I spoke with Dr. Anderson about this when we did the master class in New York City earlier this year. She is also very interested in the neuroscience of psychology and psychanalysis. In her introduction to Pathways to Pain Relief, she lists the following influences, all of whom are very interested in neuroscience and the physical basis of our psychology: "Researchers are increasingly focusing on the significant role of emotions in health and illness, for example, in the neurobiology of fear (Joseph LeDoux) and the neurobiology of trauma (Bessel van der Kolk and his colleagues). My treatment approach is also influenced by 1) Allan Schore’s (www.allanschore.com) integration of data from the psychoanalytic theory of development, neurobiology of attachment, and the neuroscience of emotional regulation; 2) Daniel J. Siegel’s (www.drdansiegel.com ) “interpersonal neurobiology,” which captures the complexity of the interpenetration of the psychological and the neurobiological realms of theorizing; and 3) Wilma Bucci’s (www.referentialprocess.org) research on the bodily basis of emotional and cognitive processing."

    Dr. Anderson also suggested books by Ruth Lanius, who studies the neuroscience of attachment. Attachment is an absolutely key concept in psychology - it is about how we become attached to the people we love, particularly those whom we knew early in our lives, like our parents. Steve Ozanich captures this with the idea of tracordification, which is a theme that runs, subtly, throughout his book. It refers to our need to draw people closer to each other. Human being need other human beings and when we find them, we like to form deep attachment bonds. One of the reasons I like reading Steve Ozanich's posts and writings is that he really understands this and it often pops up in what he writes.

    By the way, when Dr. Anderson did a teleconference for TMS Therapists that was organized by our nonprofit, she suggested the following video, along with two others, for people to watch before the teleconference. The three videos describe very early scientific studies of early attachment. They wouldn't be what one might call neuroscience today because they are out of date, but they definitely describe the foundations of the field. I feel a bit bad for the cute little baby monkey, though.
    Now, with today's technology, we can understand how attachment works in the brain. While I do believe that each one of us already know a gigantic amount about attachment just from our own experiences, I think that, over time, by looking inside the brain, we can find new ways to think about these things. I certainly find reading the books to be fascinating.​
    I do feel bad for the monkey, though. At least he got his nice soft mom at the end.​
     
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