This is your brain on drugs

One morning last summer, in the midst of my research, a longtime colleague and friend showed up at my office door looking a bit out of sorts.

“Something's really wrong with my dad,” he said. “He's not himself.”

Having spent time with my friend's father over the years, I was well aware of the twenty-year battle with Parkinson's disease that had slowly eroded the dexterity and agility of this successful trial lawyer and former athlete. And I had more than once seen the look, somewhere between pain and confusion, that engulfed my friend's face when the disease suddenly took a turn for the worse. But today there was something different.

“What do you mean?” I asked. “Is it the Parkinson's?”

“Sort of,” he replied. “Somehow his medication has gotten out of whack. He's doing the most bizarre things. Late last night, my brother found him standing in the front yard with a water pistol in his hand. He was convinced that he was protecting the house from a gang of marauders.”

“In Omaha?”

A smile momentarily broke his sobriety. “Yes. And when my brother found him, all he said was, 'It's about time you got here. I need some backup.'”

“How is he now?” I asked.

“They've got him in the hospital, and they're monitoring his medication, trying to figure out what went wrong. They have to keep him under constant supervision because whenever the nurse leaves the room, he tries to make a break for it.” He paused for a moment. “It just seems so delicate. What does it mean that the person you thought you knew can change so dramatically simply because their brain chemistry changes? What does that say about who we are?”

The relationship between brain chemistry and consciousness is one that, in the neuroscience age, is hard to get away from. As neurobiologists have deepened our understanding of the powerful neurochemicals that underlie our moods and motivations, words like adrenaline, endorphins, dopamine, and serotonin have become part of our vernacular. And for those who have spent any time studying the field, it has become increasingly difficult not to think of human behavior in chemical terms. In his 2004 book Mind Wide Open: Your Brain and the Neuroscience of Everyday Life, journalist Steven Johnson sums up the prevailing view: “Our personalities—the entities that make us both unique and predictable as individuals—emerge out of these patterns of chemical release.” Although part of the widespread confidence behind this view comes from observing cases like my friend's father, where a sudden chemical imbalance can cause a severe psychological disturbance, more of it has come from observations of the overwhelmingly positive transformations that attaining the right internal chemistry can bring about. Ever since the psychopharmacology revolution of the 1950s, when psychiatrists discovered the power of Thorazine to reduce even the worst symptoms of psychosis, the quest to chemically engineer mental health and well-being has been in full swing. Of course, most of us need look no further than our last trip to Starbucks or the local pub to see our own conviction in the benefits of chemically altered consciousness. But what if our power to chemically transform our experience went beyond a temporary release of inhibition or elevation of awareness? What if you could take a regular pill that would radically transform your personality, and even your sense of self, for the better? In the brave new world of psychopharmacology, even this bizarre possibility has become a reality.

We all probably know Prozac as the first and still most popular of the new genre of antidepressant medications to have swept the civilized world over the past two decades. By inhibiting the cellular reuptake of serotonin, this magic pill has proven overwhelmingly successful in lifting the spirits not only of the clinically depressed but of anyone simply wishing to feel a bit “better than well.” While this latter use, dubbed “cosmetic psychopharmacology” by psychiatrist Peter Kramer, raises many ethical issues and has been the subject of much heated debate, it is the results from Prozac's original clinical application that are of greatest interest here.

In his 1993 bestseller, Listening to Prozac, Kramer documents the cases of several patients who, after being prescribed the medication, experienced not only the expected elevation in mood but a wholesale transformation of their personalities. One such case was a woman named Tess who, in addition to being relieved from her depression, reported being simultaneously more at ease and more driven, less subject to emotional disturbance, and more extroverted, socially adept, and competent at her work. Two weeks after starting the medication, Kramer writes:

This new personality remained consistent for nine months—until Kramer took her off the medication. Although Tess did initially manage to hold on to some of her newfound confidence, she gradually began falling back into the personality traits that had characterized her life before Prozac. “I'm not myself,” she told Kramer after several months, at which point he promptly put her back on the medication.

Another patient, Julia, had experienced a similar transformation, following a stunning reversal of the obsessive-compulsive behavior that had been ravaging her family and work life. But when Kramer tried to lower the dose:

In reflecting on Kramer's accounts, Walter Truett Anderson writes in The Future of the Self, “What is particularly fascinating here is that in both cases, the women believed their 'real selves' to be what they had experienced during the short period of treatment and not the way they had been for the rest of their lives. Which, then, is the real self? And who decides?” Kramer himself, perhaps the single greatest advocate of cosmetic psychopharmacology, also found it hard to come to terms with this particular outcome of the treatment. “How were we to reconcile what Prozac did for Tess with our notion of the continuous, autobiographical human self?” These are big questions. And in light of the present inquiry, I would add one more: If a simple shift in brain chemistry can bring about such a dramatic transformation of the self, what aspects of our selves, or souls, do we imagine are outside the control of the brain? Like the study of brain damage, psychopharmacology also seems to suggest that we are more a product of our brains than most of us would like to think.

