Shankar Vedantam - Do We Know What We're Thinking? The Science Behind Our Behavior

NPR Science Correspondent, author of The Hidden Brain: How Our Unconscious Minds Elect Presidents, Control Markets, Wage Wars, and Save Our Lives (2010), and prize-winning writer on the effects of the unconscious mind on human behavior, Shankar Vedantam will share fascinating insights about how our actions and opinions may not always jibe with what we consciously think.

This presentation was part of the Big Change Baltimore: A Forum of Ideas that are Reshaping Our Future sponsored by the Open Society Foundations.

Do We Know What We're Thinking? The Science Behind Our Behavior

Do We Know What We're Thinking? The Science Behind Our Behavior from Open Society Foundations on FORA.tv

Chuck Klosterman - There Are No Sound Moral Arguments Against Performance-Enhancing Drugs

In the New York Times recently, in the Ethicist column, Chuck Klosterman responded to a reader's question on the hypocrisy of making PEDs illegal while other forms of performance enhancement are not illegal. Klosterman argues that there is no sound moral argument against PED use, but he does offer an ethical argument.

He believes that morality is a personal choice, but that ethics are a contextual and socially constructed set of rules. Therefore, a sport (like a religion or a board game) can have a set of rules upon which most people have agreed. However, he also acknowledges that the lines drawn in sports are  capricious - why is a shot of Toradol okay for an injured player but not a shot of testosterone, when both offer healing benefits?

I reject the ethical argument as well - and below this article I offer a brief outline of my own views on PEDS. For another excellent argument relative to the hypocrisy of making these substances illegal, see this column by Miami Herald reporter Dan La Batard.

There Are No Sound Moral Arguments Against Performance-Enhancing Drugs

By CHUCK KLOSTERMAN
Published: August 30, 2013

Q: The argument against performance-enhancing drugs in sports is that the drugs give players an unfair advantage. But how do P.E.D.’s differ from Tommy John surgery? Or pre-emptive Tommy John surgery? What about rich kids? Is their access to superior coaching, facilities and equipment a similarly unfair advantage? In a society that embraces plastic surgery, Botox injections, Viagra and all kinds of enhancements, what moral line do P.E.D.’s cross? 
~ LYNN MOFFAT, SLEEPY HOLLOW, N.Y.

The hypocrisy you recognize is undeniable. Virtually all moral arguments against P.E.D.’s involve contradictions. The presumption of competitive unfairness could be applied to any two human experiences that aren’t identical. The notion that P.E.D.’s are “unnatural” isn’t that distant from making the same argument against elbow surgery or insulin or eyeglasses. Any impulse to criminalize steroids in the name of player safety is absurd (collision sports are more dangerous than the illegal drugs used within them). Some will insist that athletes have a unique responsibility as role models, but that claim evaporates the moment you question the assumptions therein. (Why are people who happen to run fast and jump high the best models for behavior? Can someone be forced to be a role model against his or her will?) There are no sound moral arguments against P.E.D.’s.

There is, however, an ethical argument.

Morality is about personal behavior. Ethics are more contextual. They create the framework for how a culture operates. Sports, unlike life, need inflexibly defined rules. Any game (whether it’s the World Cup or Clue) is a type of unreality in which we create and accept whatever the rules happen to be. Even the Super Bowl is fundamentally an exhibition. So how do we make an unreal exhibition meaningful? By standardizing and enforcing its laws, including the ones that don’t necessarily make sense. Three strikes constitute an out; four balls constitute a walk. In order for baseball to have structural integrity, we all have to agree that this is the system we’re using. Success or failure at baseball is measured against a player’s ability to perform within the framework that defines what baseball is; the logic behind that framework is almost a secondary concern.

For a variety of reasons — statistical tradition, illegality, fear — there’s a social consensus that P.E.D.’s are bad for sports. The lines have been drawn capriciously, but the lines exist. Though it’s difficult to explain why, we’ve collectively agreed it’s O.K. for an injured football player to take a shot of Toradol to help ignore an injury, but not a shot of testosterone to help that injury heal faster. Now, you can certainly argue there’s no moral justification for that dissonance. But morality is not the motive here. The motive is to create a world — or at least the illusion of a world — where everyone is playing the same game in the same way. P.E.D.’s are forbidden because that’s what our fabricated rules currently dictate. In real life, that’s a terrible, tautological argument. But in sports, arbitrary rules are necessary. The rules are absolutely everything, so the rules are enough.

