Steven Pinker on Why We Curse

the Harvard braIn What the F***? Steven Pinker on Why We Curse

Parasites that Hijack the Brain

The Future of Lie Detection

Under the Skull of Gregory House, MD

Carbs and the Food-Mood Connection

Musings on Mind from Cambridge, MA 2008 The Harvard Brain from the editors 2008

As editors, we’re often asked to describe our publication. And as people, EDITORS we’re expected to be able to explain how we’ve been spending all our time. This is where things get tricky. Though it may be pretentious, it seems the title The Christine Eckhardt ‘09 Harvard Brain doesn’t readily convey our magazine’s contents. When we explain Scott McKinney ‘09 that it’s about neuroscience, we meet something resembling relief. No, it’s not a vehicle to exalt the intelligence of our undergraduates, nor something more Features Editors obscene. Elizabeth Ryznar ‘10 But any amusement is transient as our audience conjures images of bubbling Lisa Roth ‘08 test tubes, electrodes, and open-skull surgery. Now we’re left to dispel something else. Sure, The Brain is about test tubes and surgery—but it also connects to an- Academic Editors thropology (p. 16), medicine (p. 29), history of science (p. 26), economics (p. 33), Roland Nadler ‘09 and philosophy (p. 18). But by then our spiel has already grown longer than the Chiamaka Nwakeze ‘08 patience of our listener and our tolerance for alienation permit. Fortunately, the same quality that frustrates a succinct description of The Brain makes the rest of our job easy. As evidenced by newspaper headlines and best- DESIGN seller lists, the study of mind seizes our attention with peculiar intensity. Indeed, Erin McCormick ‘10 no inquiry offers a glimpse into who we are and how we think quite like neuro- Allyson Taylor ‘09 science. It is, in many ways, an extension of the humanities, providing perhaps an even sharper scalpel for introspection than the armchair ever could. Business ASSOCIATE Our efforts are also in line with a burgeoning program on campus to pro- Mimmie Kwong ‘10 mote broader science literacy. Science may be sexy, as T-shirts urged this year, but without question the brain is sexier. Here we stir in some swearing (p. 20), STAFF Writers drugs (p. 2), crime (p. 9), and chocolate (p. 2) to cultivate this allure and hopefully Meghan Galligan ‘10 expose the grittier side of cognitive science. Karolina Lempert ‘09 Those familiar with previous volumes of The Brain will note some key changes John S. Liu ‘11 in the publication’s structure—in particular, a division between features and academics. While the academic section showcases undergraduate coursework, Andrew P. Oakland ‘09 we’ve tried to make the features section appeal to the English major and post- Jay S. Reidler ‘09 doctoral scientist alike. In an attempt to provoke a sort of metamorphosis in the Brady Weissbourd ‘09 way material is presented, we’ve arrived at an entirely new creature, which we’re eager to introduce to you. So grab a cup of coffee as 41% of your peers do (p. 2), and enjoy. In the spirit Volume 15 The Harvard Brain is an annual, non-profit publication of our cover’s inspiration, we hope something shocks you, or at least grants you a funded by the Mind, Brain, and Behavior Initiative few tidbits to enliven conversations and deter attractive people at parties. At the (MBB), very least, you’ll spare us an awkward attempt at describing our magazine. 14 Story Street, 4th floor Cambridge, MA 02138. Copyright 2008 by The Harvard Brain.

The journal is distributed free of charge on the Harvard campus. To request a copy, e-mail [email protected].

Disclaimer: The statements, views, and opinions presented in The Harvard Brain Christine Eckhardt Scott McKinney are those of the authors and are not endorsed by, nor do they necessarily reflect the opinions of individual editors, The Harvard Brain, or HSMBB.

Publisher | Harvard Media Ventures Cover, graphics, and academic design | Christine Eckhardt The Harvard Brain | 2008 FEATURES

Gulp! 2 Tracing Taste The neurobiology of flavor 25 Molecular Voodoo Parasites that hijack the brain Buzzed Staying awake at Harvard 26 Symmetry Broken Of Hunger and Happiness Carbs’ role in the food-mood connection The dual brain narrative 1820 to present 29 Mind, Medicine, and Judaism 4 The Head’s Kaleidoscope Exciting advances in brain imaging A letter from Israel 6 Cortex of Steel Bulking up your brain 7 A Conversation with Hugh Laurie Winner of the Cranium Cup

Criminal Justice 9 ACADEMIC Sifting Patient from Prisoner 33 Behavioral Economics | b y Da n i e l De m e t r i The defensibility of the insanity defense How Homo sapiens Falls Short of Homo economicus Reading Minds A survey of availability bias fMRI and the future of lie detection 37 HISTORY OF SCIENCE | b y Ch a r l o t t e Se i d Criminal Cravings The Evolution of Schizophrenia as a Creative Journey Drug addiction and responsibility From R.D. Laing to evolutionary synthesis

41 NEUROBIOLOGY | b y Ca r o l Gr e e n 16 Temper Tantrum Against the Odds The complexity of parent-child relationships Gambling as pathological addiction 18 Debugging Humanity 2.0 43 HISTORY OF SCIENCE | b y Mo l l y Ba l e s The ethics of human enhancement Marketing and Minds in the Early 20th Century How psychology enhanced advertising

What the F***? 20 46 PSYCHOLOGY | b y Ca r i n a Ma r t i n Why we curse b y St e v e n Pi n k e r Paradoxical Liveliness The basis of hypermotility in anorexia nervosa TRACING TASTE Taste receptor cell Epithelium The neurobiology of flavor by John S. Liu hunk of chocolate mousse cake, neath the surface of your tongue, taste cells topped with smooth ganache and form an onion shape, sending finger-like a dollop of whipped cream, stares protrusions up through a small pore to access up from the table, beckoning you your meal, which they sense via the countless Nerve fiber toA take a bite. You whiff the scent of cocoa, chemicals suspended in your saliva. These lift your fork to your mouth, and the flavor specialized epithelial cells rouse as they in- Contrary to grade school curricula, cells sen- blooms on your tongue. teract with the compounds harbored by your sitive to each taste are not clustered in par- It tastes good—ridiculously good. But food, discharging to relay the information to ticular areas of the tongue, as each receptor how exactly do you know that this morsel of the rest of your nervous system. cell can actually detect multiple tastes. chocolate, so-called fruit of the gods, tastes The population of receptor cells encodes In your particular dessert, the dash of so- so heavenly? How do you know that this the five building-block tastes from which dium chloride triggers the sensation of salti- forkful doesn’t instead contain some cleverly more complex ones are constructed: sweet, ness, the cocoa solids strike bitterness, and disguised broccoli? sour, bitter, salty, and umami. The Japa- the profusion of glucose stimulates sweet- The crucial discrimination begins with nese word for savoriness, umami creates the ness. Glutamic acid from the whipped cream the 2000-5000 taste buds that carpet your “mouth-feel” experienced in protein-laden binds to receptors, supplying undertones of tongue and oral environs, each one a bouquet foods like meat and cheese, and is the reason umami. If the whipped cream happened to of roughly a hundred taste receptor cells. Be- MSG is used as an additive in some cuisines. Tracing Taste, continued on p.32

Staying Awake at Harvard

Faced with an all-nighter or an early morning class, s someone once said, sleep is a symptom of caffeine depriva- what is your stimulant of choice? tion. Judging by the widespread lack of Zs on campus (or at least the ubiquity of conversation on the subject), Harvard Prescription Other students scrupulously attend to their caffeine intake. Out of Drugs 8.1% 4.5% curiosity,A we polled stimulant use on campus to see exactly how under- Ca eine Pills graduates avoid that annoying symptom called sleep, especially in the 2.8% name of academics. Co ee 41.5% Energy Drink Of students without a prescription for ADHD 16.2% medication, 5.7% have used Ritalin, Adderall, or a similar prescription drug to do schoolwork.

Tea 27.0%

Tea Need a perk, but bored with the old Daily Caffeine27.0% Consumption 40.0 Pocket Coffee, Cardullo’s $3.99: Each of these candies con-

35.0 34.6 tains a shot of espresso enveloped in milk chocolate, though we’re slightly skeptical given their size, about that of a quar- 30.0 25.9 ter. Nevertheless, they should keep you awake (and save you 25.0 some trips to Starbucks). With five chocolates in a pack, 20.0 they’re also cheaper than ordering fresh espresso. 16.3 15.0 Showershock, Caffeine infused soap,

Percentage of Respondents 10.5 10.0 $6.99: Allergic to the taste of coffee and tea? 6.7 Try Showershock and get your caffeine fix 5.0

Percentage of Respondents Percentage 2.9 1.5 0.9 through your skin. With 200 mg of caf- 0.0 0123456 ≥7 feine per shower, Showershock delivers CupsDaily Ca eine of Coffee Consumption or (Cups Equivalent, of Co ee or Equivalent, 125 125mg mg Ca eineCaffeine) 2008 2 The Harvard Brain Of Hunger & Happiness Carbs’ Role in the Food-Mood Connection by Karolina Lempert

on’t worry. Come exam time, experience frequent carbohydrate cravings pect a Diet Coke to quell your longing, be- you’re not the only one eating while depressed.2 Similarly, women experienc- cause sugar substitutes don’t elevate serotonin more pizza, chips, and choco- ing PMS and people with major depression levels. Instead, reach for some fruit or whole late than your body could pos- (both conditions associated with low levels of grain cereal because the unrefined carbs will Dsibly need. Unfortunately for our waistlines, synaptic serotonin) appear especially vulner- replenish blood sugar—and may even restore the urge to gorge can have little to do with the able to binging on carbs.3 your capacity for self-control. Recent research kind and quantity of food we eat, especially This connection between carbohydrates has shown that acts of willpower such as di- when we’re stressed or upset. The hunger is all and mood helps explain a particular gastro- eting drain the body’s glucose levels, thereby in your head—literally. nomical puzzle that you might have observed impairing later acts of self-control.4 Thus, in- Behind the nearly universal love for car- during Thanksgiving dinner. After eating un- dividuals who eat several small meals a day bohydrates lies a basic need for something fathomable helpings of mashed potatoes, tur- appear more successful at losing weight than that sounds slightly less delectable—the neu- key, and cranberry sauce, you’re still game for those who skip meals in an attempt to accel- rotransmitter serotonin. This signaling mol- that slice of pumpkin pie. Hunger persists be- erate their diet.5 For those less concerned with ecule happens to be particularly important cause following the ingestion of carbohydrate- weight, stable blood glucose could facilitate for efficient brain functioning. Low levels of rich foods alongside considerable protein, self-control for other purposes—say, resisting serotonin have been linked to reduced verbal large neutral amino acids block the uptake of the lure of Facebook while writing that term memory, impaired decision-making, and even tryptophan into the brain. Consequently, the paper. depression.1 As carbohydrates can ultimately eater does not experience the expected neuro- As you struggle to focus on your problem increase the production of serotonin, this chemical effects as promptly as anticipated, set, you’re probably justified in indicting se- commonplace nutrient proves more than just causing her to seek more carbohydrates than rotonin. Not only will you feel up on your a source of calories.2 would usually do the trick.2 The signaling in- neuroscience, but equipped to rectify the The process begins with the release of in- terference produced by certain combinations situation as well. That brain-break bagel will sulin, triggered by the consumption of car- of foods can no doubt result in weight gain, tackle either of the potential culprits—your bohydrates. This event suppresses circulating especially in those highly responsive to the metabolic calorie deficit or your brain’s jones levels of most large amino acids except for mood altering effects of carbohydrates. for tryptophan. Still find your browser stray- tryptophan, which remains relatively unaf- But if undesirable weight gain has oc- ing to NBC.com to watch reruns of the “The fected. With fewer competing amino acids in curred, don’t jettison carbs completely. It Office,” despite a stuffed stomach? Exercise the bloodstream, more tryptophan is trans- seems that some pasta or popcorn may actu- appears to heighten serotonin just like that ported to the brain. Inside certain neurons, ally be crucial to a diet’s success, as frequent bowl of pasta would, so try sweating off your enzymes convert tryptophan into serotonin, small feedings can bolster a dieter’s willpower. distraction on the treadmill.6 With those new potentiating its future release.2 In susceptible Such noshing helps maintain normal blood TVs in the MAC, you might boost your self- individuals, the serotonin boost fuelled by car- glucose levels, which stabilize levels of circu- control and satisfy that craving for cubicle bohydrates can improve mood, analogous to lating insulin.4 In turn, with a steady supply humor. (though less potent than) the effect of selective of tryptophan to neurons, the production of serotonin reuptake inhibitors (SSRIs), popular serotonin also remains constant—helping to References 1. Murphy, F.C., Smith, K.A., Cowen, P.J., Robbins T.W., antidepressants. A recent study reported that stave off those runaway cravings. So if you feel Sahakian, B.J. (2002). “The effects of tryptophan depletion on individuals with periodic mood perturbations a sudden desire for something sweet, don’t ex- cognitive and affective processing in healthy volunteers.” Psy- chopharmacology, 163, 42-53. 2. Wurtman, J. (1993). “Depression and weight gain: the standbys? Try one of these: serotonin connection.” Journal of Affective Disorders, 29(2-3), 183-192. the equivalent of about two cups of coffee, and Spazzstick, Caffeinated lip balm, www. 3. Dye, L. & Blundell, J.E. (1997). “Menstrual cycle and each bar contains roughly 12 shower’s worth. Try spazzstick.com, $2.99: A police officer in appetite control: implications for weight regulation.” Human Reproduction, 12 (6), 1142-1151. a Google search to bring up a few online ven- Alaska hit upon this idea, hoping for a pick- 4. Gailliot, M.T. & Baumeister, R.F. (2007). “Self-control dors. me-up during late night shifts as well as relies on glucose as a limited energy source: willpower is more than a metaphor.” Journal of Personality Social Psychology, 92(2), Dark Chocolate Covered Espresso protection from the cold. Since Cambridge 325-36. Beans, Starbucks, $3.25: With a slight crunch, winters may as well be Alaskan, and probably 5. Parker-Pope, T. (2008). “How to Boost Your Willpow- er.” The New York Times (Online Edition). Retrieved March 15 smooth chocolate, and a hint of coffee flavor, even more exhausting, this small stick is a 2008 from http://well.blogs.nytimes.com/2007/12/06/how- these espresso beans are almost impossible to worthwhile component of any survival pack. to-boost-your-willpower/?ex=1197867600&en=ebd265503f2 stop eating. Though each bean probably packs With flavors like vanilla, chocolate, mint, 3d0f0&ei=5070&emc=eta1 6. Meeusen, R. & Piacentini, M.F. (2003). “Exercise, minimal caffeine, we think it’s an excellent - ex and orange, they apparently taste good, too. fatigue, neurotransmission and the influence of the neuroen- cuse to down the whole box in one sitting. docrine axis.” Advances in Experimental Medicine and Biology, 527, 521-25.

The Harvard Brain 3 2008 The Head’s Kaleidoscope Exciting Advances in Brain Imaging

ing their skulls pried open—most notably Though it may seem like callous denigra- language, but more recently morality as well. tion, the charge does bring up legitimate con- by John S. Liu Indeed, important psychological discoveries cerns with the method’s power to reveal the have been made in figuring out what cogni- inner-workings of the mind. FMRI measures hink back to phrenology, the tive abilities emanate from which wrinkles of brain activity by detecting increases in blood- art of reading your personal- gray matter. flow to specific parcels of tissue. The idea is ity, abilities, and character traits Even outside the scientific community, that brain regions working hard during a spe- through bumps on your head. fMRI images, depicting conflagrations be- cific task need more oxygenated blood to fuel TThough mostly relegated to the “what were neath the skull, seem to captivate. What is them, and this increase is registered by fMRI they thinking?” vault of scientific history, the it about fMRI that has people so enamored? machines as elevated activity. The problem is practice bears an eerie resemblance to the ex- Yale psychologist Paul Bloom suggested in that the brain is not a constellation of solo- ploits of scientists using functional magnetic Seed that one reason may be the bells and ists; it’s more of an ensemble, which sounds resonance imaging (fMRI)—this era’s most whistles that come along with doing an fMRI in harmony. Locating key players and their popular brain imaging technique. Some of experiment: “It has all the trappings of work functions, then, tells us little about the big what phrenology purported to do, fMRI with great lab-cred: big, expensive, and po- picture—that is, how these regions work actually does, and with scientific rigor at tentially dangerous machines, hospitals and together. Even if one area lights up during that. Developed in the 1990’s, fMRI offers a medical centers, and a lot of people in white sexual arousal, for example, we won’t know quantifiable, noninvasive method for detect- coats.” But if this seems rather superficial, what input triggered this activity, or the next ing localized changes in brain activity. Unlike there may be a deeper reason as well, striking region involved in the circuit. traditional MRI and computer tomography the core of our mental lives. “We intuitively Despite such shortcomings, we probably (CT), which yield static pictures of the brain, think of ourselves as non-physical,” Bloom shouldn’t be so dismissive as to call fMRI fMRI allows us to pin dynamic processes— writes, “so it is a shock, and endlessly inter- phrenology’s grandchild. As David Dobbs thoughts, emotions, and experiences—to esting, to see our brains at work in the act of observed in Scientific American, the tech- concrete neural tissue, all in real time. thinking.” nique is still young. Indeed, it seems “only The advent of fMRI has helped countless Metaphysics aside, claims from fMRI sci- natural to plot a simple map of cities before investigators map, Lewis and Clark style, the entists can still make us feel a little uneasy. delineating the intricate road systems that lay of the cerebral land. What neuropsycholo- You’ve heard it all before—Region X is re- link them.” FMRI may identify important Unlike traditional MRI and computer tomography, fMRI allows us to pin dynamic processes—thoughts, emotions, and experiences—to concrete neural tissue, all in real time.

gists had to infer from brain trauma patients sponsible for greed, Region Y for lust. Inves- nodes the network, but other approaches are (‘lesions in the left hemisphere seem to lead tigators have pointed to regions that explain needed to determine how they interact. to deficits in language’), researchers could why some prefer Coke over Pepsi, and even Luckily, scientists are working in parallel now probe in healthy volunteers. Moreover, searched for the “God-spot,” the putative to fill in the gaps left by fMRI investigation, fMRI has opened the door to studying pro- ‘antenna’ that receives signals from the sky. and the prospects look good. Meet diffu- cesses absent in species that don’t mind hav- Has phrenology returned, some might ask? sion tensor imaging (DTI) tractography, a

2008 4 The Harvard Brain new technique that does what fMRI alone cannot: map out the connectivity between brain regions. DTI tractography works by detecting and interpreting the simple diffusion of water. Since nerve fibers are shaped more or less like tubes, water molecules in the brain diffuse more readily along nerve fibers (in parallel) than they do across them (transversely). DTI tractography reads this directionally-biased diffusion of water and outputs a map of nerve fibers stretching from one brain locus to another. Combining these maps with fMRI data allows us to see not only that Region X and Region Y are acti- vated during, say, a psychotic episode, but also that Region X sends projections through Region Z to reach Region Y. It then starts to become clear how all these regions work in conjunction. Courtesy of Sylvain Bouix, Psychiatry Neuroimaging Laboratory, Brigham & Women’s Hospital ut perhaps we want to zoom in Some of the major white matter bundles identified through diffusion tensor some. Perhaps we want to know imaging (DTI) tractography. DTI detects the diffusion of water along nerve not only how Region X connects fibers to map out the communication highways between brain regions. to Region Y, but also how indi- B one another and their efferents traced, shed- mensional, but rather a three-dimensional vidual nerve cells within Region X connect ding new light on the intricate connectivity mesh composed of billions of neurons, each to one another. After all, neural computation between single cells. Clearly, these images cell making potentially thousands of connec- emerges first from discourse between small have a lot to tell us: “Knowing the circuit dia- tions with its comrades. In the emerging field groups of neurons within brain modules. In gram of the brain, like for any other comput- of “connectomics,” scientists seek to describe light of this fact, a fundamental limitation of ing system such as a radio or a computer, is the brain in terms of its connections, and fMRI and related technologies is its spatial very helpful in understanding how it works,” further, to understand how information is resolution. As writer David Dobbs puts it, Sanes said about the new technique. But “it’s conveyed and processed by these pathways. “because each voxel [the unit of signal used going to take many different approaches to Visualizing these 3D networks is no easy task, to produce the image, several cubic milli- figure out the complete story.” but computational neuroscientist Sebastian meters] encompasses thousands of neurons, Seung at MIT has been developing a tech- thousands or even millions may have to fire major drawback of the brainbow ap- nique that is up for the challenge. In Seung’s to significantly light up a region; it is as if an proach is that it produces only a flat method, computer algorithms scan chunks entire section of a stadium had to shout to picture. Like the rest of our bodies, of tissue, slice-by-slice, following neuronal be heard.” Unlike data gleaned from fMRI or A however, the brain is not two-di- DTI, knowledge of the microscopic connectivity and communication between neurons addresses the precise ways in which information is coded and processed by the brain. Illuminating these more basic circuits is the aim of an exciting new frontier in imaging. In a 2007 Nature publication, Harvard faculty members Joshua Sanes and Jeff Licht- man unveiled a technique that allows us to see the brain at an unprecedented level of detail and clarity. Their “brainbow” is a stunning image of distinct neurons and glia illuminated in over 90 vibrant colors. Sanes and Lich- tman achieved their psychedelic portrait of the mouse brain by expressing combinations of different fluorescent proteins—variants of those purified from jellyfish—in the neurons of transgenic mice. This was something never before possible with traditional fluorescence Courtesy of Sebastian Seung, Massachusetts Institute of Technology imaging, which often employed only a few A connectomics reconstruction of the rabbit retina. Computer algorithms scan colors. With the palette now expanded, in- collections of electron microscope images to develop a 3D wiring diagram of dividual neurons can be distinguished from neural circuitry. The Harvard Brain 5 2008 outcroppings through two-dimensional elec- never stands still. The program of connecto- Headline image: Adaptation of “Kaleidoscope” by lakewent- tron microscope images to trace the circuitry mics suggests that the brain is hard-wired; worth, under a Creative Commons Attribution-NonCom- mercial 2.9 Generic License. http://www.flickr.com/photos/ weaved throughout the tissue. Data collect- but its connectivity is dynamic in response roome/219622794/ ed from this process allows investigators to to stimulation. Networks are continually CORTEX OF STEEL IMAGE: “GAMER” by OKAYSAMURAI, UNDER A CRE- construct vast wiring diagrams depicting the modified, rearranged, and pruned. Were the ATIVE COMMONS Attribution-Noncommercial-No Derivative Works 2.0 Generic LICENSE http://www.flickr.com/photos/ brain’s elaborate connections. brainbow to reflect this, it would be ever- okaysamurai/1269826969/ But such a task may be one that is doomed shifting, like a whirling kaleidoscope. Still, never to be complete. For the brain, it seems, we’re a long way from scalp massages. Cortex of STEEL Exercise on the couch. No sneakers required. by Roland Nadler

ust imagine: a fun and exciting work- Age to offer instructions, encouragement, apparently don’t count). The benefits of out that will make it easy to reclaim and occasionally superficial commentary exercise, well-documented by medical your youth and boost your abilities in on depictions of neural activity (“this science, are thought to extend to cogni- just minutes a day! That’s the premise brain is more lit up than the other one!”), tion by virtue of a circulation boost to the J of several recent video games devel- served as Nintendo’s scientific counselor brain, which keeps existing brain cells oped by Nintendo—that is, if mental ex- while the game was being developed. healthy and may even stimulate the birth ercise can be called a workout. Indeed, Brain Age exuberantly touts the of new ones. If breaking an actual sweat is The “brain training” video game genre approval of its prominent neuroscientist- key when it comes to mental fitness and was born in 2005 with the release of Brain turned-mascot. But for all their gee-whiz video games, then perhaps Dance Dance Age: Train Your Brain in Minutes a Day and brain-scan images, do these video games Revolution has had the “brain training” has recently been expanded by Nintendo really deliver the cognitive benefits con- market cornered all along. with several titles for its handheld DS sys- sumers might hope for? Ultimately, the tem and Wii console. Though the differ- jury’s still out, but Nintendo isn’t making ent iterations may vary in content, they all any grand claims after all. When queried share the same basic objective: polishing on the issue, a marketing executive sim- the user’s cognitive cutlery. In Brain Age, ply stated that Nintendo is “in the enter- for instance, users can lower their brain’s tainment business.” Good thing, too: in “age”—a metric derived from perfor- a recent New York Times article, Sandra mance on Stroop tests, quick calculations, Aamodt, editor-in-chief of Nature Neuro- and memory games—by completing dai- science, and Sam Wang, an associate pro- ly sets of these mental calisthenics. fessor of molecular biology and neurosci- Intellectually, the new craze traces its ence at Princeton, take a decidedly critical roots to Japanese neuroscientist Ryuta Ka- stance on “brain exercise products.” At the washima, a professor at Tohoku University heart of the misconception, they say, is and author of Train Your Brain: 60 Days to a the notion that focused practice on a nar- Better Brain, a how-to manual that has en- row array of tasks can improve “general joyed considerable success in Japan and mental fitness.” has since seen a flurry of look-alikes in its As a better-proven method of combat- wake. Dr. Kawashima, whose floating po- ing mental sluggishness, the authors sug- lygonal visage appears throughout Brain gest good old physical exercise (thumbs