Neuroethics

If the study of brain damage and neurochemistry provides the beginnings of an outline of the profound link between brain and mind, powerful new brain scanning techniques promise to fill out the details in living color. By providing a picture of the brain's blood-flow patterns when engaged in particular activities, PET, SPECT, and fMRI scans are enabling researchers to map the regions of the brain like cartographers once charted the contours of the globe.

Through extensive imaging studies, neuroscientists have been able to identify nearly a dozen areas involved in different aspects of speech alone. And that pales in comparison to the thirty-plus different areas involved in specific aspects of vision. There is one area that recognizes vertical lines, another for horizontal lines, another for detecting motion, and another for the color blue. When it comes to face recognition, the picture gets even more complex. Would you believe that there are specific clusters of neurons that light up when presented with specific faces at specific angles—that, for instance, there is one tiny part of your brain dedicated specifically to your grandmother's profile, and another reserved for the ubiquitous mug of George Bush?

Discovering the biological basis of speech and perception is, however, just the beginning. With experimental methodologies improving by the month, even the more complex aspects of our experience, such as emotion, reason, motivation, and will, are beginning to give up their secrets. In Mapping the Mind, science journalist Rita Carter writes: “It is now possible to locate and observe the mechanics of rage, violence, and misperception, and even to detect the physical signs of complex qualities of mind like kindness, humour, heartlessness, gregariousness, altruism, mother-love, and self-awareness.”

The profound implications of these findings are not lost on the neuroscience community. Indeed, one of the more interesting new areas of discussion is what has become known as neuroethics. According to psychologist Martha Farah, brain imaging in particular has opened up an ethical can of worms with its unprecedented ability to peer into the previously private reaches of the individual mind. For instance, with neuroimaging, it has now become possible to tell when someone is being deceitful, or even when they are deceiving themselves. Enter lie-detection 3.0. Scientists can also discern whether someone was involved in a crime by showing them objects from the crime scene and seeing how their brain responds. Welcome to the new forensics, as marketed by Brain Fingerprinting Laboratories, Inc. It's even possible to tell whether someone is an illegal drug user by showing them photos of drug paraphernalia and seeing whether the brain enters a “craving state.” Meet the new war on drugs.

Then there is what Farah refers to as “brainotyping.” Using these same methodologies, neuroscientists can now look behind the scenes of your persona and find out what sort of human being you really are. Do you secretly harbor racial prejudices? By watching your brain while you look at pictures of racially diverse faces, brain scanners can provide an answer. How about sexual preferences? By showing you a variety of erotic imagery, we can see who or what turns you (or your brain) on. (And don't bother trying to suppress your response. Your brain looks different when you do that too.) Are you a risk-taker? A pessimist? An introvert? Neurotic? Persistent? Empathic? Even such core personality traits as these are now laid bare before the new neurointerrogation.

Ethical issues indeed.

Within the discussion around neuroethics, however, there is a larger issue coming to the fore that some feel may rattle the very foundations of the way we think about ethics itself. In civilized culture, our ethical norms and even our legal system are built on the notion of individual responsibility. When judging the actions of another, we hold him or her accountable for having freely chosen those actions for good or ill. But if we look at the picture of the human being emerging from neuroscience, many feel that there is little in it to support the idea that we freely choose our actions. If our actions are entirely caused by the brain, and the brain is in turn shaped entirely by the interaction between genes and environment, where does free will enter the equation? This may seem like philosophical nonsense, given that one of our most basic human intuitions is our sense of our own freedom to choose. But prominent neuroscientists claim that this deterministic picture of human behavior has, in fact, been reinforced by a number of experiments that seem to show that our brain makes choices before we are conscious of having made them, that in fact, conscious will is an illusion.

This bizarre notion, which is widely held within the neuroscience community, is clearly not one that will go over easily with the public at large. In fact, on the controversy scale, it may run a close second to what is no doubt going to be the most hotly disputed neuroscience claim of all—the notion that, as Farah puts it, even our “sense of spirituality” is itself a “physical function of the brain.”