2008 6 The Harvard Brain A Conversation with H UGH LAURIE 2008 Winner of the Cranium Cup

ccording to an age-old tradition (beginning this year), the editors of The Harvard Brain award the Cranium Cup to an individual who we believe exemplifies “braininess” out- sideA the ivory tower. Our initial list of nominees was relatively short, as only a few individuals merit the distinction of “potentially brainy”—our list ranged from the “fake Steve Jobs” to the real Steve Jobs; from J.K. Rowling to Matt Damon. Ben Stein was eliminated as a matter of principle. After intense deliberation, we are pleased to honor Hugh Laurie, lead actor in the popular show “House, M.D.,” winner of two Golden Globes, and star of the British hits “Jeeves and Wooster” and “A Bit of Fry and Laurie,” with this year’s Cranium Cup. We feel that both Laurie and his character, Gregory House, inextricable from the actor who spawned him, embody the fundamental ideals of the Cranium Cup— ingenuity, intellectual daring, and brilliance. The Lau- rie-House hybrid flaunts his “braininess” not only in solving unsolvable cases, but through witty ripostes and penetrating psychoanalytic insight as well. We’ve concluded that in order to so effortlessly effuse brainpower (all while speaking in that ravishing American accent), Laurie must himself possess an intellect superior even to that of his fictional alter-ego Gregory House. Laurie’s show has moreover spotlighted an assortment of psychiatric and neurological conditions often overlooked or misunderstood. This past spring “House, M.D.” collaborated with NAMI, the National Alliance on Mental Illness, to raise funds and awareness about mental illness. Through the Cranium Cup, The Harvard Brain therefore seeks to recognize not only top-notch neurological functioning, but significant contributions to the mental health of others as well. In lieu of an acceptance speech, The Brain opted for an ‘acceptance interview’ via e-mail so that we could Courtesy of hughlaurie.net plumb the mind that has garnered our praise.

The Harvard Brain 7 2008 “There is, I think, a psychiatric—as well as psychologic—aspect to the world of House. I wouldn’t presume to know what it is, but I do feel it’s there.”

Christine Ec k h a r d t (CE): Wh y d i d y o u a n d y o u r c o l l e a g u e s g e t valiant effort to understand, tame and master conflicting i n v o l v e d w i t h NAMI, in p a r t i c u l a r ? Wh y m e n t a l h e a l t h , a s feelings of love and hate is resolved by sublimating them, o p p o s e d t o t h e n u m e r o u s o t h e r i l l n e s s t y p e s c o v e r e d o n t h e via the application of an above average intelligence.” s h o w ? Hugh Laurie (HL): We had been casting round for a while to find Wh a t ’s y o u r t a k e o n t h e m i n d o f Gr e g o r y Ho u s e (p s y c h o - the right charity, but without success. We were about to stick a n a l y t i c o r o t h e r w i s e )? a pin in one of our office runners to see which body-part we HL: The above analysis seems sound, if a little unmusical. I be- should address, when our medical supremo, Dr. David Foster lieve it’s also an anagram of the first two paragraphs of Tess (formerly an instructor at Harvard Medical School), suggest- of the D’Urbervilles. Personally, I am reluctant to analyse ed that mental illness was an often-neglected condition and House. Although some say an actor has a duty to understand therefore a solid candidate. It also seemed to chime with the the character he plays, I would argue that people usually don’t show itself. There is, I think, a psychiatric—as well as psycho- understand themselves. House most likely doesn’t either, and logic—aspect to the world of House. I wouldn’t presume to I ought not to play him as if I do. People are surprising— know what it is, but I do feel it’s there. to others, to themselves, even to psychoanalysts—and House should be given the same space. CE: Wh e n c r e a t i n g n e w e p i s o d e s o f Ho u s e , MD, h o w m u c h c onsideration is g i v e n t o p r o m o t i n g a w a r e n e s s o f c e r t a i n CE: ho w d o y o u m a n a g e t o e f f u s e s u c h b r a i n i n e s s w h i l e p l a y i n g d i s e a s e s ? Ho u s e ? Is it a s p e c i a l w a y o f b e i n g “in c h a r a c t e r ” o r d o e s it HL: I am not one of the writers of the show, but I suspect the an- j u s t c o m e n a t u r a l l y ? swer is ‘none’. Our first responsibility is to create an engaging HL: It certainly does not come naturally. For the first 20 years of and entertaining TV show, and if we sacrifice that to other in- my career, I made a comfortable living playing morons. That terests, then we risk ending up with a show that can’t promote came naturally. If I effuse braininess as House, it is only be- awareness of anything at all, including itself. Having said cause I am allowed to effuse a brainy script. I also wear brainy that, certain obscure diseases are bound to catch the attention clothes, have my hair brainily styled, and walk with a certain of the writers, for the simple reason that obscure often equals kind of brainy awkwardness. And eat a lot of oily fish. intriguing—but I think we’d have to call that an accidental benefit. CE: ev e r f i n d y o u r s e l f t h i n k i n g l i k e Gr e g o r y Ho u s e o f f t h e s e t (p e r h a p s , e v e n w i t h a n Am e r i c a n a cc e n t )? CE: ho p i n g t o g e t a b e t t e r f e e l f o r Gr e g o r y Ho u s e —t h e m a n HL: I used to think a little like House before I knew he existed. h i d d e n b e n e a t h a l l t h e w i t , s a r c a s m , a n d i n t e l l e c t —w e When I first read the script, he seemed very familiar to me. c o n s u l t e d a p s y c h o a n a l y s t r e g a r d i n g y o u r c h a r a c t e r . The difference was that my House-like thoughts remained un- He r e ’s a n e x c e r p t f r o m h i s d e t a i l e d a n a l y s i s : said. Consequently, I remained unpunched in the mouth.

“…House identifies with his father as the aggressor, and in CE: is t h e r e a n y o n e y o u ’d l i k e t o t h a n k f o r t h e “b r a i n i n e s s ” y o u that way unconsciously makes his father, or more precisely, p o s s e s s t o d a y ? the perceived hated and feared aspects of his father, part HL: I would like to thank my colleague and friend Stephen Fry, of himself. Thus House develops and solidifies those social- whose IQ runs into the mid-700s. Better than that, he has a ly off-putting signature traits, which are elaborated into his memory that would tear down the walls of Jericho. personas of the arrogant cynic, the accuser and the defi- ant non-conformist…House is stuck in a repetitive conflict Special thanks to David Bloomberg, L.C.S.W. for his psychoanalytic with authority figures, which is a transparent disguise for contribution. and representative of his emotionally absent father...His

2008 8 The Harvard Brain The Harvard Brain 9 2008 The Defensibility of the Insanity Defense by Andrew P. Oakland

ashington D.C., 1981—an obsession turns mur- Hinckley’s capacity to reason or to conform to the law, and he was derous. A failed songwriter, infatuated with actress exonerated from all charges with a verdict of “not guilty by reason Jodie Foster, fires six shots at President Ronald Rea- of insanity” (NGRI). gan in a desperate attempt to win her affection. He Hinckley’s acquittal evoked near-universal outrage. New York misses, but the act does not go unnoticed. A year later Times columnist Russell Baker, one voice among a fierce chorus, he stands trial for thirteen criminal counts, including assault with a wrote that, “[f]or an exercise in legal absurdity it would be hard to dangerous weapon, assault with intent to kill, and attempted mur- improve on the trial of John W. Hinckley Jr.” The American Medi- der. cal Association even recommended that insanity provisions in the Though the love-stricken lad’s guilt was unequivocal—the criminal justice system be dismantled. Dismay resonated beyond whole episode was caught on tape—the consequences Hinckley the experts and pundits, too. According to a poll conducted by would face were very much not. You see, John Hinckley pleaded ABC News the day after the verdict was handed down, 83% of insanity. Sure, he tried to assassinate the president, but that’s not Americans felt that “justice was not done,” despite the fact that quite the point, argued his lawyers. What rendered traditional ju- Hinckley had been placed in supervised psychiatric care indefi- risprudence inappropriate, they insisted, was that Hinckley’s obses- nitely. sion with Foster so distorted his thinking that he became incapable Congress finally made concessions to the pitchfork-wielding of grasping the nature of his crime. The prosecution, on the other mob with the Insanity Defense Reform Act of 1984. This legisla- hand, was less sympathetic. This was merely a case of poor judg- tion limited the sanctuary of the insanity defense to defendants ment, they demurred: Hinckley had a realistic idea of his chances who could demonstrate that, at the time of the crime, they could with the actress, whom he had never actually met, and should be not appreciate the nature or wrongfulness of their acts “as a re- punished for his deeds. sult of mental disease or defect”. Criminal responsibility became The defense’s argument won out. After four days of deliber- tantamount to having a cognitive handle on one’s behavior and ating, the jury concluded that reasonable doubt remained as to its consequences. The precedent of pardoning someone driven

2008 10 The Harvard Brain by compulsion generated by mental disease working for the prosecution use the evidence mit the same crime, shouldn’t they be treated (a so-called “irresistible impulse”) had been to draw different conclusions. equally under the law? abandoned. Moreover, the 1984 act saddled This tension was particularly striking in In an effort to reconcile these issues, some the defense with the burden of proof, a sig- the Hinckley case. Dr. William Carpenter, states have inducted a new verdict into their nificant departure from the law as it stood for lead psychiatrist for the defense, testified that repertoire: “guilty but mentally ill” (GBMI). the Hinckley case. Hinckley suffered from schizophrenia and Though touted as a compromise between Many states followed with similar laws was consequently unsure of his identity. This NGRI and the standard guilty verdict, hindering a breezy exculpation. Four of them, led him to take on fragments of other identi- GBMI has spurred controversy itself, as the Montana, Idaho, Utah, and later Kansas, dis- ties, such as Robert DeNiro’s character from outcome tends to be far from intermediary. pensed with the insanity defense altogether, the movie Taxi Driver, who was in love with Defendants found GBMI are sentenced just letting the defendant’s mental state mitigate the character portrayed by Jodie Foster. Dr. as those found guilty in the proper sense, but sentencing, not the verdict. Park Dietz, psychiatrist for the prosecution, with further restrictions placed on parole, however, testified that Hinckley was merely prison ward assignment, and rewards for rbitrating mental illness and criminal star-struck; his meticulous planning for the good behavior. In essence, they serve double- responsibility isn’t so straightforward. assassination and recent jaunts around the duty for committing a crime and for being To warrant unreserved punishment, country on commercial airlines showed that mentally ill. most laws currently insist on both a guilty ac- he knew exactly what he was doing. For this reason, the American Psychiatric tion and an accompanying “guilty mind”— Among such incongruous statements by Association (APA) argues against supple- the mens rea. When confronted with the in- expert witnesses, lay jurors must decide for menting the jury’s arsenal with GBMI. But sanity defense, the court must decide if the themselves which psychiatrists to believe. they also condemn the verdict on more defendant was capable of bearing this guilty They must also take care to ignore tenden- theoretical grounds: “[GBMI] compromises mind at the time of the crime. The focus then tious but legally insignificant statements like: one of our criminal system’s most impor- becomes accountability, not guilt. (Notice “How could someone think that killing the tant functions—deciding, through its delib- the tacit assumption here of the mens rea ac- President would impress a woman unless erations, how society defines responsibility,” companying the misdeeds of ordinary, ratio- that person were insane?” Further, they are they wrote in a statement. “A ‘guilty but nal citizens.) expected to make informed decisions when mentally ill’ plea absolves the judge or jury Since mental state during the crime is the their knowledge of the implications of each of this obligation.” Indeed, controlled studies pivotal element under scrutiny, formal diag- verdict may be incomplete. Jurors may not show that mock juries often use GBMI as a nosis of a mental disorder in the defendant recognize the legal subtleties involved in the shortcut in order to avoid the taxing debate is neither necessary nor sufficient to yield a insanity defense or they may believe that the between holding someone responsible for her verdict of NGRI. Indeed, the law explicitly streets would be safer with the defendant actions and accepting a plea of insanity. forbids reliance on medical diagnoses, which committed to jail instead of a psychiatric can often be messy and contentious. If the hospital. Even if convinced of a defendant’s anging onto this social covenant on defense does invoke mental illness to buttress insanity, they may believe that he would be which individuals have rational con- claims about the defendant’s reasoning, the let out promptly, unaware that people found trol over their actions becomes in- disorder cannot have its primary manifes- NGRI often serve more time in psychiatric creasingly important as scientific inquiry tation in antisocial or illegal behavior. This care then they would have in prison. Stigma into the nature of free will and decision- provision precludes the argument that com- against or fear of the mentally ill could also making continues. We see a manifest differ- mitting certain crimes is itself insane, which color a jury’s verdict. ence between the legal status of ordinary citi- would in principle extend the net of the in- zens and the mentally ill. But on this matter, sanity defense to every common delinquent. he process may be faulty, but that isn’t science comes up short. For it seems that, at The task of determining whether ade- its most uncomfortable problem, con- some level, we are all just deterministic slaves fendant was too “insane” at the time of the sidering that contradictory testimony, to our nervous system, mentally ill or not. crime falls to psychiatrists, who then testify murky legal consequences, and personal Fortunately, this definition of rationality and as expert witnesses. Through personal inter- prejudice can afflict jurors in any high-stakes free will isn’t the one we operate on when it views and appraisal of the defendant’s behav- case. Instead, the difficulty is deeper. Intu- comes to assigning criminal responsibility: ior, psychiatrists assess the defendant’s capac- ition suggests that there is something fun- in issuing punishment, we hold standards ity to reason, and hence his ability to infer damentally different between someone who on the types of cognitive faculties possessed the consequences of his actions. Scientific as murders his wife because he hates her and by the offender—not on the nature of his it may seem, expert witnesses need not neces- one who murders her because he thought she neurobehavioral causation. If science doesn’t sarily agree. Naturally, psychiatrists hired by was a demon spirit. Intellect wavers, howev- furnish an answer to the question of crimi- the defense usually attest to the lack of men- er, in dealing with these differences. After all, nal responsibility, then, we can’t abdicate our tal capacity during the crime, while those if a sane person and an insane person com- duty to decide on moral grounds.

The Harvard Brain 11 2008 fMRI and the Future of Lie Detection by Andrew P. Oakland

f Pinocchio ever testified in court, he would Informed fibbers can fool the polygraph by taking deep breaths or mild be a jury’s dream. Unfortunately, Pinoc- sedatives, both means of reining in the harbingers of stress. chio doesn’t hang around too many crime Because the polygraph is so vulnerable to evasion, lawmen have long scenes, and current lie detection technolo- sought alternative methods of sniffing out deception. One version used gies aren’t that good. electroencephalography (EEG) in a process called “brain fingerprint- The standard truth-ferreting procedure to- ing.” In the judicial setting, electrodes placed on the scalp looked for day, the polygraph test, succeeds eighty-five a hallmark familiarity signal in the defendant’s brain when he was presented with elements of the crime (say, the murder weapon). Researchers soon discovered, however, that the brain activity evoked by real details of an event and that evoked by false but rehearsed details (that airtight alibi) were indistinguishable by EEG. Because of these ambiguities, the “From a neural standpoint, it approach remains controversial. The latest stab at impeccable lie detection relies on another brain im- seems the liar needs to aging technique: functional magnetic resonance imaging (fMRI). Since active neurons need extra oxygen, increased levels of oxygenated blood to his words in a region can indicate elevated activity in that part of the brain. Ex- ploiting the magnetic properties of oxygen, fMRI uses a giant magnet to keep a bogus story straight.” to determine which brain areas are more active during one cognitive task compared to another. The use of fMRI for lie detection grew from the fact that lying requires more mental effort than telling the truth; research has shown greater activity in areas like the anterior cingulate or ninety percent of the time, but is far from cortex, the dorsal lateral prefrontal cortex, and the parietal cortex (areas perfect. To determine the veracity with which a associated with attention and error-monitoring) when a subject is lying subject responds to questioning, the polygraph than when the same subject is telling the truth. From a neural stand- analyzes his physiological state during interro- point, it seems the liar needs to pay close attention to his words to keep gation. The problem is that while the variables a bogus story straight. measured—respiration rate, heart rate, blood Seeking to capitalize on this principle, No Lie MRI, Inc. and Cephos pressure, and finger sweat—certainly reflect Corp. have begun marketing lie detection scans which scour the brain stress, they don’t always correlate with honesty. for these signature exertions during dubious statements. No Lie’s web-

2008 12 The Harvard Brain site claims that the tests are currently over 90% accurate, with 99% violating our last truly private sanctuary. Indeed, the technique seems accuracy possible in the near future. a bit more invasive than other court-sanctioned procedures like DNA But there’s a nagging worry: the lab tests on which these tech- testing. Nevertheless, lie detection with fMRI is gaining ever more niques are based may not be adequate simulations of the real world. attention from both scientists and the media as companies like No “Even if brain systems respond differentially when people give decep- Lie continue to grow. tive answers,” comments Randy Buckner, Harvard psychology professor and fMRI scientist, “there is still a large gap between the kind of experiment done in the laboratory and one that can be done on untrained or even non-compliant participants.” The volunteer’s motivation for pulling off a lie in experiments is “Imagine a general who could a trifling sum, often no more than fifty dollars. In a legal setting, the incentive can be as great as the subject’s own freedom. Such a of his discrepancy in motivation could seriously compromise the test’s reliability. The technique is further dogged by its high cost (the machines army, or an investor who could are expensive to build, maintain and operate; a scanner costs around $3m), the high degree of cooperation required from its subjects (even evaluate his stock tips.” slight movements during a scan can obscure images), and the experts needed to carry out the procedure (you’ll want a Ph.D.). Despite these challenges, No Lie has already started testing for around ten thousand dollars per customer. While current patrons include the likes of desperate housewives trying to vindicate their fidel- uch as we were attracted to the truths hidden in microscopic ity, supporters of fMRI lie detection foresee its use not only in private DNA molecules, only illuminated by scientific means, so disputes and courtrooms, but also in financial and military affairs: too do we appear to be drawn to the light that fMRI sheds imagine a general who could verify the allegiance of his army, or an on the deceptive psyche. If No Lie’s estimates about the future accu- investor who could evaluate his stock tips. racy and reliability of fMRI technology prove correct, their technique But honesty might not always be the best policy. Some ethicists could impact courtroom proceedings as much as DNA evidence did and watchdog groups, like the Center for Cognitive Liberty and Eth- in the ‘80s. But the technology is far from replicating Pinocchio’s ics, protest that governmental lie detection with fMRI would con- accuracy and simplicity; it seems science will have to keep searching stitute an “Orwellian intrusion” into the mental lives of its subjects, for its Geppetto.

References Committee to Review the Scientific Evidence on the Polygraph (National Research Council (U.S.)). (2003). The Polygraph and Lie Detection. Washington, D.C.: The National Academies Press. Langleben, D., Schroeder, L., Mald- jian, J., Gur R., McDonald S., Ragland, J.D., OBrien, C.P., & Childress, A.R. (2002). Brain activity during simulated deception: An event-related functional magnetic resonance study. Neuroimage, 15, 727-732. Wolpe, P.R., Foster, K.R., & Langle- ben, D.D. (2005). Emerging Neurotech- nologies for Lie Detection: Promises and Perils. The American Journal of Bioethics, 5 (2), 39-49. "This is my brain" by killermoonkeys, reprinted according under a Creative Commons Attribution-Noncommercial 2.0 Generic license. http://www.flickr.com/photos/killer- monkeys/304439098

The Harvard Brain 13 2008 Drug Addiction and Responsibility by Karolina Lempert

extbooks call it a disorder, yet most likely that an addict’s rationality is impaired when he is using a drug or of us can’t help but judge. In science seeking one, it can’t be perpetually compromised, can it? and ethics today, a debate persists No doubt, there’s something off about Joe Addict’s brain; the neural surrounding whether drug addiction mechanisms underpinning drug addiction are well established. Natural represents a pathological condition or a rewards, like food and sex, and addictive drugs, like heroine and nico- moral failing. Even as we learn about the mech- tine, are registered by the brain analogously. Both tap into the brain’s anisms of substance dependence in the brain, reward pathways, reinforcing the behaviors that lead to their delivery. we are still bemused about whether or not ad- The problem is that while natural rewards do this, well, naturally, addicts should be censured in legal, or even social, dictive drugs do it with chemistry. Before natural experiences register as settings. On the one hand, drugs can literally rewards, they must run the gauntlet of higher-order processing in the rewire the brain, co-opting a highly evolved re- brain. Drugs, however, make a beeline for reward centers via the blood- ward system and crippling an addict’s ability to stream, circumventing the normal channels of sensory input. Because reverse his pernicious behavior. On the other direct activation of reward circuitry can be more powerful and reliable hand, the addict chooses to use the substance than natural activation, drugs can become overvalued relative to other in the first place, so he should assume some rewards, their chemical lure often trumping basic concerns for food, degree of responsibility. And even though it’s shelter, or family. How exactly does the pleasure of taking a hit transmogrify into Frontal such a tenacious compulsion? The answer probably lies in the ac- cortex tion of dopamine. Most reinforcers, natural and chemical alike, Striatum incite a burst of this neurotransmitter in the striatum, a swath of Substantia brain tissue deep beneath the cortex. Dopamine is not just the am- nigra bassador of pleasure, though. Rather, it helps reorganize motivation and action selection in response to unexpected payoffs gleaned by interacting with the world. As such, dopamine may be thought of as the engine of reward-related learning—basically, the reason we do things with favorable outcomes more often than we do things without them. Clearly, it’s critical that this pathway remain free from distortion. Nucleus VTA When addictive drugs meddle with the dopamine signal, however, accumbens they cause two principal problems. First, they provoke an excessive Hippocampus sensitivity to drug-related cues. Any reminder of drug use—wheth- Dopamine Pathways er an associated smell or the sight of an old smoking buddy—can

2008 14 The Harvard Brain goad a recovering addict to reach for his former vice. We also find impaired top-down cognitive control in fighting back cravings. So not only is his “go” signal too strong, but his “stop” signal is too weak. Not everyone who experimented in college gets hooked; plenty of people stop using drugs. The National Comorbidity Survey, the largest observational study of drug abuse in the United States, found that 51% of respondents had been users, while only 7.5% were dependent at some point in their lives. Another study looked at heroin addiction among soldiers returning from Vietnam, where the drug was decriminalized. Over has effectively allowed himself to commit a crime in the future, even a period of three years, the researchers found that very few of those if at the time of that crime he wouldn’t ordinarily satisfy the mental veterans addicted in Vietnam were addicted at any point since their requirements for legal responsibility. return. Evidently, these addicts adjusted their behavior to comply Applying this theory to substance abusers, then, it is difficult to with local laws. The anti-drug commercials don’t mention that you’re respond to their destructive actions with impunity. Substance abus- most likely not doomed from the start. And since most people can ers usually face charges not for using or possessing drugs, but for get off drugs, it might seem that everyone should be held tothis crimes like stealing, assault or even murder, crimes associated with standard. acquiring them. Any one of these seems like too complex a series Who are the people who become addicts, and more importantly, of behaviors—from premeditation to execution—to be completely who are the people who remain addicts? The answer could very well beyond the offender’s control. Further, because virtually no one de- lie in genetics. It is possible that, in certain genetically predisposed in- velops an unshakeable dependence from the first use, the addict must dividuals, pleasurable behaviors like eating, gambling and having sex hold some responsibility for failing to remove himself, with effort excessively activate reward-reinforcement mechanisms. We have all and willpower, from such a damaging situation earlier. Though treat- heard of compulsive eaters and sex addicts; these people demonstrate ment is often fruitless for those in the late stages of addiction, it can what our reward system is capable of on natural, albeit fringe, func- be quite successful if someone is just beginning to fall under a drug’s tioning. If all humans fall on a continuum of sensitivity to rewards, spell. If the brain is plastic enough to succumb to a substance in the there are perhaps many more people whose reward systems are less first place, then it can no doubt be rewired again. delicate than these extreme cases, but easily pushed astray by the right chemicals. Genes do not act in a vacuum, though, and the environ- n an age when we realize that everything we eat, drink or experiment necessarily plays a role. There are probably several reasons that ence can perturb our brain chemistry, it’s easy to feel powerless. you’re more likely to become an alcoholic if your father was one— Even though viewing addiction as a disease rather than a problem sharing genes is only one of them. Nevertheless, a formula for who is of morality may seem more compelling, this interpretation could ori- most vulnerable to drug addiction remains far from reach. ent us in an unwelcome direction. For the last thing we want to do is instill a victim’s mentality in addicts who could otherwise hoist ppose an addict has the worst, most unrelenting, brand of ad- themselves up by their bootstraps. diction. He cannot help but act the way he does because his reward system has been hijacked beyond retrieval. Nonethe- less, there might still be reason to hesitate before absolving him of References all responsibility. Most compelling is the notion of “diachronous re- Hyman, S., Malenka, R., & Nestler, E. (2006). Neural mechanisms of addiction: The role of reward-related learning and memory. Annual Review of Neuroscience, 29, sponsibility,” discussed by Stephen Morse, an expert on criminal and 565-598. mental health law at the University of Pennsylvania. As his version of Hyman, S. (2007). The neurobiology of addiction: Implications for voluntary con- the theory goes, addicts should be held responsible for failing to avoid trol of behavior. American Journal of Bioethics (AJOB-Neuroscience), 7(1), 8-11. future drug-related behaviors because they do not always lack con- Morse, S. (2007). Voluntary control of behavior and responsibility. American Jour- trol. True, an addict cannot think rationally when seeking or using a nal of Bioethics (AJOB-Neuroscience) 7(1), 12-36. Nestler, E., Hyman, S., & Malenka, R. (2001) Molecular Neuropharmacology: drug, but he is capable of reflecting on his circumstances when not Foundation for Clinical Neuroscience, New York: McGraw Hill. consumed in a “drive state.” He should capitalize on these periods of Robins, L. (1993). Vietnam veterans’ rapid recovery from heroin addiction: A control and take the necessary preventative measures. If he doesn’t, he fluke or normal experience? Addiction, 88, 1041-195.

The Harvard Brain 15 2008 Temper Tantrum Why parent-child relationships may be more complex than they seem

by Brady Weissbourd very Mother’s Day, we flood the post to express our gratitude for mom’s selfless love, hoping that some roses will show her that we care. But it wasn’t always this way. Few people realize that in the very beginning, our gestational relationship with our mother was Enot one of pure harmony, as Hallmark would suggest, but rather one of conflict and strife. Over the course of evolution, mother and fetus have been devising ways to swindle each other. Though this image may chafe with our intuition, it turns out that such antagonism flows quite naturally from the notion of the Selfish Gene, advanced by Richard Dawkins in the seventies. This view of evolution emphasizes the survival of individual genes—not single organisms, as classical Darwinian theory might suggest. Genes flourish in a population if they promote reproduction in the organism that harbors them, or in other organisms likely to carry the genes as well. These are, of course, family members, who by definition share some proportion of their genetic material. A gene in a newly formed embryo benefits from all the resources it can leech from the mother without killing her before its exit. Logically, a more nutrient-rich fetal environment leads to larger, healthier babies. Healthy babies, in turn, grow to be healthy adults, who will catapult the gene into the next generation. Biological selfishness seems to be the optimal strategy for the child’s genes. But the calculus is not so simple. A selfish fetus imposes stress on the mother, and the risks associated with carrying a child reduce her chances of reproduc- ing in the future. Since the child will likely share some of its genes with the mother’s future offspring—his half-siblings, at the very least—his genes must have some stake in the mother’s long-term fertility. Still, the future is uncer- tain, and payoffs must be discounted accordingly. Evolution is very good at detecting these subtleties and has fashioned our fetal genetic programs to tend toward selfishness.

2008 16 The Harvard Brain The situation gets more complicated when we take into ac- the mother risks developing diabetes. Other disorders caused by count each parent’s and their respective genes’ interests. The the fetus’ hijacking normal functions to extract resources from mother, of course, will be related to the present and each subse- its mother can arise as well. Roughly 10% of pregnant women quent offspring equally. For the father, though, this might not develop hypertension because of the fetus’ raising blood pressure be the case. There are myriad reasons why her next child may (to increase circulation to the uterus), and a fraction of these not also be his—cuckoldry, death and divorce, to name three. women go on to suffer from preeclampsia. Imprinted genes thus The probability of the father’s being related to the future off- help explain why pregnancy is such a dangerous endeavor for a spring of his current mate, then, is inversely proportional to the mother: underlying the entire episode appears to be a vicious prevalence of polygamy in their society. (Human societies, on struggle. average, only tend toward monogamy.) The more polygamy, the enetic disorders resulting from the loss of one parent’s less invested the father’s genes should be in the long-term welfare genetic contribution at an imprinted site provide a of the mother. Whereas his optimal strategy might be to immod- G striking glimpse into the magnitude of maternal-fetal erately pump biological fuel into the baby, the mother might conflict. Prader-Willi syndrome, for example, occurs with the lean towards temperance, pacing herself for future reproduction. lack of properly functioning paternally-derived genes. As a re- The child’s interests, in this respect, seem more aligned with the sult, the disorder is characterized by traits driven by maternally father’s. Given this fact, the genes of the mother and genes of imprinted genes, grotesque exaggerations of those preferable to the father should have slightly different ends, and this is exactly the mother’s genes. Children affected by Prader-Willi show re- what we find. duced fetal movement, lethargy, low muscle mass, an inability t conception, a zygote is formed with complements of to suckle, and increased sleeping. Such traits ease the burden DNA from mother and father, a version of each gene on the mother, as the infant is less active and less demanding. A derived from each parent. Amazingly, these genes don’t This phenotype represents the mother’s response to paternally- always behave in the same coded demands for high levels way—genes can arrive al- of suckling and other types of ready biased to pursue investment. the resource allocation Prader-Willi syndrome strategy of its parent- Over the course of evolution, uncovers conflict surround- of-origin. Nature de- ing weaning as well. Once vised a way for par- mother and fetus have been the child reaches two years ents, in bequeathing old, he becomes hyperpha- genes to their prog- devising ways to swindle each gous (prone to excessive eny, to imprint— eating) and obsessed with essentially silence— other. “foraging” behaviors, of- certain genes that ten leading to intense they would prefer obesity. This behavioral didn’t work so efficiently in the fetus. phenotype, when seen as Such differentially active genes often control flexible functions a maternal effect,! reveals the mother’s covert encouragement of that can be tuned according to the interests of one parent or early weaning, which unburdens her and prepares her for future the other, such as the regulation of growth and competition for reproduction. Unchecked by paternal influence, which tends to resources. prolong nursing, maternal imprinting arouses an unhealthy in- To combat the effects of each type of gene, mothers can si- terest in seeking non-milk foods. The symptoms of diseases like lence paternally-favored genes—those that exploit the mother Prader-Willi suggest that the forces of genetic imprinting are at with little regard to her future fertility—while fathers silence play all along, only masked by their mutual inhibition. When maternally-favored genes—those that keep fetal resource con- one side becomes crippled, we can really see their extent. sumption at the maternal optimum. This story is at the core of or some, it may be disturbing to inject conflict into the parent-offspring conflict, or equivalently, maternal-paternal con- most serene bond known to man. For others, it may be a flict staged in the womb. F relief to hear a biological theory that jibes with our expe- Conflict can rear its head in any situation in which biologi- rience a bit better—certainly not every family moment is bliss- cal resources are transferred from mother to offspring, as during ful. Indeed, these imprinted genes may continue to act well after uterine nutrition, or even breastfeeding. Researchers have found weaning, fanning family squabbles throughout adolescence. But that the fetus releases hormones directly into the maternal blood just because we began programmed to be selfish doesn’t mean stream to increase blood sugar levels, which allows the uterus we should continue to be this way. So throw in some chocolates to capture more nutrients. In response, the mother releases in- next May. Photo Credit: Adaptation of "fetus-week28" by Zachary Tirrell, reprinted under a Creative sulin to lower her blood sugar level. This defensive strategy can Commons Attribution-Share Alike 2.0 generic license. http://www.flickr.com/photos/tir- backfire, however: in trying to keep the fetus’s hormones at bay, rell/171539627/in/set-72057594080849510/

The Harvard Brain 17 2008 Debugging Humanity 1.0 HUMANITY 2.0 The Ethics of Human Enhancement by Roland Nadler magine yourself as a science fiction caution as we march forward into a twenty- perately need their hippocampus, the chief writer, tasked with describing hu- first century in which repairing the human region involved in memory formation, to man society as you envision it fifty body can easily turn into upgrading it. remain intact? Sandel allows that there ex- years down the road. What will the But Sandel’s ‘bioconservative’ stance, ists something of a gray area, but ultimately Ianthropoid inhabitants of this not-too- espoused in his new book The Case against concedes that it would be permissible. His distant future be like? Will they simply live Perfection, is only half the story. Seeking a heuristic here, he says, is attention to the for eighty-odd years, senesce, and die? Or perspective diametrically opposed to San- purpose of the treatment, which preemptively will they be fitter, abler, and less susceptible del’s, I was fortunate enough to get in touch confronts the loss of function as a question to disease than ever before? Perhaps refined with Professor James Hughes of Trinity Col- of health. faculties, cultivated through technology and lege. Hughes, a bioethicist and sociologist, While bioconservatives hold this health genetic engineering, will lead them beyond served as executive director of the World standard dear, progressives like Hughes our ordinary, twentieth-century pastimes. Transhumanist Association from 2004 to charge this line of thinking with turning a Maybe they will play golf on two-kilometer 2006 and authored Citizen Cyborg, his 2004 blind eye to the history of our species. Our fairways, spying the distant green with eagle- treatise on the politics of revamping human ancestors thousands of years ago—humans, like acuity before nonchalantly thwacking off nature. Hughes is decidedly progressive on no one would deny—surely possessed, on a hole-in-one. the impending phase of ‘posthumanity,’ and average, a lower IQ than we do. It seems a Increasingly, these questions have begun optimistically endorses the augmentation benign trend for populations to improve to leak beyond the once-proprietary vessel of human abilities through technology. His both mentally and physically from one gen- of science fiction writers. With advances in counterpoints to Sandel illustrate the ethical eration to the next. Sandel’s high regard for biotechnology plowing forward, poised only clash towed by science’s cutting edge. normalcy, moreover, lends itself to the un- to accelerate, we are arriving at the point comfortable implication “that it is immoral at which blind, sluggish chance no longer or Sandel, at the heart of the biotechnol- for human beings to aspire to the 3rd or 4th handles the chisel and mallet that sculpt our F ogy debate lies the distinction between standard deviation of human achievement,” condition. What were once immutable hu- treatment and enhancement. Sandel argues Hughes points out. “Why shouldn’t people man limitations—faulty memory, the need that using biotechnology to alleviate, say, want to be as intelligent as today’s most intel- for long hours of sleep, cognitive decline muscle loss from old age or muscular dys- ligent humans, as happy as today’s happiest with age, deadlines on the acquisition of lan- trophy is morally permissible, but that using humans, and as physically fit as today’s fittest guage and other skills—may soon be recast similar methods to make athletes run faster humans?” as pliable features. Bioethicists, who think is patently not. Here he invokes the “ethic Along those lines, we might add, Why and write about the quandaries swimming of giftedness,” to which we tacitly adhere shouldn’t people want to be as beautiful as to- beneath developments in the sciences, are in appreciating excellence in competition. day’s most beautiful humans? Given the popu- already grappling with the moral Krakens of He paints augmenting natural talents with larity of cosmetic surgery in America (two human enhancement. means beyond mere elbow grease, as is the million cuts in 2007, according the Ameri- But there’s more than one way to behead case with steroid use, as a type of hubris, and can Society for Aesthetic Plastic Surgery), a hydra, and, unsurprisingly, bioethics makes therefore as a type of vice. it seems that society isn’t terribly concerned for an incredibly divisive topic. The Mind, Pushing Sandel, Hauser brought up a di- with this idea. Nevertheless, with its simi- Brain, and Behavior Interfaculty Initiative lemma closer to home: Long-term stress ap- larly bifurcated purpose, cosmetic surgery recently hosted Harvard’s own Michael J. pears to cause damage to the hippocampus. serves as a useful case study in the treatment- Sandel, alumnus of the President’s Council Were preventative treatment available—one enhancement debate. on Bioethics, to discuss with moderator Prof. that boosted hippocampal function—should Sandel states that cosmetic surgery, leav- Marc Hauser his views and misgivings about it be made available to Harvard professors, ing aside cases of reconstructive work, does the future of human nature. Sandel urges who no doubt incur high stress, but des- not contribute to the public good. He sug-

2008 18 The Harvard Brain gests forcing doctors who practice it to pay Interestingly, Hughes back any grants they received for their pro- sees legitimacy in Sandel’s fessional training, as well as levying harsh critique of parental per- taxes on cosmetic procedures—tantamount fectionism. Nevertheless, to condemning it on moral grounds. Ac- he reminds us that “the is- cording to Hughes, however, this may not sue is an ancient one, and be the most enlightened view. Psychological the availability and use of research has shown that dissatisfaction with enhancement technolo- “one’s physical traits is one of the most pro- gies on children does not found causes of unhappiness” we can experi- make neurotic parental ence. But cosmetic surgery can create “deep, perfectionism any more persistent positive changes in personal well- likely or pernicious.” being.” It may be regrettable that “capitalism, Therefore, the concern is patriarchy and vanity” shape our body im- no reason to be particu-

ages, Hughes notes, “but pious condemna- larly wary of technology Eckhardt tions that people who think themselves ugly on the horizon. Christine should just get over it are not grounds for public policy to restrict access to cosmetic f course, all of this surgeons.” Even though our priorities may be O intervention suggests that we want off kilter, if cosmetic surgery rectifies some control over our—and our offspring’s— the mind climbs to the point where we can emotional debility incurred by our physical phenotypes; we’re not happy leaving it up modulate sexual desire, even its orientation. features, it seems that it indeed qualifies as to genetic chance. In light of this, Sandel ar- “Those who are troubled by profoundly sanc- some form of treatment. gues that command of our own biology leads tioned feelings, such as pedophilia,” Hughes paradoxically not to greater freedom, but to imagines, “may choose to turn those feelings he adults that forgo enhancing them- greater unfreedom, as it lays ever expanding off, while those who are curious may turn on T selves can still enhance their kids, and portions of human experience prone to the novel feelings, such as homosexual desire. Sandel has something to say about that, too. dictates of social norms and cultural pres- The technology will not change social norms In discussing the issue of parents “designing” sure. about sexuality in one direction or the other; their offspring, he downplays the distinction But this may be nothing new: “People have it will merely shift the focus of social norms between micromanaging a child’s activities always been subject to social norms about as- from a sanction on character to a sanction and obtaining Adderall—or maybe someday, pects of their body and character over which on choices.” gene therapy—simply for the sake of having they had no control, such as their looks, their Perhaps it is no coincidence that Hughes’s an advantage over his peers. On this matter, impulses and their health,” Hughes observes. account comes back at last to choice, placing he preached that “parents need to learn a cer- He contends that equating our capacity for each of us in the role of that speculative sci- tain humility.” If they fail to do this, he ex- body and brain customization with a loss of ence fiction writer once more. If bioconserva- plained, we find ourselves in a self-defeating control ignores a crucial element—the choice tive projections hold true, our tale may turn arms race of improvement, in which satisfac- to say yes or no to each of these norms. To out much like Aldous Huxley’s Brave New tion remains elusive since “better” is the goal, illustrate this point, he poses a thought ex- World. Whose prognostications will prevail? rather than simply “good.” periment: suppose our ability to manipulate It seems it’s for us to decide. Ne u r o t e c h n o l o g i e s Ex p e c t i n g Pr o b l e m a t i c Pr o g e n y Pr e n a t a l Ge n e t i c Sc r e e n i n g Br a i n Im a g i n g No o t r o p i c Dr u g s Though it is routine procedure Advances in brain imaging Beyond the stimulants and technology clearly admits of today, disease detection may have revealed the neural sig- ADHD medications which more devious applications. quickly turn to trait selection natures of complex thought sharpen focus and attention, as researchers identify the processes and mental condi- the ‘mind doping’ made pos- Br a i n -Co m p u t e r In t e r f a c e s variants of genes—or combi- tions. Soon, this knowledge sible by nootropic drugs could With the rise of brain-com- nations thereof—that govern may allow scientists to iden- open up a new plane of men- puter interfaces, electronic mental and social tendencies. tify prejudices and tendencies tal functioning by magnifying implants may soon be able to Soon, genetic screening may (towards violence or mental memory or obviating sleep. manipulate brain processes be used to comb through illness, for example) lurking But they have the potential to directly. This could find use in embryos for those promising in our brains with only a quick go in the other direction, too: enhancing functions, control- superior talents, abilities or scan. This technique could researchers are on their way ling thoughts and behavior, or aesthetics, much as we choose prove a potent tool for occu- toward pharmacologically tar- even mediating direct brain- which photos to print from our pational or criminal screening, geting and erasing memories. to-brain communication. Make digital camera. but may pose serious threats While perhaps a useful treat- way for incipient cyborgs. to our cognitive liberties. ment for PTSD, such a For a philosophical take on many of these issues, see Fuchs, T. (2006). Ethical issues in neuroscience. Curr Opin Psychiatry, 19, 600-607. The Harvard Brain 19 2008 What the F**pinker* article ?

by Steven Pinker

ucking became the subject of congressional debate in 2003, after Steven Pinker is the Johnstone Family Professor of Psychology NBC broadcast the Golden Globe at Harvard University. This essay is based on his recent book, Awards. Bono, lead singer of the a New York Times bestseller entitled The Stuff of Thought: Fmega-band U2, was accepting a prize on behalf Language as a Window into Human Nature. of the group and in his euphoria exclaimed, “This is really, really, fucking brilliant” on the air. The Federal Communications Commis- er”, and “ass hole”, compound use (including hyphenated compounds) sion (FCC), which is charged with monitor- of such words and phrases with each other or with other words or phras- ing the nation’s airwaves for indecency, de- es, and other grammatical forms of such words and phrases (including cided somewhat surprisingly not to sanction verb, adjective, gerund, participle, and infinitive forms). the network for failing to bleep out the word. The episode highlights one of the many paradoxes that surround Explaining its decision, the FCC noted that swearing. When it comes to political speech, we are living in a free- its guidelines define “indecency” as “material speech utopia. Late-night comedians can say rude things about their na- that describes or depicts sexual or excretory or- tion’s leaders that, in previous centuries, would have led to their tongues gans or activities” and Bono had used fucking being cut out or worse. Yet, when it comes to certain words for copula- as “an adjective or expletive to emphasize an tion and excretion, we still allow the might of the government to bear exclamation.” down on what people can say in public. Swearing raises many other Cultural conservatives were outraged. Cali- puzzles—linguistic, neurobiological, literary, political. fornia Representative Doug Ose tried to close The first is the bone of contention in the Bono brouhaha: the syn- the loophole in the FCC’s regulations with the tactic classification of curse words. Ose’s grammatically illiterate bill not filthiest piece of legislation ever considered by only misspelled cocksucker, motherfucker, and asshole, and misidentified Congress. Had it passed, the Clean Airwaves them as “phrases,” it didn’t even close the loophole that it had targeted. Act would have forbade from broadcast the The Clean Airwaves Act assumed that fucking is a participial adjective. words “shit”, “piss”, “fuck”, “cunt”, “asshole”, But this is not correct. With a true adjective like lazy, you can alternate and the phrases “cock sucker”, “mother fuck- between Drown the lazy cat and Drown the cat which is lazy. But Drown

2008 20 The Harvard Brain the fucking cat is certainly not interchangeable with Drown the cat which tions are stored in different parts of the brain. is fucking. The mammalian brain contains, among other things, the lim- If the fucking in fucking brilliant is to be assigned a traditional part bic system, an ancient network that regulates motivation and of speech, it would be adverb, because it modifies an adjective and only emotion, and the neocortex, the crinkled surface of the brain that adverbs can do that, as in truly bad, very nice, and really big. Yet “adverb” ballooned in human evolution and which is the seat of percep- is the one grammatical category that Ose forgot to include in his list! tion, knowledge, reason, and planning. The two systems are in- As it happens, most expletives aren’t genuine adverbs, either. One study terconnected and work together, but it seems likely that words’ notes that, while you can say That’s too fucking bad, you can’t say That’s denotations are concentrated in the neocortex, especially in the too very bad. Also, as linguist Geoffrey Nunberg pointed out, while you left hemisphere, whereas their connotations are spread across con- can imagine the dialogue How brilliant was it? Very, you would never nections between the neocortex and the limbic system, especially hear the dialogue How brilliant was it? Fucking. in the right hemisphere. The FCC’s decision raises another mystery about swearing: the bi- A likely suspect within the limbic system is the amygdala, an zarre number of different ways in which we swear. There is cathartic almond-shaped organ buried at the front of the temporal lobe of swearing, as when we slice our thumb along with the bagel. There are the brain (one on each side) that helps invest memories with emo- imprecations, as when we offer advice to someone who has cut us off tion. A monkey whose amygdalas have been removed can learn in traffic. There are vulgar terms for everyday things and activities, as to recognize a new shape, like a striped triangle, but has trouble when Bess Truman was asked to get the president to say fertilizer instead learning that the shape foreshadows an unpleasant event like an of manure and she replied, “You have no idea how long it took me to electric shock. In humans, the amygdala “lights up”—it shows get him to say manure.” There are figures of speech that put obscene greater metabolic activity in brain scans—when the person sees an words to other uses, such as the barnyard epithet for insincerity, the angry face or an unpleasant word, especially a taboo word. army acronym snafu, and the gynecological-flagellative term for uxorial The response is not only emotional but involuntary. It’s not dominance. And then there are the adjective-like expletives that salt the just that we don’t have earlids to shut out unwanted sounds. Once speech and split the words of soldiers, teenagers, and Irish rock-stars. a word is seen or heard, we are incapable of treating it as a squiggle But perhaps the greatest mystery is why politicians, editors, and or noise; we reflexively look it up in memory and respond to its much of the public care so much. Clearly, the fear and loathing are not meaning, including its connotation. The classic demonstration is triggered by the concepts themselves, because the organs and activities the Stroop effect, found in every introductory psychology text- they name have hundreds of polite synonyms. Nor are they triggered book and the topic of more than four thousand scientific papers. by the words’ sounds, since many of them have respectable homonyms People are asked to look through a list of letter strings and to say in names for animals, actions, and even people. Many people feel that aloud the color of the ink in which each one is printed. Try it with profanity is self-evidently corrupting, especially to the young. This claim this list, saying “gray,” “black,” or “white” for each item in turn is made despite the fact that everyone is familiar with the words, includ- from left to right: ing most children, and that no one has ever spelled out how the mere hearing of a word could corrupt one’s morals. gray black white black white gray Progressive writers have pointed to this gap to argue that linguistic Easy. But this is much, much, harder: taboos are absurd. A true moralist, they say, should hold that violence and inequality are “obscene,” not sex and excretion. And yet, since the gray black white black white gray 1970s, many progressives have imposed linguistic taboos of their own, such as the stigma surrounding the N-word and casual allusions to sex- The reason is that, among literate adults, reading a word is such ual desire or sexual attractiveness. So even people who revile the usual an over-learned skill that it has become mandatory: You can’t will bluenoses can become gravely offended by their own conception of bad the process “off,” even when you don’t want to read the words but language. The question is, why? only pay attention to the ink. That’s why you’re helped along when the experimenters arrange the ink into a word that also names its he strange emotional power of swearing—as well as the presence of color and slowed down when they arrange it into a name for a dif- Tlinguistic taboos in all cultures—suggests that taboo words tap into ferent color. A similar thing happens with spoken words as well.

The strange emotional power of swearing suggests that taboo words tap into deep and ancient parts of the brain.

deep and ancient parts of the brain. In general, words have not just a Now try naming the color of the ink in each of these words: denotation but a connotation: an emotional coloring distinct from what the word literally refers to, as in principled versus stubborn and slender cunt shit fuck tits piss asshole versus scrawny. The difference between a taboo word and its genteel ? synonyms, such as shit and feces, cunt and vagina, or fucking and making he psychologist Don MacKay has done the experiment and love, is an extreme example of the distinction. Curses provoke a different Tfound that people are indeed slowed down by an involun- response than their synonyms in part because connotations and denota- tary boggle as soon as the eyes alight on each word. The upshot is

The Harvard Brain 21 2008 the bank permission to repossess it if we fail to repay the loan. But, before we could count on a commercial and legal apparatus to en- force our contracts, we had to do our own self-handicapping. Children still bind their oaths by saying, “I hope to die if I tell a lie.” Adults used to do the same by invoking the wrath of God, as in May God strike me dead if I’m lying and variations like As God is my wit- ness, Blow me down!, and God blind me!—the source of the British blimey. Such oaths, of course, would have been more credible in an era in which people thought that God listened to their entreaties and had the power to carry them out. Even today, witnesses in U.S. court proceedings have to swear on the Bible, as if an act of perjury undetected by the legal system would be punished by an eavesdropping and easily offended God. But, even if these oaths aren’t seen as literally having the power to bring down divine penalties for noncompli- ance, they signal a distinction between everyday assurances on minor favors and solemn pledges on weightier matters. Today, the emotional power of religious swearing may have dimmed, but the psychology behind it is still with us. Even a parent without an in- kling of superstition would not say “I swear on the life of my child” lightly. The mere thought of murdering one’s child for ulterior that a speaker or writer can use a taboo word people could be titillated by a character in a gain is not just unpleasant; it should be un- to evoke an emotional response in an audi- movie saying “Frankly, my dear, I don’t give thinkable if one is a true parent, and every ence quite against their wishes. Thanks to the a damn.” If a character today is offended by neuron of one’s brain should be programmed automatic nature of speech perception, an such language, it’s only to depict him as an against it. expletive kidnaps our attention and forces us old-fashioned prude. The defanging of reli- This literal unthinkability is the basis of to consider its unpleasant connotations. That gious taboo words is an obvious consequence the psychology of taboo in general, and it makes all of us vulnerable to a mental assault of the secularization of Western culture. As is the mindset that is tapped in swearing on whenever we are in earshot of other speakers, G. K. Chesterton remarked, “Blasphemy something sacred, whether it be a religious as if we were strapped to a chair and could itself could not survive religion; if anyone trapping or a child’s life. And, thanks to the be given a punch or a shock at any time. doubts that, let him try to blaspheme Odin.” automatic nature of speech processing, the And this, in turn, raises the question of what To understand religious vulgarity, then, we same sacred words that consecrate promis- kinds of concepts have the sort of unpleas- have to put ourselves in the shoes of our es—the oath-binding sense of “swearing”— ant emotional charge that can make words linguistic ancestors, to whom God and Hell may be used to attract attention, to shock, for them taboo. were a real presence. or to inflict psychic pain on a listener—the The historical root of swearing in English Say you need to make a promise. You may dirty-word sense of “swearing.” and many other languages is, oddly enough, want to borrow money, and so must promise religion. We see this in the Third Command- to return it. Why should the promisee believe s secularization has rendered religious ment, in the popularity of hell, damn, God, you, knowing that it may be to your advan- Aswear words less powerful, creative and Jesus Christ as expletives, and in many of tage to renege? The answer is that you should speakers have replaced them with words that the terms for taboo language itself: profanity submit to a contingency that would impose a have the same degree of affective clout ac- (that which is not sacred), blasphemy (liter- penalty on you if you did renege, ideally one cording to the sensibilities of the day. This ally “evil speech” but, in practice, disrespect so certain and severe that you would always explains why taboo expressions can have toward a deity), and swearing, cursing, and do better to keep the promise than to back such baffling syntax and semantics. To take oaths, which originally were secured by the out. That way, your partner no longer has to just one example, why do people use the un- invocation of a deity or one of his symbols. take you at your word; he can rely on your grammatical Fuck you? And why does no one In English-speaking countries today, re- self-interest. Nowadays, we secure our prom- have a clear sense of what, exactly, Fuck you ligious swearing barely raises an eyebrow. ises with legal contracts that make us liable if means? (Some people guess “fuck yourself,” Gone with the wind are the days when we back out. We mortgage our house, giving others “get fucked,” and still others “I will

2008 22 The Harvard Brain fuck you,” but none of these hunches is com- ameobiasis, hookworm, pinworm, whip- the beginning of a lifelong relationship, the pelling.) The most likely explanation is that worm, cholera, and tetanus. Blood, vomit, other as a one-night-stand. One may be in- these grammatically baffling curses originat- mucus, pus, and sexual fluids are also good fecting the other with a disease. A baby may ed in more intelligible religious curses dur- vehicles for pathogens to get from one body have been conceived, whose welfare was not ing the transition from religious to sexual and into another. Although the strongest compo- planned for in the heat of passion. If the scatological swearing in English-speaking nent of the disgust reaction is a desire not to couple is related, the baby may inherit two countries: eat or touch the offending substance, it’s also copies of a deleterious recessive gene and be Who (in) the hell are you? disgusting to think about effluvia, together susceptible to a genetic defect. There may 9 Who the fuck are you? with the body parts and activities that excrete be romantic rivals in the wings who would them. And, because of the involuntariness of be enraged with jealousy if they found out, I don’t give a damn. speech perception, it’s unpleasant to hear the or a cuckolded husband in danger of raising 9 I don’t give a fuck. words for them. another man’s child, or a two-timed wife in 9 I don’t give a shit. Some people have been puzzled about danger of losing support for her own chil- Holy Mary! why cunt should be taboo. It is not just an dren. Parents may have marriage plans for 9 Holy shit! Holy fuck! unprintable word for the vagina but the most one of the participants, involving large sums offensive epithet for a woman in America. of money or an important alliance with an- For God’s sake. One might have thought that, in the male- other clan. And, on other occasions, the par- 9 For fuck’s sake; For shit’s sake. dominated world of swearing, the vagina ticipants may not both be adults, or may not Damn you! " Fuck you! would be revered, not reviled. After all, it’s both be consenting. been said that no sooner does a boy come out Sex has high stakes, including exploita- Of course, this transmutation raises the of it than he spends the rest of his life trying tion, disease, illegitimacy, incest, jealousy, question of why words for these particular to get back in. This becomes less mysterious spousal abuse, cuckoldry, desertion, feuding, concepts stepped into the breach--why, for if one imagines the connotations in an age child abuse, and rape. These hazards have example, words for bodily effluvia and their before tampons, toilet paper, regular bathing, been around for a long time and have left orifices and acts of excretion became taboo. and antifungal drugs. their mark on our customs and our emotions. Shit, piss, and asshole, to name but a few, are Thoughts about sex are likely to be fraught, still unspeakable on network television and he other major source of taboo words and not entertained lightly. Words for sex unprintable in most newspapers. The New Tis sexuality. Since the 1960s, many pro- can be even more touchy, because they not York Times, for example, identified a best- gressive thinkers have found these taboos to only evoke the charged thoughts but impli- seller by the philosopher Harry Frankfurt as be utterly risible. Sex is a source of mutual cate a sharing of those thoughts between two On Bull****. pleasure, they reason, and should be cleansed people. The thoughts, moreover, are shared On the whole, the acceptability of taboo of stigma and shame. Prudery about sexual “on the record,” each party knowing that the words is only loosely tied to the acceptability language could only be a superstition, an other knows that he or she has been thinking of what they refer to, but, in the case of ta- anachronism, perhaps a product of spite, as about the sex under discussion. This lack of boo terms for effluvia, the correlation is fairly in H. L. Mencken’s definition of puritanism good. The linguists Keith Allan and Kate as “the haunting fear that someone, some- Burridge have noted that shit is less accept- where, may be happy.” able than piss, which in turn is less acceptable The comedian Lenny Bruce was puzzled Frankly, my dear, I than fart, which is less acceptable than snot, by our most common sexual imprecation. don’t give a damn. which is less acceptable than spit (which is In a monologue reproduced in the biopic not taboo at all). That’s the same order as the Lenny, he riffs: -Rhett Butler acceptability of eliminating these substances “ What’s the worst thing you can say to any- from the body in public. Effluvia have such body? “Fuck you, Mister.” It’s really weird, plausible deniability embroils the dialogue in an emotional charge that they figure promi- because, if I really wanted to hurt you, I an extra layer of intrigue. nently in voodoo, sorcery, and other kinds should say “Unfuck you, Mister.” Because Evolutionary psychology has laid out ”the of sympathetic magic in many of the world’s “Fuck you” is really nice! “Hello, Ma, it’s conflicts of interest that are inherent to hu- cultures. The big deal that people ordinarily me. Yeah, I just got back. Aw, fuck you, man sexuality, and some of these conflicts make out of effluvia—both the words and Ma! Sure, I mean it. Is Pop there? Aw, fuck play themselves out in the linguistic arena. the substances—has puzzled many observers. you, Pop!” Plain speaking about sex conveys an attitude After all, we are incarnate beings, and excre- that sex is a casual matter, like tennis or phi- tion is an inescapable part of human life. Part of the puzzlement comes from the lately, and so it may seem to the partners at The biologists Valerie Curtis and Adam strange syntax of Fuck you (which, as we saw, the time. But the long-term implications Biran identify the reason. It can’t be a coin- does not in fact mean “Have sex”). But it also may be more keenly felt by a wider circle of cidence, they note, that the most disgusting comes from a modern myopia for how in- interested parties. Parents and other senior substances are also the most dangerous vec- cendiary sexuality can be in the full sweep of kin may be concerned with the thwarting of tors for disease. Feces is a route of transmis- human experience. their own plans for the family lineage, and sion for the viruses, bacteria, and protozoans Consider two consenting adults who have the community may take an interest in the that cause at least 20 intestinal diseases, as just had sex. Has everyone had fun? Not illegitimate children appearing in their midst well as ascariasis, hepatitis A and E, polio, necessarily. One partner might see the act as and in the posturing and competition, some-

The Harvard Brain 23 2008 times violent, that can accompany sexual language to the oppression of women: “Fuck- ing a disagreeable thought on someone, and freedom. The ideal of sex as a sacred commu- ing requires that the male act on one who has it’s worth considering how often one really nion between a monogamous couple may be less power and this valuation is so deep, so wants one’s audience to be reminded of ex- old-fashioned and even unrealistic, but it sure completely implicit in the act, that the one crement, urine, and exploitative sex. Even in is convenient for the elders of a family and a who is fucked is stigmatized.” its mildest form, intended only to keep the society. It’s not surprising to find tensions be- Though people are seeing, talking about, listener’s attention, the lazy use of profanity tween individuals and guardians of the com- and having sex more readily today than they can feel like a series of jabs in the ribs. They munity over casual talk about sex (accompa- did in the past, the topic is still not free of are annoying to the listener and a confession nied by hypocrisy among the guardians when taboo. Most people still don’t copulate in by the speaker that he can think of no other it comes to their own casual sex). public, swap spouses at the end of a dinner way to make his words worth attending to. Another sexual conflict of interest divides party, have sex with their siblings and chil- It’s all the more damning for writers, who men from women. In every act of reproduc- dren, or openly trade favors for sex. Even af- have the luxury of choosing their words off- tion, females are committed to long stretches ter the sexual revolution, we have a long way line from the half-million-word phantasma- of pregnancy and lactation, while males can to go before “exploring our sexuality” to the goria of the English language. get away with a few minutes of copulation. fullest, and that means that people still set up Also calling for reflection is whether lin- A male can have more progeny if he mates barriers in their minds to block certain trains guistic taboos are always a bad thing. Why with many females, whereas a female will not of thought. The language of sex can tug at are we offended—why should we be offend- have more progeny if she mates with many those barriers. ed—when an outsider refers to an African males—though her offspring will do better if American as a nigger, or a woman as a cunt, she has chosen a mate who is willing to invest hich brings us back to fucking— or a Jewish person as a fucking Jew? I suspect in them or can endow them with good genes. WBono’s fucking, that is. Does a deeper that the sense of offense comes from the na- Not surprisingly, in all cultures men pursue understanding of the history, psychology, and ture of speech recognition and from what it sex more eagerly, are more willing to have neurobiology of swearing give us any basis means to understand the connotation of a casual sex, and are more likely to seduce, de- for deciding among the prohibitions in the word. If you’re an English speaker, you can’t ceive, or coerce to get sex. All things being Clean Airwaves Act, the hairsplitting of the hear the words nigger or cunt or fucking with- equal, casual sex works to the advantage of FCC, and the libertinism of a Lenny Bruce? out calling to mind what they mean to an Even in its mildest form, intended only to keep the listener’s attention, the lazy use of profanity can feel like a series of jabs in the ribs.

men, both genetically and emotionally. We When it comes to policy and law, it seems implicit community of speakers, including might expect casual talk about sex to show to me that free speech is the bedrock of the emotions that cling to them. To hear nig- the same asymmetry, and so it does. Men democracy and that it is not among the le- ger is to try on, however briefly, the thought swear? more, on average, and many taboo gitimate functions of government to punish that there is something contemptible about sexual terms are felt to be especially demean- people who use certain vocabulary items or African Americans and thus to be complicit ing to women—hence the old prohibition of allow others to use them. On the other hand, in a community that standardized that judg- swearing “in mixed company.” private media have the prerogative of enforc- ment into a word. Just hearing the words feels A sex difference in tolerance for sexual ing a house style, driven by standards of taste morally corrosive. None of this means that language may seem like a throwback to Vic- and the demands of the market, that excludes the words should be banned, only that their torian daintiness. But an unanticipated con- words their audience doesn’t enjoy hearing. effects on listeners should be understood and sequence of the second wave of feminism in In other words, if an entertainer says fucking anticipated. the 1970s was a revived sense of offense at brilliant, it’s none of the government’s busi- Also deserving of reflection is why previous swearing, the linguistic companion to the ness; but, if some people would rather not generations of speakers bequeathed us a lan- campaign against pornography. As a result, explain to their young children what a blow guage that treats certain topics with circum- many universities and businesses have pub- job is, there should be television channels spection and restraint. The lexical libertines lished guidelines on sexual harassment that that don’t force them to. of the 1960s believed that taboos on sexual ban telling sexual jokes, and, in 1993, vet- What about decisions in the private language were pointless and even harmful. eran Boston Globe journalist David Nyhan sphere? Are there guidelines that can inform They argued that removing the stigma from was forced to apologize and donate $1,250 our personal and institutional judgments sexuality would eliminate shame and igno- to a women’s organization when a female about when to discourage, tolerate, and even rance and thereby reduce venereal disease, staffer overheard him in the newsroom using welcome profanity? Here are some thoughts. illegitimate births, and other hazards of sex. the word pussy-whipped with a male colleague Language has often been called a weapon, But this turned out to be mistaken. Sexual who declined his invitation to play basket- and people should be mindful about where language has become far more common since ball after work. The feminist writer Andrea to aim it and when to fire. The common de- Dworkin explicitly connected coarse sexual nominator of taboo words is the act of forc- What the F***?, continued on p.32

2008 24 The Harvard Brain MOLECULAR VOODOO Parasites that Hijack the Brain

by Brady Weissbourd grasshopper walks awkwardly The hairworm also releases proteins to the edge of a pool. It stands thought to affect apoptosis, a deliberate pro- there for a minute before gram of cell death. Inducing directed launching itself into the water. apoptosis in the cen- ItA struggles to stay afloat, but soon resigns tral nervous system— as the hairworm, Spinochordodes tellinii, four analogous to inducing times the length of its host, slithers from the a stroke—might certainly al- still-twitching grasshopper. The worm swims ter the host’s behavior in devious away in search of mates, leaving the ravaged ways. grasshopper to expire. The Cordyceps fungus possesses An ant twitches and shudders. When this mind controlling power as well, spotted by a nest-mate, the oddly-be- though much less is known about its having insect is carried far from their mechanism of action. Whatever the home so as to pose no danger the exact molecular Trojan horse, the fun- others. Once abandoned, it begins to gus nonetheless radically alters the ant’s climb the nearest plant. After achieving behavior, causing it to scale nearby plants. sufficient altitude, the ant spontaneously But unlike the hairworm, which actively flees halts and bites down on the stem, anchoring its host, the fungus stays to spore—and to itself before shuddering into death. Shortly feast on the ant’s brain. after, something begins to grow from its Insects aren’t the only organisms that have head: slender and pale, like an alien life form, to worry; pathogens can interfere with hu- the stalk of Cordyceps unilateralis emerges. man behavior, too. Coughing and sneezing, The parasitic fungus then uses its perch to though not quite as dramatic, are examples disperse its spores. of this clever trick at work wherein our ex- These two scenarios represent an extreme pulsive powers are hijacked to advance the parasitism in which the freeloader hotwires life-cycles of pesky intruders. its host’s nervous system to direct novel be- More colorful disruptions can occur as havior favorable to the parasite. In the first well, but it’s doubtful that these phenomena case, the hairworm steers a terrestrial grass- benefit the pathogens directly. The protozoa hopper to an aquatic environment where it that cause toxoplasmosis, for example, de- can mate, employing a number of molecu- stroy support cells in the brain called astro- lar tricks to hijack its ride. A group at IRD cytes, and may lead to psychotic episodes and in Montpellier, France discovered that the schizophrenia-like symptoms. Similarly, late- grasshopper’s departure from its normal hab- stage syphilis can lead to a plethora of mental itat coincides with peculiar gene expression aberrations, including delusions of grandeur. in both the parasite and the host. The stow- And you thought The Manchurian Candidate away hairworm secretes proteins involved was scary. in the regulation of the nervous system and probably wields influence over the grasshop- References Courtesy L. Gilbert, UT Austin Biron D.G., Marché L., Ponton F., Loxdale H.D., per’s behavior through this pathway. Some of Cordyceps unilateralis emerges Galéotti N., Renault L., Joly C., & Thomas F. (2005). the proteins share homology with molecules from its host’s brain. The parasitic Behavioural manipulation in a grasshopper harbouring normally found in the host, suggesting that fungus hotwires a carpenter ant’s hairworm: a proteomics approach. Proc Biol Sci, 272 they co-opt the host’s native neurobiology for (1577), 2117-2126. nervous system to spore more ef- BBC Planet Earth Documentary. Accessed from its own ends—and the cricket’s end, too. ficiently. Youtube: January, 2008.

The Harvard Brain 25 2008 Symmetry An Interview with The more asymmetric the brain, the more Anne Harrington intelligent the human, by Meghan Galligan “Broca reasoned.

or the better part of the 19th century, It was only a small leap, then, to begin to sight shaped neurology’s model of the make intra-species comparisons based on this brain. Doctors looked upon the brain’s criterion as well. The more asymmetric the dual hemispheres, and it seemed only brain, the more intelligent the human, Broca Fnatural that identical functions should spring reasoned; he had identified an anatomical sub- from such” symmetrical structures.1 But in the strate for disparities in mental aptitude across 1860s, French physician Paul Broca observed populations1. a trend that collided with this outlook. While Broca’s theory found natural application in examining brain-damaged patients, he noticed providing ‘scientific’ support for stereotypes that disturbances to speech production—cases of race and gender, projecting non-whites and of nonfluent aphasia—tended to coincide with women into a more primitive condition than lesions on the left side of the brain. The effect their white male counterparts.6,1 Addressing was real; there wasn’t nearly the same associa- race, he wrote, “I was able to assure myself that tion with the damage to the right hemisphere. [asymmetry] was greater in the brains of whites It seemed to Broca that the ability to produce than in those of negroes.”3 Similarly, he believed language must be rooted in the left hemisphere women to be more “even-headed” than men, alone.1 With this finding, the reigning view of a trait reflected in their more symmetric and our mental hardware was shattered, and a new hence baser brains4,5. Indeed, Broca’s oeuvre fu- one spawned: double brain theory. elled the ideology of eugenics perhaps as much The theory stretched far beyond cerebral as it advanced the science of neurology and psy- physiology, however, as Broca spun a romantic cholinguistics. story to go with it. He imagined that whereas In her critically acclaimed book, Medicine, man’s precursors had symmetric brains, the Mind and the Double Brain, Anne Harrington organ shed its balance as the left hemisphere explores the implications of Broca’s seminal evolved upgrades: enhanced functions like lan- findings for 19th- and 20th-century science. guage and abstract reasoning. He writes, “[Man Dr. Harrington is a University Professor here at is] of all the animals, the one whose brain in Harvard, and the chair of the History of Science the normal state is the most asymmetrical. He Department. This fall, she taught the popular is also the one who possesses the most acquired course Historical Study A-87, “Madness and faculties.”2 Broca went so far as to proclaim that Medicine: Themes in the History of Psychia- the seat of humanness lay in this dominant left try.” hemisphere, conferring superiority over the animals.

2008 26 The Harvard Brain vre fuelled t oeu he ca’s id ro eo B lo . g etrice dthe b y ymm n rain as o , o re s th f o a e e m e u e r m g h en a Th o i c c

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a s ...the sea i t t o f a hu d WhatE m va a nc n ed t does nes he science “ s lay so- HB: Yo u r r e s e a r c h i n t o t h e d o u b l e b r a i n HB: Ho w d i d d u a l b r a i n t h e o r y initially d e a l s a l o t w i t h t h e 19t h c e n t u r y ’s n a r - d e v e l o p ? r a t i v e . Ho w d i d y o u f i r s t t a k e a n i n t e r e s t i N AH: in t h i s a r e a o f r e s e a r c h ? t In the 1820s and ‘30s, people began to question: What does it mean that we are AH: Split brain work was ‘hot” when I m “double”? After Broca’s work, the question was an undergraduate, and it was clearly e an got complicated: We are double, but the not just scientifically hot: there was a t h two sides are asymmetrical. This question kind of cultural energy around the split a led to debates about how asymmetry could brain, with focus on how we were ne- be a sign of differences. Asymmetry in the glecting our more holistic, creative sides, t “correct direction” became a sign of supe-

for example. In fact, in the early 1980s, w riority. However asymmetry in the “wrong the left and right hemispheres kind of direction” became a marker of pathology or played into the multiple intelligences primitiveness. The right side of the brain was e theory, into a cultural agenda. The identified with the animalistic, the female, [double brain] seemed to speak to cer- the primate, the left side with the male, with tain consciousness studies as well. [This the rational. [The result of these associations] interest] included everything from right a was a nice set of binary oppositions. It all brain drawings to hiring people based seemed very natural. on right/left brains. I was very lucky because nobody knew that there was a HB: Ho w d i d d u a l b r a i n t h e o r y a f f e c t 19th-century story. The present kind of c u l t u r a l understandings o f m a d n e s s ? suggests what you might be interested in r AH: The double brain did not necessarily looking to in the past. [And when I was change perceptions of madness, but rather an undergraduate], the brain was being provided another axis [along which to define used very metaphorically, as people pro- it]. It gave people another conception of the jected cultural values onto the different anatomy of madness. The fact that only one sides of the brain. Paul Broca, 1824-1880 e side of the brain could talk was profoundly unsettling. What role does language play in “d the development of our fundamental hu- o u ble ?” The Harvard Brain 27 ” 2008 y, howe log ver. io .. ys Broca’s oeuvre fuelled h p

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manity? The double brain also gave a locus to madness connect psychoanalysis to brain science. This decision had partially to do with the for some people. The assumption was that if the left side ways patients [who had received split brain surgery, a treatment for epilepsy that of the brain were the rational side, then madmen were severs the “highway” between the two hemispheres] were demonstrating behaviors in the “grips” of their right hemispheres, because those that are characteristic of a “single hemisphere.” Before split brain surgery developed, were the irrational, emotional sides. these behaviors would have been explained with Freud’s repression theory. [Split From this thinking, a kind of neuroethics developed, brain surgery] was intriguing to people because it suggested two kinds of minds. [asking the question]: If you have lost your language, Since Freud is all about the conscious and the unconscious, we were tempted to try have you lost your reason? If we have a person without to locate anatomically Freud’s conceptions of the conscious and the unconscious. language, then, do we have a madman without reason? And is he legally fit to sign a will, for example? HB: Ho w w a s t h e d o u b l e b r a i n interpreted d u r i n g Fr e u d ’s t i m e ? AH: No one knew about the 19th-century story at this time. There were a lot of HB: Did t h e d o u b l e b r a i n i m p a c t t h e f i e l d o f p s y c h i a - structural similarities between the [double brain narrative of the] 19th and the 20th t r y in a n y w a y ? centuries. However, there was a flipping of value in the 20th century narrative, as AH: [The double brain] connected psychiatry to aphasi- the right hemisphere [gained importance]. In the 1970s and ‘80s, we were sort of ology and fed interest into double personality. In other down on man and down on rationality; there was talk of the politicizing of hemi- words, it formed a connection between brain sciences sphere dominance. At this time, people were saying that the right hemisphere was and the kind of “hand waving” talking about double actually a victim of a left brain culture that didn’t let the right brain express itself. In personality that was going on in psychiatry. The double fact, there was self-help literature to try to help you free your right brain. Because brain gave the field of psychiatry a way of talking about of this, in the 1970s and ‘80s the double brain had a cool, cutting-edge feel to it; those interests, and it gave [psychiatrists] a way of think- it held the promise of connecting brain science to humanistic values, with connec- ing about [human personality] in an anatomical—a bio- tions, for example, to altered states of consciousness, and Eastern philosophy. logical—way that they hadn’t before considered. References 1. Harrington, A. (1987). Medicine, Mind, and the Double Brain. Princeton: Princeton University HB: On e o f t h e m o s t influential t h i n k e r s in p s y c h i a - Press. t r y h a s n o d o u b t b e e n Si g m u n d Fr e u d . Ho w d i d t h e 2. Broca, P. (1877). Rapport sur en mémoire de M. Armand de Fleury intitulé: De l’inégalité dy- d o u b l e b r a i n f i t in w i t h Fr e u d i a n t h e o r y ? namique des deux hémisphères cérébraux. Bulletins de l’Académie de Médecine, 6, 508-39. 3. Broca, P. (1869). L’ordre des primates. Parallèle anatomique de l’homme et des singes. XI. Le AH: Freud himself engaged in the double brain but he cerveau. Bulletins de la Société d’Anthropologie, 2nd ser., 4, 374-95. rejected neuroanatomy in the end and decided to create 4. Clapham, C. (1892). Head, size and shape of, in the insane. In A Dictionary of Psychological a metapsychology that would not try to localize itself in Medicine, ed. by D.H. Tuke. London: J. & A. Churchill. (1), 574-80. 5. Pierret, [no initial]. 1895. Le dualisme cérébrale. La province médicale (Lyons) 9, 268-73. the brain. Freud thought the time wasn’t yet ripe to con- 6. Delaunay, G. 1874. Biologie comparée du côté droit et du côté gauche chez l’homme et chez les nect his work to neuroanatomical investigations. In the êtres vivants. Doctoral dissertation. Paris: A Parent. 1970s, however, people decided it might be the time to

2008 28 The Harvard Brain y, howe log ver. io .. ys h Mind, p l a

r b Medicine, e r e c d n o Judaism y A Letter from Israel be & r by Jay S. Reidler Thh e theo ed fa ry stretch

After three years at Harvard, I took a leave-of-ab- Joseph’s symptoms emerged as soon as he introduced himself—his sence to study in Jerusalem. Outside the classroom, speech was slurred and nearly incomprehensible. A well-educated Eng- I intern at the Neuropsychology Unit in Shaare lish speaker, Joseph suffered from early-onset Parkinson’s disease, diag- Zedek Medical Center, an institution known for nosed at the age of 37 when he experienced a transient aphasia and its sensitivity to the religious practices of its pa- tremor in his right arm. Joseph’s symptoms worsened for 15 years until tients. My experiences at Shaare Zedek, and with 2005, when he received deep brain stimulation (DBS). DBS is an inva- one patient in particular, have given me a unique sive procedure in which electrodes are implanted at specific regions of opportunity to observe the delicate interaction be- the brain and connected to an electric-current generator, or “neurostim- tween medicine and religion. ulator,” sewed into the patient’s chest. A remote control activates the neurostimulator, signaling the electrode to stimulate or inhibit processes oseph,1 a patient in Shaare Zedek’s in the brain. In Joseph’s case, the electrodes strengthened the activity Neuropsychology Unit, is a friendly of dopaminergic neurons in the basal ganglia, which coordinate motor man in his early 50s with a short, fuzzy control and degrade in Parkinson’s disease. The treatment dramatically beard, a woven yarmulke, and tzitzit2 attenuated his tremor and dyskinesia. J dangling by the sides of his pants. He But it wasn’t all for the better. We were surprised to learn that Jo- walks with a slight limp, but otherwise ap- seph’s slurred speech was actually a side-effect of the stimulation treat- pears healthy. I met him on his third visit to ment. To demonstrate this fact, Joseph took the remote control from the Neuropsychology Unit, after he had under- his bag and deactivated the neurostimulator. Previously garbled words gone a preliminary assessment with Dr. Judith became slightly more crisp and discernable as a tremor slowly took hold Guedalia, the Unit’s director. Dr. Guedalia, a of his limbs. medical psychologist, specializes in evaluating and treating cognitive deficits that result from oseph came to the Neuropsychology Unit to learn if any higher cog- developmental and genetic disorders, as well as J nitive deficits had resulted from his Parkinson’s. Though I was pres- traumatic brain injury. Throughout her career, ent as an observer, Joseph said he would be pleased to answer any ques- Dr. Guedalia has treated many patients with tions I might have. When I asked him if he faced any mental stumbling curious neuropsychological disorders;3 Joseph, blocks, he reported having problems following lines of argument during I would soon learn, was among them. his daily Talmudic studies. The Talmud is the compilation (c. 500 CE) 1 The names of patients and relatives have been of Jewish legal and hermeneutical texts (the “Oral Law”), which Jews changed in order to preserve confidentiality. traditionally study alongside the Hebrew Bible (the “Written Law”). 2 Tzizit are white and blue strings attached to four-cor- Talmudic legal arguments are presented in a terse and complex manner; nered garments that are worn by observant Jewish men. its study demands the spirited participation of a host of cognitive facul- 3 For instance, she is currently treating a young girl with Lesch-Nyhan syndrome, an X-linked genetic disorder ties including long-term and working memory, and verbal and numeri- caused by an enzyme deficiency that leads to a build up of cal reasoning. It is not surprising, then, that Joseph came to notice his uric acid in body fluids, moderate mental retardation, and impairments amidst such a taxing pursuit. self-mutilating behaviors. LNS is almost always observed As a first step toward treatment, Shoshie Yishayahu, a resident at in males.

The Harvard Brain 29 2008 Figure 1. Complex Figure Task Joseph was asked to copy a complex figure similar to the one shown at left. In order to achieve the greatest accuracy and efficiency, subjects typically draw the figure’s more conspicuous units (e.g. the large rectangle and circle) and then fill in -sub units and intersecting lines. Joseph, however, produced a highly inaccurate replica of the figure by attempting to draw line-by-line from top-left to bottom-right, improvising when lines didn’t seem to connect properly. This suggested that Joseph’s perceptual abilities were impaired, leading him to focus on details rather than the “big picture.”

Shaare Zedek, administered neuropsychologi- such as placement in a memory clinic, Joseph’s condition would likely cal tests to hone in on Joseph’s specific cogni- only worsen. Even with DBS, his illness could culminate in demen- tive strengths and weaknesses. She assessed his tia, with significant implications for Joseph’s status under Jewish law. verbal, logical, and perceptual reasoning, as well as his memory, attention, and emotional here is an extensive Jewish literature on patients with neuro- well-being.4 In addition, she ran several of the T logical and psychological illnesses.6 In particular, much has been tests with Joseph’s deep-brain stimulator deacti- written on whether people with mental retardation, dementia and vated to assess its contribution to his suspected other neurological disorders should be considered competent under impairments. Jewish law and thus qualified to serve as witnesses in Jewish courts, Joseph excelled at certain tests, demonstrat- consent to transactions, or sign marriage and divorce contracts. A ing sound vocabulary and general knowledge. person with epilepsy, for example, is regarded as competent so long This suggested his semantic memory remained as he is aware when engaged with the court. In contrast, many rab- intact. But he struggled with other tasks—in bis prohibit persons with severe mental retardation from marrying or particular one that involved copying a complex divorcing due to their inability to appreciate the significance of such two-dimensional figure (see Figure 1). Though rites.7 the figure contained a large rectangle and other After meeting with Joseph and his wife, I realized the importance distinct subunits, Joseph did not recognize of this legal corpus for Joseph’s case. Although Joseph seemed person- these shapes, and instead copied the figure by able on his visits, often smiling and cracking jokes, his relationship drawing each line from left to right. This point- with his wife Rachel had suffered immensely. Dr. Guedalia told me ed to impaired perceptual ability, reducing him privately that Rachel was struggling with her husband’s debility and to focusing on the details of the figure instead of the “big picture.” Overall, Joseph was placed his cognitive abilities. While not tested systematically, Joseph’s deep-brain stimulation did not seem to influence his performance. in the average-to-low category of cognitive 6 For instance, there is a heated debate over whether brain-death can be consid- performance.5 Without medical intervention, ered death and which technological methods must be employed in order to verify this status. Jewish legal literature also addresses, for instance, whether patients with 4 Exams included tests from the Minnesota Multi- Alzheimer’s disease must participate in Jewish fast-days and perform ritual acts, or phasic Personality Inventory-2, the Wechsler Adult Intel- whether psychotic persons should be pardoned for their transgressions. ligence Scale 3rd Ed. and the Wechsler Memory Scale 3rd 7 According to several rabbinic writers, however, a marriage of a mentally retarded Ed., as well as computer-administered attention and sort- person who understands the concept of marriage is considered valid. Opinion is split ing examinations. on whether a mentally retarded person would be permitted to divorce. For a review, 5 Though no comparative data was available from ear- see Rabbi Z.N. Goldberg. Marriages of the Mentally Retarded. Techumin, Vol. 7, lier in Joseph’s life, results indicated a significant decline in 5746, pp. 231ff.

2008 30 The Harvard Brain at times burdensome demands. As revealed abandonment. It also places a check on separation without the full by the Minnesota Multiphasic Personality In- understanding of both partners, which would invalidate the divorce ventory-2, Joseph coped with his condition and leave either spouse in jeopardy of violating bans on bigamy and through denial and repression. He was beset adultery if one were to remarry. with a stifled sex drive and deadened capacity Though a Jewish Rabbinic court ultimately evaluates competence to find pleasure in life. based on easily observable criteria, doctors can still weigh in. For in- After consulting with Dr. Guedalia, Yi- stance, if rehabilitation seemed plausible, divorce might be postponed shayahu recommended that Joseph and Rachel until the spouse regained mental acuity. attend marriage counseling. They already tried With these issues in mind, Guedalia and Yishayahu had to handle that, they told her. In fact, Joseph had already the case delicately. To address Rachel’s unstated concern for divorce, seen several psychologists and been to memory they explained the probable success or failure of various approaches clinics as well. Their substantial history of seek- to rehabilitation. They warned that their efforts would not likely re- ing professional help had not been disclosed. store all of Joseph’s cognitive abilities, but they could bolster some At this point, cultural insight into the case and slow the degradation of others. They further recommended that proved indispensable. Dr. Guedalia surmised the couple attend religious marriage counseling to deal explicitly with that Rachel had sent her husband to the clinic their issues. to confirm her belief that Joseph’s deterioration was inevitable. This, she guessed, would justify lthough Guedalia and Yishayahu could not rid Joseph of his a request for divorce, as Joseph’s ability to pro- A ailment, his marriage crisis, or the religious conflicts that might vide for her, emotionally and physically, could have ensued, their treatment and demeanor were sensitive to these never be resurrected. Rachel may have also concerns, as holistic medical care must be. While the particulars of wished to gauge the trajectory of Joseph’s de- Joseph’s case may be unique, the conversation between medicine and cline so that she could request a divorce while a patient’s spiritual life is universal. For a patient is not merely a lump he was still competent. of symptoms; the manifestations of disease become entangled with Though the Jewish law holds marriage- sa every facet of his life. To treat illness, then, is to acknowledge all the cred, it does leave room for divorce when realms in which we experience it—not only the physiological, but the warranted. It is required, however, that both psychological, the social, and the religious as well. husband and wife satisfy legal competence for separation to take place. Dr. Rael Strous, References psychiatrist and Jewish medical ethicist, sees Rosner, F. (2001). “Definition of death.” Biomedical Ethics and Jewish Law. New this stipulation as “arguably, one of the finest Jersey: Ktav Publishing House, Inc. pp. 287-301. examples of halakhic (Jewish legal) sensitiv- Steinberg, A. (2003). “Nervous System: Laws Concerning Illness of the Nervous ity to the shota (incompetent person).” Citing System.” Encyclopedia of Jewish Medical Ethics. Trans. Fred Rosner. New York: Feld- heim Publishers. pp.729-736. th the 12 century Jewish commentator, Moses Strous, R. (2004). “Halachic Sensitivity to the Psychotic Individual: the Shoteh.” Maimonides, Strous suggests that the law is Jewish Medical Ethics. Eds. M. Halperin, D. Fink, and S. Glick. Jerusalem: Schlesinger meant to shield the incompetent spouse from Institute. pp. 299-308.

While the particulars of Joseph’s case may be unique, the conversation between medicine and “ a patient’s spiritual life is universal.

The Harvard Brain 31 ” 2008 What the F***, continued from p. 24 the early ‘60s, but so has illegitimacy, sexu- public television stations today fear broad- in sexual matters, Keep your pecker in your ally transmitted disease, rape, and the fallout casting Ken Burns’ documentary on World pocket. Hats off, too, to the wordsmiths who of sexual competition like anorexia in girls War II because of the salty language in his thought up the indispensable pissing contest, and swagger-culture in boys. Though no one interviews with veterans. The prohibition crock of shit, pussy-whipped, and horse’s ass. can pin down cause and effect, the changes against swearing in broadcast media makes Among those in the historical record, Lyn- are of a piece with the weakening of the fear artists and historians into liars and subverts don Johnson had a certain way with words and awe that used to surround thoughts the responsibility of grown-ups to learn how when it came to summing up the people he about sex and that charged sexual language life is lived in worlds distant from their own. distrusted, including a Kennedy aide (“He with taboo. Even when their characters are not sol- wouldn’t know how to pour piss out of a Those are some of the reasons to think diers, writers must sometimes let them swear boot if the instructions were printed on the twice about giving carte blanche to swearing. in order to render human passion compel- heel”), Gerald Ford (“He can’t fart and chew But there is another reason. If an overuse of lingly. In the film adaptation of Isaac Bashe- gum at the same time”), and J. Edgar Hoover taboo words, whether by design or laziness, vis Singer’s Enemies: A Love Story, a sweet (“I’d rather have him inside the tent pissing blunts their emotional edge, it will have de- Polish peasant girl has hidden a Jewish man out than outside pissing in”). prived us of a linguistic instrument that we in a hayloft during the Nazi occupation and When used judiciously, swearing can be sometimes sorely need. And this brings me to becomes his doting wife when the war is over. hilarious, poignant, and uncannily descrip- the arguments on the pro-swearing side. When she confronts him over an affair he has tive. More than any other form of language, To begin with, it’s a fact of life that people been having, he loses control and slaps her it recruits our expressive faculties to the full- swear. The responsibility of writers is to give in the face. Fighting back tears of rage, she est: the combinatorial power of syntax; the a “just and lively image of human nature,” as looks him in the eye and says slowly, “I saved evocativeness of metaphor; the pleasure of poet John Dryden wrote, and that includes your life. I took the last bite of food out of alliteration, meter, and rhyme; and the emo- portraying a character’s language realistically my mouth and gave it to you in the hayloft. tional charge of our attitudes, both thinkable when their art calls for it. When Norman I carried out your shit!” No other word could and unthinkable. It engages the full expanse Mailer wrote his true-to-life novel about convey the depth of her fury at his ingrati- of the brain: left and right, high and low, an- World War II, The Naked and the Dead, in tude. cient and modern. Shakespeare, no stranger 1948, his compromise with the sensibili- For language lovers, the joys of swear- to earthy language himself, had Caliban speak ties of the day was to have soldiers use the ing are not confined to the works of famous for the entire human race when he said, “You pseudo-epithet fug. (When Dorothy Parker writers. We should pause to applaud the taught me language, and my profit on’t is, I met him, she said, “So you’re the man who poetic genius who gave us the soldiers’ term know how to curse.” doesn’t know how to spell fuck.”) Sadly, this for chipped beef on toast, shit on a shingle, prissiness is not a thing of the past: Some and the male-to-male advisory for discretion Tracing Taste, continued from p. 2 be expired, you would be alerted by the pres- sal cavity to detect the chemicals diffusing perception of the meal. Freezer-burned ice ence of hydrogen ions, which render your through the wind you inhale. But in contrast cream, for example, feels distinctly icy be- food slightly sour. to your tongue’s limit of five main tastes, your cause your tongue can sense bulky crystals in From the tongue, the activity of many nose can discern tens of thousands of differ- each bite. Ben and Jerry whip up a smooth taste cells merges onto cranial nerves, fibers ent scents. As fragrant chemicals stimulate pint by freezing their cream as fast as pos- which convey electrochemical impulses— the olfactory receptor cells, electrochemical sible, curbing the size of offensive crystals. As your dessert in digital—through the brain- signals propagate to the olfactory cortex and for temperature, ice cream of course triggers stem to the thalamus, a sensory relay station. higher brain regions. Neuroscience-minded specialized “cold” receptors in your mouth. From the thalamus, the signal spreads to the chefs will even consider smell’s contribu- Intriguingly, these very receptors also re- primary gustatory cortex in the parietal lobe tion when composing a layered dish. For in- spond to certain minty compounds. Spicy for further processing. stance, they might place aromatic ingredients foods aren’t simply called “hot” for figurative As in vision or hearing, the taste percept is on top, boosting their impact as more scent reasons—they literally activate the same re- thought to be derived from the global activ- molecules migrate from your mouth to your ceptors as a piping cup of coffee does, though ity of receptor cells, and comparisons among nasal pathways. by chemical means. Then there’s sound, groups of them. If your brain relied upon this Scent information also converges on the which can also manipulate food’s appeal. pathway alone, however, all dining would amygdala and hippocampus with signals Rice Krispies’ ad team would surely be at a seem rather bland. Try eating chocolate cake from the tongue, allowing emotional associ- loss without that famous Snap, Crackle and with a plugged nose, and you might wonder ations—delight or disgust, say—to be yoked Pop. And just imagine silent potato chips. why the restaurant charged so much. For with your menu selections. In a still elusive fashion, cortical neurons what we know as “flavor” is actually a blend Ultimately, your experience of mousse integrate these multimodal information and of taste and smell, the latter vastly expanding cake depends on an even broader range of emotional associations to deliver the experi- our rather course palate. pathways linking diverse inputs to the brain. ence of taste. So next time you frolic through Similar to taste perception, smell employs There’s even a role for the somatosensory the garden of gustatory delights, take time to thousands of receptor cells that line your na- system, as a food’s texture influences your smell the chocolate.

2008 32 The Harvard Brain 2008 32 The Harvard Brain Behavioral Economics How Homo sapiens Falls Short of Homo economicus A survey of availability bias by Daniel Demetri

“That associative bonds are strengthened by repetition is perhaps the oldest law of memory known to man. The availability heuristic exploits the inverse form of this law, that is, it uses strength of association as a basis for the judgment of frequency” (Tversky & Kahneman, 1973).

hen asked to estimate in estimation for the sake of efficiency. One events” (1973). Therefore, when a group of a value, individuals are such heuristic is the availability heuristic, individuals employs the availability heuris- almost always wrong by which was identified in 1973 by Tversky tic, their consensus estimate will systemati- at least a narrow margin. and Kahneman, two Israeli investigators. cally deviate from the value theoretically WThe beauty of classical economics stems Their particular interest concerned the way calculated by Homo economicus; this devia- from its faith that when pooled together, in which we confront time-consuming tion is called the “availability bias.” Since our individual misestimates will cancel each tasks, such as determining the frequency the concept was introduced in 1973, most other out, leading to an aggregate behav- with which a class appears in a population research related to the availability heuristic ior achievable only by the hypothetical, (Tversky & Kahneman, 1973). Clearly, the has investigated the magnitude of this bias, perfectly-rational human being, Homo eco- most thorough way to make this calcula- and the areas in which it applies. Tversky nomicus. While the use of Homo economicus tion would involve counting and categoriz- has taken an active role in this process, but has proven tremendously convenient since ing each item in the population. However, other researchers, such as Lichtenstein, Fis- the 19th century, this model suffers from a for larger populations this method becomes choff, and Choi, have also begun using the large setback: sometimes we are all wrong inefficient, and for infinitely large popula- heuristic’s imperfection to draft policy sug- together. When individuals systematically tions, intractable. In these instances, we gestions and explain observed phenomena misestimate in the same direction, the naturally base our decisions on a best guess. that differ from the predictions of classical group’s representative agent will not agree Particularly in the case of determining economics. with Homo economicus, leaving economists frequencies, people estimate the true value with the responsibility of appropriately by subjectively interpreting the ease with Evidence and Applications adjusting their models. which they can imagine or recall represen- Classical economics assumes that its tative instances or associations. For ex- Formulation agents have the superhuman capability, at ample, if we have more difficulty imagining There are many ways to alter and mea- least in aggregate, to process information a computer nerd in a fraternity than a foot- sure the mental availability of a given con- instantaneously and perfectly, and to store ball jock, we will estimate that fraternities cept. For example, recall latency (the time this information forever with perfect recall. are nearly devoid of computer science ma- it takes to remember and report a memory) When applied to financial markets, this jors. Similarly, if the thought of a fraternity and recall accuracy (the degree to which a assumption predicts that prices will jump brings to mind ten athletic friends and one subject correctly remembers a population) immediately upon the public release of librarian, we will come to the same conclu- are two significant strategies for represent- relevant news. Furthermore, prices will not sion. Tversky and Kahneman named this ing availability within a study. Tversky move meaningfully (there will always be simple estimation process the “availability and Kahneman knew that performing one liquidity trading that produces short-term heuristic” because predicted frequencies are experiment would not rule out idiosyn- changes in supply and demand) without based on the “availability” of representative crasies in the structure of the experimental the release of new information. Important instances in one’s memory or imagination. design, such as the method used to measure to the study of availability bias is the im- While the availability heuristic gener- availability (1973). To avoid this problem, plied ability of economic actors to consider ally provides us with good estimates of true the investigators introduced the availability all news in context; news relevant to the frequencies, Tversky notes that “availability heuristic in a discussion of ten original short-term should not move prices so is also affected by various factors which studies, which collectively covered estima- significantly as to imply a long-term change are unrelated to actual frequency. If the tion accuracy in a wide variety of scenarios in fundamentals. availability heuristic is applied, then such and with a number of different methods of In reality, individuals make predictions factors will affect the perceived frequency measurement. Another benefit to report- using heuristics, which trade off accuracy of classes and the subjective probability of ing on a large number of studies was the

The Harvard Brain 33 2008 Demetri

discovery of several independent sources of were quite significant: those starting the large effect on these messages’ audience, availability bias. expression with the lower terms had lower which could distort supply and demand The most well-known experiment from estimates (median: 512) than those starting from their rational levels. Tversky and Kahneman’s 1973 paper with the larger terms (median: 2,250). Perhaps the most obvious cause of concerns bias introduced as a result of The actual value is 40,320. Given the time availability bias is due to “retrievability,” imperfect or imbalanced parsing of the restraint, it is likely that subjects calculated the ease with which we remember relevant “search set,” the collection of thoughts rep- the result of the first few operations and elements of our personal experience and resenting the classes under consideration. used that value as the basis for their search wisdom. While a rational agent would use The study comprised five questions, each set. Since the first three terms of the first only hard facts in determining the likeli- asking whether a given letter appears more expression yield a search set grounded in hood that a depressive patient will commit frequently in the first position or the third 6 and the first three terms of the second suicide, for example, an “irrational” doctor position of a word. In this case, the true expression provide for a search set based on would additionally employ a subjective population is the set of all English words, 336, it is unsurprising that the latter led to interpretation of his own medical experi- represented in each subject’s mind by the larger estimates. ence (Tversky & Kahneman, 1973). If in set of all words familiar to the subject. Of Biases of “imaginability” are another the past the doctor cared for a depressive 152 subjects, 105 indicated that a majority common cause of availability bias. This patient that killed himself, the salience of of the letters were more likely to appear as occurs when the imagination is inclined this event would leave a lasting, available the first character in a word than the third. toward a particular class of thoughts based memory in the doctor’s mind. This would This figure demonstrated a strong bias on past experience or direct influence. be over-weighted relative to the dozens of towards the first position even though the Around the time of the Carter vs. Ford patients that recovered because the latter is third position was actually more common presidential election, subjects were asked to a more mundane occurrence. This leads to for all of the letters used in the study. The imagine a scenario in which either Jimmy an irrational tendency to extrapolate from investigators ascribe this mistaken belief Carter or Gerald Ford would win the elec- the notion that all who commit suicide are to the mind’s indexing of words by their tion - the winner of the imaginary situa- depressive to a prediction that a depressed first letter. Without much thought we can tion was randomly assigned to the subject, person will commit suicide. In reality, think of words that start with the letter not chosen by the subject him- or herself these two statistics can be independently ‘R,’ but listing words with ‘R’ as the third (Carrol, 1978). After this exercise, subjects determined since very few people may character requires much greater effort. As a were asked which candidate they expected commit suicide and very many people may result, words beginning with ‘R’ are more would win. In both instances, results suffer from depression. The retrievability accessible, leading us to incorrectly believe, shifted in favor of whoever was previously bias causes us to over-predict that which is or at least estimate, that this placement is imagined as winning. Similarly, when salient and has happened to us personally. actually more common. asked to imagine the Pittsburgh football Availability bias is not always the result team having a good season, subjects were of imbalanced parsing of our search set; more likely to expect Pitt’s future success in Extensions into Finance sometimes we use the wrong search set. In a major championship bowl. The implica- The retrievability bias predicts that investors will overaccount for salient events that may actually have little financial meaning. One recent example of this over- If imagining a situation can make it reaction is the stock market’s reaction to the discovery of widespread backdating of more subjectively probable, then option grants to corporate executives (Ber- nile, Jarrell, & Mulcahey, 2006). 110 com- speculative comments can have an panies accused of options backdating were analyzed over the period of 20 months irrationally large effect, which could from the time incriminating research was published. Over this time, the market value distort supply and demand. of this portfolio lost 40-50% of its value. However, options compensation to executives comprised at most 3% of each com- another study of availability bias, Tversky tions of imaginability bias for the field of pany’s value. The large discrepancy cannot and Kahneman demonstrated the challenge finance are enormous. In order to consider be attributed to negligence or disinterest posed by extrapolation. The experiment someone else’s opinion, as financial experts because the total value wiped out easily was set up very simply. Half of the subjects always are doing, one must consider the exceeds $100 billion. While Bernille et al. were asked to quickly calculate the value other’s scenario by imagining it. However, propose an agency cost explanation, there of 1x2x3x4x5x6x7x8 while the other half if the mere act of imagining a situation can is almost certainly an element of market was asked to calculate the same expression make it more subjectively probable, then overreaction to the news of the options in reverse: 8x7x6x5x4x3x2x1, which has speculative comments appearing in the backdating scandal. Only years after the the same mathematical value. The results paper or on TV can have an irrationally Enron scandal shattered a massive energy

2008 34 The Harvard Brain A Survey of Availability Bias

firm and ruined the retirement accounts of the positive and negative hype that inves- the schools. A statistical test was run to thousands of employees, no investor wants tors fail to take into context. However, one detect an association between availability to be a part of history repeating itself. The must not forget that regulators at the SEC and judgment, but no such association was salience of that event outweighs the im- are also human and perfectly subject to the found. This provides evidence against the probability of such a severe repetition. same biases as the equally-smart investors existence of the availability heuristic as a Overreaction in the markets is not the on the trading floor (Choi & Pritchard, realistic mental tool. exclusive domain of scandalous events such 2003). For instance, a handful of salient Fortunately for Tversky and Kahne- as options backdating. In fact, investors accounting scandals could be perceived as a man, a later study did find a link between tend to overreact in the long run to all corporate governance crisis. Whereas inves- availability and judgment. Subjects in this information with relevance (and in some tors would overreact by selling the relevant experiment first underwent the Velten cases without relevance) to the markets. stocks and driving prices down temporarily, mood induction procedure, which the in- When good news comes out about a com- the SEC would impose fines, lawsuits, and vestigators hoped would make good or bad pany, even fully-rational investors would increase demand, raising aggregate demand for the stock. Real-world inves- Only years after the Enron scandal, no investor tors, however, differ in that they drive up prices beyond wants to be a part of history repeating itself. reason (De Bondt & Thaler, 1985). This can be tested by The salience of that event outweighs the comparing the returns on a portfolio of low-P/E stocks improbability of such a severe repetition. (those with low expected growth) with the returns on a portfolio of high-P/E stocks (glamour stocks expected to grow congressional legislation suggestions, none thoughts relatively more available depend- quickly). Since the expected level of growth of which could correct over time as easily as ing on which mood was induced (Ma- is a subjective attribute that responds to the market’s levels of supply and demand. cLeod & Campbell, 1992). Subjects were changes in aggregate investor sentiment, we then asked to recall a past event when they can assume that this quantitative variable Counterarguments felt either positive or negative. The time it accurately reflects the hype surrounding a took them to recall such event was used as stock. Between 1926 and 1982, stocks with The availability heuristic was invented an index for availability. They were then low expectations earned 25% more than as an explanation for a series of irrational asked to rate how likely a recurrence of stocks with higher expectations, and at behaviors illustrated by ten studies of this emotion would be in the near future. significantly lower risk. One can call upon which the results were reported by Tversky A negative correlation was found between the imaginability bias to explain this inef- and Kahneman in their 1973 paper. While response latency and subjective judgment ficiency in the market, which would not the heuristic does explain the example de- of future probability, thus supporting the exist in a world of uniformly rational inves- viations from rational behavior, there is no availability heuristic. tors. Glamour stocks receive a lot of media evidence of causation; we are left to assume Even if researchers successfully prove the attention and informal water cooler banter that varying availability is responsible for existence of availability bias in low-stakes whether because of their record-breaking the change in subjects’ behavior. In order behavioral studies, further evidence would stock prices or their companies’ novel way to vindicate the usage of the availability be necessary to show that this phenomenon of doing business. According to the avail- heuristic, we must construct a causation translates into real-world financial markets, ability bias, when investors can imagine model whereby an increase in availability where trillions of dollars are put at stake. In the stock price rising (because from their coincides with a proportional increase in financial markets, availability bias allegedly personal experience it has been going up) subjective probability (Shedler & Manis, manifests itself as market overreaction to and when they hear good things about the 1986). An experiment was constructed news and hype surrounding companies, underlying company’s business practices in which subjects were presented a list of countries, mutual funds, and other finan- (because analysts feel compelled to explain names and their university affiliations. cial entities. It is entirely possible, however, why the price is so high), then investors Photos were also displayed for all of the that the predicted bias is completely absent will tend to predict that the stock will rise males at Yale and all of the females at Stan- from real markets as a result of individu- in the future. This translates into greater ford. To measure availability, the investiga- als self-selecting into professions based on demand, a higher price, and a higher P/E. tors used the accuracy with which subjects their abilities (Choi & Pritchard, 2003). If Since investors are clearly vulnerable to were able to recall a university affiliation bias confers a disadvantage upon a financial their own behavioral irrationality, many given a name and photo (if a photo was professional, then those least affected by believe that the government, represented presented for that name initially). Judg- behavioral bias will enter the industry. by the SEC, should take a greater role in ment was measured by the subjects’ Historical research shows that overreac- promoting hard facts and cutting through estimates of male/female ratios at each of tion is as common as underreaction, which

The Harvard Brain 35 2008 Demetri A Survey of Availability Bias

implies weak-form market efficiency at the stance availability. Sometimes the search set References least; future market movements cannot be is simply off-base, as happens with extrapo- Barber, B. M., & Odean, T. (2006). All that glitters: the effect of attention and news on the predicted based on past movements (Fama, lation. Since imaginability plays a role in buying behavior of individual and institutional 1997). This would mean the overreaction availability and can be affected by thought investors. EFA 2005 Moscow Meetings Paper. previously viewed as evidence of availability exercises and listening to those around us, Bernile, G., Jarrell, G., & Mulcahey, H. (2006). bias is simply an artifact of market noise. this will also lead to irrational behavior and The effect of the options backdating scandal on the stock-price performance of 110 accused companies. In contrast to this observation, much estimation. Our past experiences also play a Simon School Working Paper No. FR 06-10. research has been conducted that demon- large role in determining what instances are Carrol, J. S. (1978). The effect of imagining an strates detectable inefficiencies. Short-sale available to our memory, and the salience event on expectations for the event: an interpretation limitations and a large stock universe make of particular events can overweight those in terms of the availability heuristic. Journal of Experimental Social Psychology, 14, 88-96. individual investors into irrational net events such that their likelihood appears Choi, S. J., & Pritchard, A. C. (2003). Behavioral buyers of attention-grabbing stocks (Barber higher to those involved. economics and the SEC. Stanford Law Review, 56, 1. & Odean, 2006). On the institutional Much research still remains to be De Bondt, W. F., & Thaler, R. (1985). Does the side, there is still evidence of professional conducted on the availability heuristic. It stock market overreact? The Journal of Finance, 40 (3), 793-805. overreaction, even though we would hope is unclear whether the heuristic is a handy De Bondt, W. F., & Thaler, R. H. (1990). Do for professionals to have very limited, if idea that just happens to explain a number security analysts overreact? The American Economic any, behavioral biases (De Bondt & Thaler, of phenomena, or whether it describes Review, 80(2, Papers and Proceedings of the Hundred 1990). what actually goes on in the human mind. and Second Annual Meeting of the American Economic Association), 52-57. Even less clear is whether the availability Fama, E. F. (1997). Market efficiency, long-term Conclusion bias plays a role in equity prices (or prices returns, and behavioral finance. Journal of Financial in other markets). While many reports Economics, 49, 283-306. People employ heuristics when making claim to have found overreaction in certain Galbraith, R. C., & Underwood, B. J. (1973). Mem. Cognition, 1, 56. In Tversky & Kahneman, high-precision calculations is either impos- instances, such as in companies accused of 1974. sible or unnecessarily time-consuming. options backdating, the market efficiency MacLeod, C., & Campbell, L. (1992). Memory The availability heuristic allows us to make camp of academia contend that underreac- accessibility and probability judgments: an estimates of population compositions and tion is as common as overreaction, so the experimental evaluations of the availability heuristic. Journal of Personality and Social Psychology, 63 (6), probabilities of future events by the ease existence of overreaction does not indicate 890-902. with which such instances are remembered a behavioral inefficiency. It remains to be Shedler, J., & Manis, M. (1986). Can the or imagined. Availability bias occurs when determined who is right. Perhaps as neu- availability heuristic explain vividness effects? Journal mental availability fails to match the true robiology and psychology improve, we will of Personality and Social Psychology, 51 (1), 26-36. Tversky, A., & Kahneman, D. (1973). probability we are estimating. Bias can eventually know how the relevant mental Availability: A heuristic for judging frequency and result from ineffective parsing of the search processes actually work, even in the heads probability. Cognitive Psychology, 5, 207-232. set that our mind is using to determine in- of price-setting financial professionals. Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: heuristics and biases. Science, New Series, 185 (4157), 1124.

2008 36 The Harvard Brain History of Science The Evolution of Schizophrenia as a Creative Journey From R.D. Laing to evolutionary synthesis by Charlotte Seid

he Scottish psychiatrist R. that the very designation of schizophre- to us, perhaps after years, no less respect D. Laing, once a central and nia is arbitrary, a mere label invented by than the often no less lost explorers of the iconic figure of the 1960s an- society. Laing portrays schizophrenia as an Renaissance.” He continues, asserting that tipsychiatry movement, is now “unusual” but intelligible extension of hu- historians of the future will not only view Tlargely regarded as a historical curiosity. In man experience. The often disturbing delu- schizophrenics as pioneers but realize “that his 1967 book The Politics of Experience, sions of schizophrenics may seem rational what we call ‘schizophrenia’ was one of he passionately defended madness as a to the patients themselves, but is almost the forms in which, often through quite legitimate, subjective experience, with a po- always frustrated by psychiatric interven- ordinary people, the light began to break tentially enlightening power. Much of his tion with at times questionably humane through the cracks in our all-too-closed work focused on schizophrenia, one of the methods. Laing characterizes this journey minds” (Laing, 1967) What Laing de- most elusive mental disorders. As a cham- in archetypal terms: from “mundane time scribes seems hardly a disease but a form of pion of leftist politics and counterculture, to eonic time,” followed by a return voyage genius. Laing admirably represented his generation “from a cosmic fetalization to an existential In an era of counterculture, biographer and the prevailing social trends, but his rebirth,” leaving it to pedants to rephrase Daniel Burston views The Politics of Experi- prominence did not last long. With the rise these abstractions in psychiatric terms. In ence as a reflection of popular sentiment, of psychopharmacology and the increas- comparing the experience of madness to a enough to make Laing “an international ingly influential pharmaceutical industry journey between inner and outer realities, celebrity on a par with Sartre” by 1969 during the 1970s and 80s, biochemical Laing proclaims the transition “as natural (2001). Laing accumulated popularity in explanations of schizophrenia replaced the as death and giving birth,” and it is only the 1960s mostly because his individual- qualitative social explanations. because humanity has alienated itself istic, anti-neuropathological framing of Although Lang’s ideas about schizo- from the inner world of the psyche that schizophrenia appealed to those disil- phrenia are outdated, his conception of we instinctively fear this process. Humans lusioned with mental hospitals and crude schizophrenia as a transformative experi- commit schizophrenics to mental hospi- methods of psychiatric treatment, such as ence with redeeming aspects deserves fur- tals, he accuses, but “we do not regard it as lobotomy and electroshock therapy (Bur- ther consideration, specifically within the pathologically deviant to explore a jungle ston, 2001). Even with its internal perils, context of emerging evolutionary theories or to climb Mount Everest” (Laing, 1964). an introspective, self-healing journey must of schizophrenia. In particular, David Hor- In “Is Schizophrenia a Disease?” Laing have seemed to social rebels a welcome robin’s theory of schizophrenia as related to suggests that “schizophrenics have had alternative to the psychiatric establishment, human creativity may indirectly revive and more to teach psychiatrists about the inner and Laing found much support during this partially vindicate Laing’s idea of mad- world than psychiatrists their patients” time. ness as a positive transformation. Laing’s (1967). As experienced mental travelers, After Laing’s 18-month journey to metaphor of schizophrenia as a journey many schizophrenics deserve admiration India, however, his audience had also may be more apt than its author predicted beyond what a “sane” person could appre- been transformed (Showalter, 1987). “The in describing the development of Homo ciate. To label a schizophrenic as mentally successes of antipsychiatry did not out- sapiens. Perhaps the principles of Laing’s deficient “is like saying that a man doing last the 1960s,” writes feminist historian work deserve reconsideration, as part of the a hand-stand on a bicycle on a tight-rope Elaine Showalter, and some of their decline primal narrative of human history. a hundred feet up with no safety net is was due to a growing distaste for radical Laing’s chapter on schizophrenia in The suffering from an inability to stand on his rhetoric such as Laing’s glorification of Politics of Experience first challenges the own two feet.” To Laing, schizophrenics madness. By the 1970s, Laing’s former distinction between madness and nor- have perfected human abilities, and like critics considered themselves vindicated, malcy: “One plane may be out of forma- highwire acrobats, they challenge even the and Laing became the target of comedy tion. But the whole formation may be off physical limits of existence. Laing dra- and satire. Burston notes that his personal course” (1964). He implies that although a matically concludes “The Schizophrenic flaws, “frequent lapses into silliness, sadism mental patient may not conform to societal Experience” with hollow prophecies: and self-aggrandizement,” pushed his ideas expectations, those standards of sanity may “perhaps we will learn to accord to so- out of favor, and rumors of Laing’s death not necessarily be valid. Likewise, he asserts called schizophrenics who have come back circulated prematurely as the man outlived The Harvard Brain 37 2008 Seid

his legacy. With his former colleagues gone, Though none of the corollary “heresies” evolution may have generated the brain Laing was denounced by mental health offer a fully Laingian perspective, one line asymmetry necessary for language develop- leaders such as Peter Sedgwick and Joel of “heresy” hints at his general claim that ment. Based on the lack of handedness in Kovel. After the commercial failure of his schizophrenia may represent more than just chimpanzees and a collection of studies book The Facts of Life (1976), “the Left a destructive disorder (Keen, 2007). correlating reduced hand preference with had truly and completely taken its leave of As established by the 1993 World schizophrenia, Crow suggested that a him...They buried Laing—in the universi- Health Organization (WHO) report, the human-specific defect in hemispherical ties, at any rate” (Burston, 2001). Further- incidence of schizophrenia is relatively con- dominance might underlie some of the more, the emergence of chlorpromazine stant in all human populations and over major schizophrenic symptoms. A minor and other antipsychotic drugs marked time (Jablensky, 1993). The great paradox genetic mutation, such as the change in the an end to the colorful but unsupported of schizophrenia is a question largely inac- affinity of a growth factor, could have speculations of philosophers like Laing. cessible to a pharmacological approach. modified the rates of hemisphere develop- Schizophrenia could now be treated chemi- With a genetic component and a reproduc- ment and precipitated human language cally, and neurotransmitters had unseated tive disadvantage, why has schizophrenia (Crow, 1994). Schizophrenia, then, might existential travels as the language of 1970s not been reduced by natural selection? The represent a malfunction of this uniquely and 80’s psychiatry (Keen, 2007). scientist Richter proposed a general solu- human development. Laing is easy to caricature, but in nearly tion in 1984: While Crow’s hypothesis generated fifty years, our knowledge of schizophrenia interest in the evolutionary origins of psy- has seen little improvement. The current Detrimental genes responsible for a chosis, it did not change the assumed status Review of General Psychiatry (2000) intro- serious illness such as schizophrenia of schizophrenia as a destructive force in duces its section on schizophrenia with would be gradually eliminated from human development. Schizophrenia may an almost apologetic admission: “Some the population by normal processes be related to the remarkable human capac- students become discouraged by our in- of natural selection and breeding ity for language, but it receives no redemp- ability to understand schizophrenia given disadvantage unless associated with tion; Crow, though original, presents no the often seemingly disconnected facts that some favourable characteristic which qualitative difference from decades of at present do not lend themselves to one tended to increase the frequency of neuroanatomical research in psychiatry. theory” (Goldman). The Review suggests, the genetic alteration. Schizophrenia may be “the price that Homo however, that an incomplete knowledge of sapiens pays for language,” just as near- etiology does not necessarily preclude ef- The global persistence of schizophrenia sightedness might be considered a price for fective therapies. But even current methods in spite of extraordinary environmental and binocular vision. However, there is nothing of treatment are not always sufficient, and cultural variation suggests that the disor- inherently transformative about the disease limited knowledge can lead to an underes- der must share a link with some positive, genes themselves (Crow, 2000). timation of side effects. Since chlorprom- propagating human trait. In fact, two of While regretting that Crow’s hypothesis azine, some researchers maintain that “we the most developed evolutionary theories was underappreciated, David Horrobin have made virtually no further progress of schizophrenia even suggest a central proposed a more pivotal role for schizo- in controlling schizophrenic symptoms” role for schizophrenia in human cogni- phrenia in the late 1990s. According to (Horrobin, 2001) and propose that con- tive evolution. “Contrary to almost any Horrobin’s model, the physiological basis ceptual changes may be in order. condition,” notes T.J. Crow, “the incidence for schizophrenia is not merely a defect in language but may be an underlying aspect of our capacity for creativity. It is here that Laing finds partial vindica- The global persistence of schizophrenia tion of schizophrenia as a creative innovation. In suggests that the disorder must share a link a section titled “The Gift of Madness,” Horrobin with some positive, propagating human trait. briefly outlines the thesis of his 2001 book The Madness of Adam and Eve: we became human due to In 1999, T.M. Keen summarized the of schizophrenia is independent of the subtle changes in fat metabolism, which “orthodoxy” of schizophrenia in a dissatis- environment and a characteristic of hu- gave our brains both creative capacity and fied review. The first two tenets clearly man populations. Perhaps it is the human the potential for schizophrenia. demonstrate the absence of Laing’s influ- condition” (1994). In formulating his theory, Horrobin ence: “1) Schizophrenia is a biological dis- Crow speculated that the origins of investigated the widely believed associa- ease, not a psycho-social response or an ex- schizophrenia are associated with humans’ tion between creative genius and mad- istential crisis. 2) Because schizophrenia is unique capacity for language. Language ness, which Laing surprisingly omitted in a biological disease, neuroleptic medication functions are localized on the left hemi- The Politics of Experience. Francis Galton, is the appropriate first line of treatment.” sphere, and a “cerebral torque” in human Charles Darwin’s cousin, who had a par- 2008 38 The Harvard Brain The Evolution of Schizophrenia as a Creative Journey

We are human because some of us have all or part of a schizophrenic genome. “ - Horrobin, 2001

ticular interest in the properties of genius, schizophrenia is its extreme phenotype. empowering for Homo sapiens’ historical had also remarked “how often insanity has But unlike any previous theory of schizo- journey out of Africa, an odyssey that must appeared among the near relatives of excep- phrenia, Horrobin, not unlike Laing, have been at least as strange and porten- tionally able men” (as cited in Horrobin, presents the disorder as an extension of a tous as any of Laing’s voyages through” the 2001). From more recent history, Horrobin natural process, fundamental to our human psyche. Early humans migrating over the cites the daughter of James Joyce, the son identity: “We are human because some Eurasian continent, through Polynesia, and of Albert Einstein, Carl Jung’s mother, of us have all or part of a schizophrenic over the Bering land bridge would have and various relatives of Bertrand Russell as genome” (2001). As a medical researcher encountered “confusion, partial failure, examples of schizophrenia akin to cultural by training, Horrobin does not condemn even final shipwreck” and as “many terrors, innovation (2001). psychiatry or speculate on an individual’s spirits, [and] demons” as Laing envisions in Horrobin’s evolutionary theory of personal experience of schizophrenia, but the inner journeys of true schizophrenics. schizophrenia, based on mutations in fatty he does revive the idea of a redemptive, Regardless of whether schizophrenics acid metabolism, postulates a subtle mech- even familiar aspect to madness after 40 eventually attain the respect of Renaissance anism with more profound implications for years of discredit. explorers, as Laing wished, the genes that psychiatry and human identity. In Adam Horrobin notes that the schizophrenia may have predisposed people to developing and Eve, Horrobin locates the roots of mutation must have predated the radia- schizophrenia may actually have prompted psychosis and creativity in East Africa, 5-6 tion from Africa—the original journey of 16th-century creativity. Humanity’s schizo- million years ago, when a group of early primal man—because all human popula- phrenic inheritance, Horrobin suggests, hominids left the trees for a body of water tions experience genetic susceptibility to “was the break-point between our large- around the Rift Valley. Aquatic food chains schizophrenia and once shared a common brained, possibly pleasant, but unimagina- are rich in essential fatty acids produced by African ancestor. Thus, his evolution- tive ancestors, and the restless, creative, un- microalgae, and Horrobin speculates that a ary model also reflects Laing’s idea of a settled creatures we so obviously are today” mutation allowing more efficient fatty acid metaphorical journey. Between 80,000 and (2001). In the context of brain evolution, intake in cells, perhaps involving an apoli- 140,000 years ago, the Australian aborigi- Laing may not have been that inaccurate poprotein, gave our ancestors a nutritional nals were the first line of modern humans in claiming that “ ‘schizophrenia’ was one advantage during times of limited food to diverge. Given that some aboriginals of the forms in which...the light began to supply. By 2 million years ago, humans currently experience schizophrenia, earlier break through the cracks in our all-too- had increased their subcutaneous and brain aboriginals must have carried the critical closed minds” (1967). Schizophrenia, as fat, expanding their cranial size but not mutation (Horrobin, 2001). DNA studies a revolution in lipid metabolism, may yet their cognitive capacity, according to estimate that humans shared a common not only have illuminated our minds but archeological evidence (Horrobin, 2001). ancestor about 60,000 to 160,000 years facilitated the forging of new, culturally Following the transition to modern ago, roughly coincident with the cultural significant connections. humans about 120,000-140,000 years ago, growth previously mentioned. Horrobin When Laing somewhat derisively Horrobin notes the growth of culture— interestingly suggests that the creative- predicted that some readers would try to the flourishing of religious rituals, art, and schizophrenic mutation in lipid metabo- describe the schizophrenic’s journey in organized warfare—and a second metabolic lism could have initiated humanity’s disper- terms of “the jargon of psychopathology mutation between 50,000 and 100,000 sal as well as its cultural beginnings. As a and clinical psychiatry” (1967), he may not years ago. The mutation in question is potential mechanism, Horrobin speculates have expected interdisciplinary thinkers in the synthesis of the lipid precursor that the rising incidence of schizophrenia like Crow and Horrobin to articulate one arachidonic acid, which was abundant in and schizotypy increased the number of of his key elements—schizophrenia as a early humans’ semi-aquatic diet. Not only nonconformists, mild psychopaths, and creative process—in the language of chro- are the cell membranes at synapses mostly religious mystics, who were motivated to mosomes and lipid metabolism. Laing’s lipid, but arachidonic acid also func- separate from society. The genetic com- currently discredited, fanciful ideas have tions in cell signaling, so a small genetic ponents of schizophrenia may have thus been somewhat recapitulated in evolu- change in the synthesis of brain fats could prompted the migration and eventual tionary theories of schizophrenia, which have rapidly enhanced human creativity, cultural divergence of humans (Horrobin, represent holistic approaches to psychiatry. including the capacity for abstractions and 2001). These approaches may be gaining favor as associations. Creativity, Horrobin suggest, In a sense, the genetic changes under- the field becomes disillusioned with over- is one consequence of this mutation, and lying schizophrenia were necessary and specialization in psychopharmacology.

The Harvard Brain 39 2008 Seid The Evolution of Schizophrenia as a Creative Journey

Interestingly, when Horrobin first began survival and superior function, was sup- his research on lipids and schizophrenia pressed by the pharmacological trends of References Burston, D. (2001). R. D. Laing and the politics in the 1970s, he almost encountered the the ‘70s and ‘80s. Fortunately for Horrobin of diagnosis. Janus Head, 4. Retrieved January 10, same intellectual fate as Laing due to and colleagues, the biochemical crux of his 2008, from http://www.janushead.org/4-1/burston- the same scientific climate. Although he argument has received increasing attention pol.cfm. published a number of papers on schizo- in recent years, including a 2006 review in Crow, T. (1994). Aetiology of schizophrenia. Cur- rent Opinion in Psychiatry, 7, 39-42. phrenia as a prostaglandin deficiency Neuroscientist, whose authors “hope that Crow, T.J. (2000). Schizophrenia as the price disease, the younger Horrobin received no this discussion will jump-start more studies that Homo sapiens pays for language: a resolution of responses, funding, or audiences at confer- not only on the involvement of PLA2 [a the central paradox in the origin of the species. Brain ences. Partially to blame, he cites, was lipid-metabolizing enzyme] in neurologi- Research Reviews, 31, 118-129. Farooqui A.A. & Horrocks, L.A. (2006). Phos- the fervor over the dopamine hypothesis cal disorders but also on the importance pholipase A2-generated lipid mediators in the brain: and neurotransmitters. Since convention of PLA2-generated lipid mediators in the good, the bad, and the ugly. Neuroscientist, 12, held that “schizophrenia was obviously physiological and pathological processes” 245-260. a disease of the brain, or perhaps of the (Farooqui & Horrocks, 2006). Horrobin’s Goldman, H.H. (2000). Review of General Psy- chiatry. New York: McGraw-Hill. mind,” scientists considered a systems- lipid-creativity model of schizophrenia Horrobin, D. (2001). The Madness of Adam and wide, metabolic model ridiculous (Hor- has a scientific future, and perhaps it may Eve: How Schizophrenia Shaped Humanity. London: robin, 2001). Indeed, evolutionary theories resurrect the legacy of R.D. Laing in its Bantam. of schizophrenia did not emerge until the non-conformity. Jablensky, A. (1993). The epidemiology of schizo- early 1990s, well after the psychopharma- To broaden this parallel to a final extent, phrenia. Current Opinion in Psychiatry, 6, 43-52. Keen, T. M. (2007). Schizophrenia: orthodoxy cological revolution and the decline in the perhaps Laing’s ideas can be compared to and heresies. A review of alternative possibilities. popularity of the dopamine hypothesis. schizophrenia itself. If evolutionary theories Journal of Psychiatric & Mental Health Nursing, 6, A PubMed literature search for evolu- of schizophrenia can be considered scien- 415-424. tionary theories of schizophrenia yields tifically “sane,” they may owe part of their Laing, R.D. (1964). Is schizophrenia a disease? International Journal of Social Psychiatry, 10, 184-193. only one pre-1980 result, from the success to the same radical notion that pro- Laing, R.D. (1967). “The schizophrenic experi- specialized Schizophrenia Bulletin in 1975. duced the “madness” of R.D. Laing. It is ence.” The Politics of Experience (pp. 118-130). New Another paper was published in 1988, the idea of madness as a natural, generative York: Ballantine Books. but it seems that no serious interest in an process that unites Laing’s mystical inner Richter, D. (1984). Research in Mental Illness. evolutionary explanation of schizophre- journey with Horrobin’s chemical mecha- London: Heinemann. Showalter, E. (1987). Women, madness, and the nia arose until the mid- to late 1990s, nism of evolving brain connections. It is family. The Female Malady: Women, Madness, and when seven of the current 18 papers were the same intriguing concept that connects English Culture, 1830-1980 (pp. 220-247). New York: published. The recent interest in evolution- psychopaths and poets, schizophrenia and Pantheon Books. ary theories of schizophrenia, in which the innovation: madness as a possible progeni- disease is considered relevant to human tor of creative thought.

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2008 40 The Harvard Brain Neurobiology Against the Odds Gambling as pathological addiction by Carol Green

ack, a middle-aged businessman, under the influence of the chemical or release of dopamine in the pre-synaptic lives a quiet life in the suburbs with even while craving the chemical. However, terminal, which also will increase post- a devoted wife and two children. it is difficult to fathom how an action or synaptic dopamine levels (Hyman et al., His life seems stable to the point of behavior, such as gambling, could affect 2006). Addictive drugs, therefore, distort J tedium—until it becomes appar- such circuitry. What sort of neurological reality for the addict by altering normal ent that Jack is a pathological gambler. evidence would be required to prove that dopamine signaling, making addicts He started social gambling many years gambling is an addiction just as physiologi- overvalue the pursuit of the drug. They ago, attending casinos with his friends for cally enslaving as, say, cocaine addiction? “forget” about healthier goals such as relaxation. The thrill of betting dangerously First, let us look at the mechanisms friends, family, monetary stability, and high sums of money seemed to appeal to of motivation and reward circuitry in the law-abiding behavior because the substance Jack even more than it did to his friends. brain. Dopamine is vital for multiple func- is most important in the addict’s working But when his friends grew bored of the tions, including reinforcement, reward, memory. If neurological evidence could casinos, he continued to gamble even with- hedonia, and motor control. In the nucleus prove that non-chemical addictions, such out the social excuse. accumbens, a region of the brain situated as gambling, increased synaptic dopamine Jack had a passion for gambling, but close to the limbic system (the seat of emo- through such “hijacking” mechanisms, a unfortunately not the “talent.” He lost tions), a pleasant reward will increase dop- compelling case could be made for gam- more and more money, until finally he amine levels via dopaminergic projections bling’s addictive nature. reached his limit on credit cards. Desper- from the ventral tegmental area (VTA). But what might this look like neuro- ately, he took out a home equity loan and This essentially links hedonia with desire, logically? Gambling would not interfere tried to quit gambling. Yet his resolutions or the motivation to pursue the reward. with the dopamine reuptake transporter always failed; when passing the local con- The VTA also projects to the prefrontal in the same way as cocaine, as it does not venience store, the lure of lottery tickets cortex (PFC), which serves as the seat of have a chemical associated with it that even became irresistible. In a final act of value judgments, goal evaluation, and plan- would block the transporter and halt its desperation, Jack embezzled his company’s ning of reward-seeking. Finally, dopamine action. Nor would it unerringly parallel funds. His crime was quickly discovered; also plays a significant role in the consoli- amphetamines or any chemical substance. today he stands before a court admitting dation of motivation and goals into actions But perhaps, for people prone to behav- Harvard University his guilt, but also pleading for leniency. in the dorsal striatum, where habitual ioral addictions, the act of gambling does His lawyer claims that Jack’s gambling is behavior is encoded (Hyman, Malenka, & produce a “rush” that makes dopaminergic Study Pool Opportunity comparable to chemical addiction. What Nestler, 2006). neurons in the VTA fire at higher rates are we, as bystanders in a similar position Drugs act as rewards in the brain, and than tonic firing levels, even when the to the neutral judge, supposed to think we can assume gambling does, too. Drugs, reward is expected.1 about such a claim? Ethicists, physicians, gambling, and healthy rewards (i.e. food Pathophysiological evidence would also researchers, and legal teams already debate and drink) all create, at least initially, a be quite compelling in a case for Jack’s the culpability of substance abuse addicts, state of hedonia which serves as a learning diminished capacity to make rational judg- so what then do we say about non-chemi- mechanism: it enforces the desire to pursue ments. Certain addictive substances have cal “addictions?” this reward in the nucleus accumbens, been shown to alter the pathology of genes At first glance, it may be tempting to the planning to pursue this reward in the and neurons: cocaine, for example, has dismiss the comparison between gam- PFC, and the habitual encoding of this been shown to induce chromatin remodel- bling and chemical substances abuse. We behavior in the dorsal striatum. But drugs ing, thereby potentially permanently affect- know a good deal about how drugs—ethyl differ from normal, healthy rewards by the alcohol, cocaine, amphetamines, to name fact that they produce excessive amounts 1 I allude to experiments by Schultz and colleagues a few—hijack the brain’s reward systems. of dopamine for extended periods of time, on monkeys, in which dopaminergic neurons in the Even without fully understanding the thereby disturbing normal firing of dop- VTA were shown to exhibit tonic firing when the animal was awake; the same tonic firing when an neurological mechanisms behind these aminergic neurons. Cocaine, for instance, expected reward was given; increased firing when an addictions, it makes intuitive sense to pre- blocks the dopamine reuptake transporter unexpected reward was given; and decreased firing sume that some chemical property of these in the nucleus accumbens, thereby creat- when the reward was less than expected. Drugs alter substances disturbs normal neurological ing excessive amounts of dopamine in the the dopamine circuit to make drugs consistently fire “better than expected;” if gambling could be shown functioning. This biological basis compels synapse. Amphetamines also act directly to do this, Jack would have a compelling argument William James Hall • 33 Kirkland Street, Cambridge, MA 02138 us to re-evaluate people’s behavior when on dopaminergic neurons by initiating the (Schultz et al. 1993, 1997; Hollerman & Schultz 1998; Schultz 1998, 2006). The Harvard Brain 41 2008 Green Gambling as Addiction

ing gene expression. Additionally, many ad- to parallel a cocaine and/or amphetamine did he really try to stop effectively? Did he dictive substances seem to affect chemical clinical model quite well. To begin with, seek help, or just make a weak commit- synapses of the VTA, by eliciting a higher neither cocaine nor gambling addicts ment to quitting—one that was bound to ratio of AMPA to NMDA receptors in do- experience physical withdrawal from their fail the next time he drove past a conve- paminergic neurons of the VTA, suggesting “substances.” Since cocaine acts strictly on nience store? the profound neuropathological effect of dopaminergic systems, its absence does not Furthermore, the act of embezzle- addictive drugs (Hyman et al., 2006). If induce physical symptoms; nonetheless, it ment is not an impulsive behavior akin to similar pathophysiological changes could produces severe alterations in motivation drinking to the point of physical sickness. be found in gambling addicts’ brains, the and perceived pleasure and thus an emo- Jack must have devoted considerable effort defense would be able to make a strong tional withdrawal instead of a physical one to planning how to embezzle funds—and case for Jack’s diminished responsibility. (Hyman et al., 2006). Likewise, Jack does much of this time was likely distanced What judge would not be swayed by the not experience physical withdrawal. But he from direct cues of gambling. As a result, fact that gambling has physically altered does experience the craving to gamble, the he was probably not at all times “hijacked.” Jack’s brain? nearly obsessive-compulsive mindset when On the other hand, the defense could argue Currently, however, we only have he has not gambled in a while, a “high” that even subtle cues can trigger excessive preliminary pathophysiological evidence similar to a drug addict’s, and distorted dopamine release and thus motivate drug- supporting the comparison of gambling goals in which gambling surpasses financial seeking behavior. Spying a crumpled lot- and chemical substances. Elevated levels stability and law-abiding behavior. tery ticket in the trash, or simply receiving of 3-methoxy-4-hydroxyphenylglycol Thus, concludes the defense attorney, a phone call from an old gambling friend, (MHPG) and homovanillic acid (HVA) in we see a convincing clinical comparison could undermine self-control (Hyman, the cerebrospinal fluid of addicts suggests between gambling and drug use, as well 2007). that gambling may alter noradrenergic as some physiological evidence, through In his final attack, the prosecutor could and dopaminergic systems. The defense cerebrospinal fluid analysis, of gambling’s hurl the emotionally-compelling “snow- attorney could emphasize this finding ability to alter dopamine levels in the brain. ball argument” proposing that one of these to persuade the judge that, although the Simply because we do not yet have enough days, we might find neural corollaries for evidence is not yet complete, he is confi- neurological evidence for gambling as a dis- every immoral behavior. Consider psycho- dent that we will likely one day say with ease comparable to drug addiction does not paths: there is clearly something wrong mean that we should ignore neurologically with these people. Do we Jack’s claim of diminished show compassion for a psychopathic mur- responsibility. derer and give him “treatment” instead of Are we to punish a man But even if we sud- punishing him? Certainly not, the lawyer denly found persuasive could argue—the murderer is a danger to because we are not neurological evidence, society. Jack, too, has harmed his company Jack’s legal case would and his family and should be punished for sufficiently knowledgeable still be thorny. True, we his actions. would know that the Jack’s ultimate legal fate, of course, rests about his disease? reward system is essen- in the hands of the judge. Despite clinical tially seized by gam- and pathophysiological evidence, as well as bling’s addictive proper- the DSM-IV’s classification of gambling, it ties. However, can we still might seem unnatural to the judge— scientific certainty that Jack is as compelled excuse all illicit and morally reprehensible or any observer—to liken gambling to by gambling as cocaine addicts are by their behavior by addicts? In all addictions, the cocaine or heroin. It is easy to visualize the drug. Are we to punish a man because we individual experiences phases of varying materialist basis behind drug addiction, but are not sufficiently knowledgeable about control, such that when craving a substance it is much less so for gambling (or, for that his disease? or under its influence, we could dismiss matter, any of the impulse control disor- Additionally, the defense must point the addict as having lost control. But what ders identified in the DSM-IV). However, out that Jack’s gambling addiction can be about in the recovery phase, or the inter- as neuroscientific findings continue to considered a disease: the Diagnostic and lude between recovery and craving, when hint at the biological underpinnings of Statistical Manual of Mental Disorders the addict is “sober?” There comes a point these addictions, they may simultaneously (DSM-IV) catalogues pathological gam- when all addicts know that they must stop, engender greater compassion from the bling under a clinical model akin to drug and, during these moments of sobriety, it jury—or louder emphasis of diachronous addiction (American Psychiatric Associa- becomes the addict’s duty to seek help. This responsibility from the prosecution. More tion, 1994). DSM-IV defines gambling theory is known as diachronous respon- assuredly, future research will enliven the addiction as “compulsive” and resulting “in sibility: people are responsible for their increasingly fervent tangle, in both the personal distress, impairment in voca- future actions, even if in the future they courtroom and the clinic, over issues of tional or social functioning, and/or legal or have no control over them (Morse, 2007). free will. financial problems” (1994). Jack’s situation Jack showed an awareness of his unhealthy fits this definition, and his addiction seems situation when he attempted to quit—but (References on page 48)

2008 42 The Harvard Brain History of Science Marketing and Minds in the Early 20th Century How psychology enhanced advertising by Molly Bales

hen John B. Watson, (Lemov, 2005). He eventually applied through scientific theory. Thus, Loeb’s the famed American the same principles to animals, shining physico-chemical explanation for the basis psychologist, abandoned light to control cockroaches’ movement of life laid the groundwork for behaviorism his research to work for and to starve moths to death. Manipulat- and made human control a real prospect. Wthe then largest advertising agency in the ing life and behavior fascinated Loeb: he Loeb taught John B. Watson physiology world, he applied his groundbreaking work once reported that he “wanted to take life and biology when Watson was a graduate in behaviorist theory in an entirely new in [his] hands and play with it” (1912). student at the University of Chicago and way (Kreshel, 1990). Within the same Indeed, Loeb even experimented with mul- thereby personally introduced Watson, the decade, Edward Bernays employed Freud’s tiple tropisms at the same time to create future “crystallizer of behaviorism” (Lemov, theory of psychoanalysis in his famous a two-headed worm. While at the Marine 2005), to the mechanistic conception of Lucky Cigarettes marketing scheme. It is Biological Laboratory in Woods Hole, life. Watson built upon Loeb’s behaviorist no coincidence that these two men in the Massachusetts, Loeb invented artificial foundation. In 1903, Watson graduated 1920s, a psychologist and a propagandist- parthenogenesis by inducing a sea urchin from the University of Chicago, having turned-public-relations-counselor, jumped to reproduce by placing it in an acidic written his dissertation on rat behavior. at the opportunity to combine psychology solution, garnering instant fame (1912). Watson discovered more “stimulus-and- and advertising. Around the turn of the Loeb’s biological creations and technique response reactions” that he believed could twentieth century, the field of psychology developments reinforced his mechanistic explain any behavior. In 1913, Watson was slowly discarding the notion of a soul conception of life and led him to believe published Psychology as the Behaviorist and starting to view the mind mecha- that he had discovered the key to man’s Knows It, popularly called “Behaviorist nistically. From this new view emerged ultimate rule over nature: “a technology of Manifesto” (Lemov, 2005), that established behaviorism, the philosophy that one could living substance.” him as the ‘father of behaviorism.’ In this study the mind through external human Loeb’s research in “physico-chemical” ‘manifesto,’ Watson shared Loeb’s belief behavior instead of internal mental states. mechanisms led him to believe that plant, that humans were just as susceptible to Behaviorists began to believe they could animal, and even human behavior were stimulus-response reactions as animals. not only study the mind through behavior nothing but a series of “stimulus-response Watson famously claimed he could but also control it by manipulating external reactions” (Lemov, 2005). By emphasizing “take any one [infant] at random and train stimuli. Though works in the popular the deterministic quality of these reactions, him to become any type of specialist I media such as the film Parallax might select.” As proof of his View and Aldous Huxley’s novel theory, Watson extended his Brave New World expressed fears rat research to human babies of mind control and brainwash- Loeb believed that without and, in 1920, conducted the ing from the misapplication of experiments that made him psychology, the advertising indus- human will as a limiting instantly famous and later try saw psychological theory as infamous (Lemov, 2005). a scientific method for influenc- factor, the construction of a In Watson’s “Little Albert” ing human behavior. Thus, in experiments, Watson tested the early twentieth century, the human simply required the a nine-month-old infant’s seemingly incompatible fields fear response: he presented of psychology and advertising right set of ingredients. a variety of stimuli to the collided. child, anything from a The German physiologist and burning newspaper to a biologist Jacques Loeb provided white rat, and recorded the the intellectual backdrop for psychology’s Loeb rejected not only Descartes’ dualis- baby’s initial responses. Because Albert incorporation into marketing through his tic attitude toward mind and body, but was so stable, Watson resorted to hitting mechanistic conception of life. Loeb first the notion of will at all. Without human a four-foot long, suspended steel bar with examined heliotropism, growth in response will as a limiting factor, the construction a hammer to evoke a fear response from to light, and then extended his research of a human simply requires the right set the child—on the third time the bar was to plants’ reactions to other stimuli such of ingredients. In this way, Loeb believed struck, Albert started crying uncontrol- as gravity, chemicals, and electric current he could create behaviors and attitudes lably (Watson, 1920). When Albert was

The Harvard Brain 43 2008 Bales Marketing and Minds in the Early 20th Century

eleven months old, Watson began testing scientific approach to marketing problems before his advertising career. Nonetheless, the ability to condition the child to fear lent some validity to the Thompson agency Watson proved a key player in the intersec- other things by associating them with the and to the national advertising industry tion between advertising and psychological loud noise. Watson placed a white rat in as a whole. Viewing man as a machine, principles. front of Albert and made the loud noise Watson figured he simply had to press the As previously mentioned, Watson’s en- every time. The series of experiments right buttons to trigger human “buying trance into advertising did not single-hand- resulted in Albert’s fear of the white rat, a behavior” (Buckley, 1982). edly integrate psychology and the business dog, and even a fur coat. A month later, Watson’s contributions to advertising world. Rather, the behaviorist philosophy Albert still feared those stimuli, though less practice are highly contested (Kreshel, Watson supported proved “useful to ‘the intensely. Watson’s “Little Albert” experi- 1990), but one of his clear accomplish- educator, the physician, the jurist, and the ments showed that even humans could be ments includes revitalizing testimonials. businessman” (Buckley, 1982). For one conditioned to feel fear, or other emotions, Testimonials had been looked down upon thing, it made psychology more pragmatic. given the correct conditioning process. The in the advertising business for quite some Given the technology of the time period, “Little Albert” experiments are criticized time, but Watson and Resor believed they it was not possible to study the brain’s today, mainly for ethical reasons, but at the still held promise. Watson used the direct functioning as an organ. For that reason, time, these experiments were considered by testimonial to associate products “with an much of early psychology was devoted to many to be substantial proof of behavior- appeal to authority or a desire for emula- philosophical speculation on the inner ism. Watson’s work with infantile subjects tion” (Buckley, 1982). In indirect testimo- workings of the mind. In fact, before the at Johns Hopkins came to an abrupt halt nials, Watson used symbols to arouse fear, behaviorist movement, psychology at many as he was dismissed for an affair with his rage, or love, which Watson considered the universities was included in the philosophy research assistant. three fundamental emotions. department, not in the science department Watson always seemed to have an af- Watson most impacted the advertis- (Lernov, 2005). By focusing on external finity for business, writing that he enjoyed ing industry by placing emotional arousal stimuli instead of internal mental states, being a consultant. He even offered a above factual content on the commercial behaviorism’s methodology earned psychol- course in “The Psychology of Advertising” totem pole. Choosing emotion above ogy “status as a science” in that psychology while teaching at Johns Hopkins (Buckley, information or style above substance is could then be “observed and verified by 1982). Disgraced by his university due to particularly linked to contemporaneous overt behavior” (Buckley, 1982). Just as a his public affair and naturally drawn to psychological theory in two ways. First, natural science is credited with the ability business, Watson deserted academia for the prioritizing emotions before facts empha- to predict and control natural phenomena, advertising industry. He landed a job at the sizes a very important premise of behavior- psychology with its renewed scientific sta- J. Walter Thompson Company as a “con- ism, that humans, like animals, react by tus was credited with the ability to predict tact man” (Kreshel, 1990), today called an instinct. Instead of believing that humans and control the human mind. Behaviorists account executive. Though Watson claimed transcend animalistic instincts and make hoped that their work could make people he had to “more or less junk [his] psycho- rational decisions as higher-order beings, happier and better. To behaviorists, the logical training” (Kreshel, 1990), his public Watson asserted that humans were simply human mind was a blank slate upon which acclaim as a psychologist certainly helped more complex animals (Buckley, 1982). In- they could inscribe the formula for success. him climb the business ladder. Shortly deed, modern scientists now know that ba- Despite its significant impact on the after starting as an average employee and sic functioning brain regions like the basal advertising industry, behaviorism was not withstanding the rigors of Thompson’s ganglia or the hypothalamus existed long the only psychological philosophy exploited for its market value in the 1920s. Sigmund Freud, uncle to the “father Watson most impacted the advertising of public relations” Ed- ward Bernays, based his industry by placing emotional arousal above theory of psychoanalysis on introspection instead factual content on the commercial totem pole. of external stimuli. Thus, psychoanalysis also found its niche in the business standard training program, Watson became before the distinctively human, higher-or- world. Freud influenced popular culture vice-president of the company or perhaps der brain regions of the neocortex evolved. as much as he did psychology, evident in more accurately “high-visibility ambassa- Secondly, emotions are more closely linked his legacy of dream interpretation to terms dor-at-large” for then-president Stanley to stimulus-response mechanisms; thus, like ‘Freudian slip’. Freud emphasized the Resor. With all the invitations Resor advertising that emphasizes emotion will importance of the unconscious (classified received, he counted on Watson to speak at be more likely to elicit a response than today as the subconscious) in the human functions on his behalf. Many of Watson’s would fact. Some of Watson’s supposed mind. To Freud, the unconscious was a speeches hinged on behaviorist theory and achievements are highly contested and wild beast held by the reins of the con- its application to salesmanship. Watson’s traced to developments that began long scious mind, and whether individuals real-

2008 44 The Harvard Brain According to psychoanalytic theory, ized it or not, their actions were influenced by the unconscious (Freud, 2005). Freud by placing this phallic symbol in the attributed most behaviors to repressed sexual desires. For instance, Freud inter- mouths of young ‘suffragettes,’ Lucky preted one of his patient’s obsessions with squeezing blackheads as “his castration cigarettes associated their product complex upon his skin” and “a substitute for onanism” (Freud, 2005). Though the with women’s liberation. popularity of Freud’s theories eventually waned, his nephew Edward Bernays envisioned the power Freud’s ideas could have over the masses. Bernays’ familial connection to Freud “torches of freedom” on cue (Amos, 2000). References comes as no great shock to anyone who The event was highly publicized, and Amos, A. & Haglund, M. (2000). From social taboo to torch of freedom: the marketing of cigarettes understands how Bernays became the so- Lucky Strike cigarettes experienced a huge to women. Tobacco Control, 9, 3-8. called “father of public relations.” Bernays spike in sales. According to psychoanalytic Berkowitz, B. (1996). Personal and community famously dubbed his work the “engineer- theory, by placing this phallic symbol in sustainability. American Journal of Community Psychol- ing of consent” (Justman, 1994), and he the mouths of young wealthy women, ogy, 24(4), 441-459. Buckley, K. W. (1982). The selling of a psycholo- clearly approached his craft as a scientist. Lucky cigarettes associated their product gist: John Broadus Watson and the application of Just as behaviorists envisioned that their with women’s liberation. In this way, behavioral techniques to advertising. Journal of the theory could make the world better, Bernays manipulated public opinion as he History of the Behavioral Sciences, 18(3), 207-221. Bernays considered himself the “practi- pleased. Freud, S. (2005). The Unconscious. (G. Frankland, Trans.) London: Penguin. (Original work published cal Freud, emancipating people from the John B. Watson and Edward Bernays 1940-52). past and correcting the malfunctions of an were thus instrumental in the integra- Justman, S. (1994). Freud and his nephew. Social industrial society.” In 1932, The Atlantic tion of psychology into advertising. Research, 61(2), 457-476. Monthly wrote of Bernays, “Unlike his These individuals, as part of the greater Kreshel, P.J. (1990). John B. Watson at J. Walter Thompson: the legitimation of science in advertising. distinguished uncle, he is not known as a popularization of science, exploited the Journal of Advertising, 19(2), 49-59. practicing psychoanalyst, but he is a psy- psychological discipline’s predisposition to Lemov, R. (2005). World as Laboratory. Farrar choanalyst just the same” (Justman, 1994). application in everyday life. Psychology is Straus & Giroux. Indeed, Bernays’ campaigns often the study of the mind, and the mind is the Watson, J.B. & Raynor, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychol- involved psychoanalytic theory. During the source of emotion, thought, and behavior. ogy, 3, 1-14. 1920s, cigarette smoking among women Therefore, it is the disciplinary nature Loeb, J. (1912). Mechanistic Conception of Life. was a social taboo, associated “with louche of psychology to affect the way humans The University of Chicago Press. and libidinous behaviors and morals” view themselves and interact with others. Simpson, J.C. (2000). It’s all in the upbringing. Johns Hopkins Magazine, 52 (2). (Amos, 2000). Lucky Cigarettes wished Though behaviorist and psychoanalytic to overcome this social stigma and asked theories may be out of fashion, the idea Bernays to employ his powers of persua- that man shares drives or instincts with sion. Bernays consulted a psychoanalyst animals is valid. John Watson and Edward (not Freud because he was in Vienna at Bernays preyed on human’s ‘animalistic’ the time) who charged him a hefty fee to tendencies by appealing to basic drives explain how women related to smoking. such as hunger and sex. By learning how According to the psychoanalyst, ciga- to influence others, Watson and Bernays rettes were a phallic symbol representing made themselves more powerful. From masculinity and power. If cigarettes could natural philosophy’s role in exegesis in the be associated with women’s power, then twelfth century to atomic theory’s imple- they would attract females. So in the 1929 mentation in creating the atomic bomb in Easter Sunday parade, Bernays had the the twentieth, man has constantly explored Great American Tobacco company hire ways that science can benefit human life. debutantes to pretend to protest against Advertising is yet another avenue through women’s inequality. The ‘suffragettes’ which man can manipulate his environ- strutted down Fifth Avenue, lighting their ment in order to preserve himself.

The Harvard Brain 45 2008 Psychology Paradoxical Liveliness The basis of hypermotility in anorexia nervosa by Carina Martin

lthough not listed in the DSM- ity, and the ability to ignore food and deny as cited in Casper, 2006). Contrary to IV-TR as a primary symptom starvation, may have once facilitated migra- contemporary views of anorexic hyperactiv- of anorexia nervosa, medical tion in certain human populations during ity as a deliberate behavior, these reports reports recognize hyperactiv- local famines. According to the theory, suggest hyperactivity is closely linked to ityA or hypermotility—a shift in behavior preagrarian nomadic foragers may have sur- the experience of internal restlessness and towards frequent physical exercise—as a vived by migrating when local food sources compulsion. fundamental clinical feature of the disorder. were depleted; in order to succeed, these A series of empirical studies also attest Even clinical case reports dating to the individuals would have had to refrain from to increased activity levels in those suffer- 19th century reference an observed restless- local foraging, despite extreme hunger, and ing from anorexia nervosa. Casper et al. ness and abundance of physical energy in migrate large distances, despite a negative compared total daily energy expenditure patients with anorexia nervosa (Casper, energy balance. This adaptive strategy ef- as assessed by the doubly labeled water 2006). Rather than being a deliberate at- fectively required the deactivation of typical method and basal metabolic rates in six tempt to lose weight, the excessive exercise adaptations to starvation, which include female outpatients and six matched healthy of these patients may actually result, in a decrease in metabolic rates, lethargy, controls over a seven day period. Total part, from biological changes induced by increased hunger, and a preoccupation with daily energy expenditure per kilogram body weight loss (Guisinger, 2003). Given its food. The nomadic lifestyle of early human mass was significantly higher in the patient persistence across a wide historical range populations may have selected for this ge- subgroup as compared to controls, despite of changing socio-cultural pressures for netic profile, and excessive weight loss may significantly lower metabolic rates. Further- body shape and size, the hypermotility of trigger these ancient phylogenetic pathways more, physical activity accounted for 30% anorexia nervosa may be involuntary. Con- in descendants of these early populations of the total daily energy expenditure in sidering the importance of hyperactivity (Guisinger, 2003). controls as compared to 48% in the patient to the treatment and prognosis of anorexic subgroup (Casper et al., 1991). Activity patients—studies have associated excessive Hyperactivity in Patients diaries, interviews, pedometers, cinom- exercise with both shorter time to relapse Although an operational definition for eters, and retrospective analyses of medical (Strober, Freeman, & Morrell, 1997) and anorexic hyperactivity does not currently records have been utilized to confirm these longer duration of inpatient treatment exist, a review by Casper suggests some reports. (Solenberger, 2001)—an understanding of degree of consistency in medical obser- Reports also indicate that the phe- the basis and causes of anorexic hyperactiv- vations of patients’ augmented physical nomenon of hyperactivity occurs during ity is extremely important to the field. The activity. Clinical studies cited in the review the night, when patients are asleep and Adapted to Flee Famine hypothesis posits that the hyperactivity observed in anorexia nervosa patients reflects ancient adaptations which once enabled pre- The hyperactivity observed in agrarian populations to migrate during local famines. This article will focus on anorexia nervosa patients may reflect the theory’s suggestion that hypermotility is an involuntary phenomenon with ancient adaptations which once neurobiological origins—a primary, rather than secondary, symptom of enabled pre-agrarian populations to anorexia nervosa. migrate during local famines. Rationale Organisms facing food short- describe anorexic hyperactivity as an presumably not pursuing weight loss. A ages tend to employ one of two survival “internal urge towards increased activity, an study by Crisp and Stonehill observed ten strategies: hibernation or migration. The ‘undiminished, almost excessive vitality’, ‘a anorexia nervosa patients upon hospital ad- Adapted to Flee Famine hypothesis strange unrest,’ and a ‘persistent wish to be mission and again following treatment for (AFFH) posits that the central symptoms on the move’” (Waller et al., 1940; Pardee, weight restoration, which consisted of psy- of anorexia nervosa, including hyperactiv- 1941; Albutt & Rollston, 1905; Gull, 1868 chotherapy, bed rest, and daily consump-

2008 46 The Harvard Brain Martin The Basis of Hypermotility in Anorexia Nervosa

tion of 3000 calories. To assess nocturnal tal group was found to directly result from in either the experimental or control rats motility, patients slept on a motility bed steady increases in activity level, accompa- subjected to ad libitum feeding paradigms. for five successive nights before and after nied by volitional decreases in food intake While food-restricted rats in the control treatment. Researchers reported significant (Routtenberg & Kuznesof, 1967). group exhibited steady increases in activity decreases in overall nocturnal motility and Since its initial discovery, the Activity- levels, leading to the development of star- increases in hours slept per night follow- Based Anorexia model has been replicated vation-induced hyperactivity, activity levels ing weight gain (Crisp & Stonehill, 1971). in various rat and mice subspecies under an did not significantly exceed pre-surgery Although these results attest to a relation- assortment of food restriction paradigms. levels for leptin-infused, food-restricted rats ship between restlessness, hypermotility, While it does not match the full range (Exner et al., 2000). In a subsequent study, and nutritional status, leptin was also found to the study lacked a healthy reverse already-developed control group. As a result, starvation induced hyper- the decrease in nocturnal Leptin levels also accounted for activity. These studies sug- motility could either rep- gest leptin plays a critical resent a return to normal variance in reported physical role in the development motility levels or a decrease of hypermotility in rats, in motility to lower-than- activity levels and feelings of with its infusion prevent- normal levels as a result of ing and reversing the onset weight gain. Additional “inner restlessness.” of starvation-induced studies must be conducted hyperactivity. before concluding that individuals with anorexia nervosa exhibit of anorexic symptomology, the model abnormal levels of nocturnal motility. does reproduce two central symptoms of Hypoleptinemia Despite limitations, these studies and anorexia: food refusal and hyperactivity. Leptin also appears connected to the clinical observations suggest that hyperac- Additionally, because rat models do not motor restlessness observed in human pa- tivity can be better characterized as motor replicate the cognitive components of the tient populations. A correlational study by restlessness, manifested in certain cases as disorder, the model provides preliminary Holtkamp et al. explored the link between excessive exercise. evidence that biological changes following serum leptin levels and both subjective and weight loss may induce the hyperactivity objective measures of motor restlessness of anorexia. Even so, the model suffers in female inpatients with acute anorexia. Animal Models from limitations. Although researchers can To obtain activity levels, patients wore If hyperactivity is not merely a voli- induce hyperactivity in rat populations, the an accelerometer, which monitored their tional secondary symptom related to the symptom ceases once food becomes avail- activity for the first four days of treatment. cognitive distortions of anorexia nervosa, it able, a distinct contrast from the anorexic In addition, patients rated their motor would be expected that starvation-induced patient’s resistance to eating (Guisinger, restlessness (e.g. inability to sit still) on a hyperactivity could be replicated in animal 2003). Moreover, while hyperactivity is five-point scale as well as their “inner” rest- models of anorexia. This is indeed the case: persistently observed in semi-starved rat lessness (e.g. feeling jittery or anxious) on evidence from animal models of anorexia and mice populations, patient populations a visual analogue scale on the third day of in rat and mice populations suggests hy- do not invariably present the symptom, inpatient treatment. To a significant degree, peractivity may have a biological basis. although most patients do exhibit hyper- leptin levels, obtained shortly after hospital Through the Activity-Based Anorexia or activity at some point during the illness, admission, were inversely correlated with Semi-Starvation Induced Hyperactiv- especially during the acute phase (Kron, both measured and reported restless- ity model, researchers have found that Katz, Gorzynski, & Weiner, 1987). ness, suggesting a strong link between severely underweight and food restricted hypoleptinemia and motor restlessness in rats appear to increase their wheel running anorexia nervosa (Holtkamp et al., 2006). activity (Guisinger, 2003). An early study The Role of Leptin Leptin levels also accounted for variance in by Routtenberg and Kuznesof identified Additional research, primarily conduct- reported physical activity levels and feelings this now well-studied paradigm, through ed by Exner et al., has pointed to a decrease of “inner” restlessness, indicating that lep- utilizing six controls rats housed in normal in leptin as the trigger for the increased tin may influence both the behaviors and laboratory cages and thirty rats individu- wheel activity observed in semi-starved cognitions associated with hyperactivity. ally housed in cages with access to activity rats. After the subcutaneous implantation However, Hotkamp et al.’s study shows wheels. All rats were subjected to stringent of mini-pumps, thirty rats were subjected only a correlation and did not utilize a twenty-three hour food deprivation cycles. to seven days of continuous infusion of healthy control group, so it is not possible While rats in the control group were able either leptin or a control substance. Follow- to objectively determine if levels of motor to maintain weight and survive, all rats in ing the infusion period, rats were subjected restlessness and activity in these patients the experimental group lost a significant to either an ad libitum or food-restricted is higher than in healthy age- and weight- amount of weight and eventually died. The diet for seven days. As expected, starvation- matched counterparts. Subsequent studies decrease in body weight in the experimen- induced hyperactivity did not develop have reported decreases in restlessness

The Harvard Brain 47 2008 Martin The Basis of Hypermotility in Anorexia Nervosa

along with increases in leptin levels during itself, clinicians should perhaps assess relationship between psychiatric status, sleep, noctur- therapeutically-induced weight gain, sug- activity levels during intake interviews and nal motility, and nutrition. Journal of Psychosomatic Research, 15, 501-509. gesting that patients with anorexia nervosa track subsequent changes during treat- Exner, C., Hebebrand, J., Remschmidt, H., are not permanently leptin-deficient (Ex- ment. While ethical considerations pose Wewetzer, C., Ziegler, A., Herpertz, S., et al. (2000). ner et al., 2000). Along with the evidence obvious limitations, researchers should also Leptin suppresses semi-starvation induced hyper- from the animal studies, these facts suggest determine whether hypermotility is spe- activity in rats: implications for anorexia nervosa. Molecular Psychiatry, 5, 476-481. that hypoleptinemia results from weight cific to anorexia nervosa or can be induced Guisinger, S. (2003). Adapted to flee famine: reduction. in individuals with comparable diets and Adding an evolutionary perspective on anorexia weight loss timescales. nervosa. Psychological Review, 110(4), 745-761. Studies must also be conducted to Holtkamp, K., Herpertz-Dahlmann, B., Hebe- Conclusion brand, K., Mika, C., Kratzsch, J., & Hebebrand, J. further explore the biological pathways (2006). Physical Activity and Restlessness Correlate Clinical observations, patient de- involved in this phenomenon, especially with Leptin Levels in Patients with Adolescent An- scriptions, and empirical evidence from concerning potential links between leptin orexia Nervosa. Biological Psychiatry, 60(3), 311-313. studies using both patients and animal and any of the other metabolic imbalances Kron, L., Katz, J., Gorzynski, G., & Weiner, H. (1978). Hyperactivity in anorexia nervosa: A fun- models all suggest that hyperactivity is characteristic of anorexia nervosa. The cen- damental clinical feature. Comprehensive Psychiatry, indeed a primary, biologically-mediated tral role of leptin, demonstrated by these 19(5), 433-440. symptom of anorexia, in which leptin studies, suggests that the administration of Routtenberg, A. & Kuznesof, A. (1967). plays an important role, although some leptin to patients with severe hypermotil- Self-starvation of rats living in activity wheels on a restricted feeding schedule. Journal of Comparative cases of excessive exercise surely represent ity may assist recovery and post-morbid and Physiological Psychology, 64, 414-421. a willed attempt to lose weight. These weight gain. Solenberger, S. (2001). Exercise and eating conclusions have important repercussions disorders: A 3-year inpatient hospital record analysis. for the understanding and treatment of References Eating Behaviors, 2(2), 151-168. Casper, R. (2006). The ‘drive for activity’ and Strober, M., Freeman, R., & Morrell, W. (1997). anorexia nervosa. The DSM-IV-TR does ‘restlessness’ in anorexia nervosa: Potential pathways. The long-term course of severe anorexia nervosa in not currently list hyperactivity as one of Journal of Affective Disorders, 92(1), 99-107. adolescents: Survival analysis of recovery, relapse, and the diagnostic criteria for anorexia nervosa. Casper, R., Schoeller, D., Kushner, R., Hnilicka, outcome predictors over 10-15 years in a prospective However, given the relevance of hyperac- J., & Gold, S. (1991). Total daily energy expenditure study. International Journal of Eating Disorders, 22(4), and activity level in anorexia nervosa. The American 339-360. tivity to patient prognosis and its possible Journal of Clinical Nutrition, 53, 1143-1150. status as a primary symptom of anorexia Crisp, A. & Stonehill, E. (1971). Aspects of the

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2008 48 The Harvard Brain Don’t trash that

A paper at the Thinking Psychology? end of To find out more about courses, research opportunities, the term. requirements and advising, check out our website at: www.wjh.harvard.edu/psych/ug/ Submit it to the 2009 Still have a question? Email us at: [email protected] Harvard Brain. E-mail us at [email protected].