E-mail queries to ethicist@nytimes.com, or send them to the Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018, and include a daytime phone number. 

Okay, here are my views on PEDs, which I have posted in various forms over the years (this is a slight revision of the comments I left at Debate.com on the PED in sports topic).

All performance enhancing drugs should be legalized for use under a doctor's supervision - for athletes, for you, for me. Athletes whose income (in the tens of millions of dollars) depends on producing statistics and being able to play as many games as possible (performance incentives) are going to do whatever it takes to stay on the field or in the game/race. The real benefit of HGH and testosterone (and all of their derivatives, as well as other drugs), are that they speed recovery from injury or simply from the wear and tear of the game (soccer, rugby, football).

The bottom line with PEDs is that they are simply another form of technology - like top of the line basketball shoes, the insanely lightweight bikes used at the Tour de France, the knee braces worn by NFL linemen, or the high-tension tennis racquets used on the pro tours. The list could go on and on.

In the 1940s and 1950s, just as an example, NFL players only had food as a "sports supplement," or maybe some dessicated liver pills (which you can still get, incidentally). Now all athletes have access to whey protein (quicker recovery and better immune health), creatine (strength and muscular endurance), a variety of amino acid supplements (l-tyrosine for alertness, l-leucine for muscle building, BCAAs for recovery), nutrient repartitioning supplements (ursolic acid, CLA), and even basic post-workout supplements specifically designed to aid recovery (containing a 2:1 carb to protein ratio with hydrolyzed whey, extra l-leucine, and other insulin potentiating substances). PEDs are in this same category, only more effective when used correctly.

Which is why they should require a doctor's supervision. With testosterone one needs to avoid the conversion into estrogen (so we also need an aromatase inhibitor), the increase in LDL cholesterol (so we need fish oil and other healthy lipids), or, with oral steroids, liver damage (so we need alpha lipoic acid, curcumin, and/or milk thistle extract).

PEDs can be used safely and effectively, but that will not happen as long as they are banned and/or illegal.

Franck Ramus Doesn't "Get" Neuropsychoanalysis Because He Still Thinks Psychoanalysis Is Freudian

In a recent "Reappraisal" article written for The British Journal of Psychiatry, Franck Ramus, a CNRS senior research scientist at the Laboratoire de Sciences Cognitives et Psycholinguistique, Institute of Cognitive Studies, Ecole Normale Supérieure in Paris, invokes many of my favorite authors (Eric Kandel, Jaak Panskepp, Joseph LeDoux, and even Antonio Damasio) as he argues that psychoanalysis is archaic and dangerous to clients (in so many words), and therefore, neuropsychoanalysis is simply old wine in a new skin:

I have no doubt that the respected neuroscientists mentioned above condemn all these abuses and show indefectible commitment to evidence-based psychology and psychiatry. But they should think twice before making any statement that may be interpreted as a rehabilitation of psychoanalysis (unless they have stunning new data to reveal, of course). They should be aware of all the consequences of unduly preserving the popularity of psychoanalysis. They should be aware that they will be unwittingly enrolled in the support of dismal diagnostic and therapeutic practices, at the expense of patients, albeit in distant places.

Ramus's research focuses on the development of language and social cognition and their disorders (developmental dyslexia, specific language impairment, autism), so it's unclear to me from where his lack of knowledge about modern (or really, postmodern) psychoanalysis is sourced. He clearly believes, wrongly, that psychoanalysis is still Freudian - it's not.


With Heinz Kohut and a few others (Heinz Hartmann [ego psychology], Harry Stack Sullivan, Karen Horney, Erich Fromm, Erik H. Erikson, and Frieda Fromm-Reichmann [interpersonal psychoanalysis], John Bowlby and Mary Ainsworth [attachment theory], Otto Rank, Donald Winnicott, Harry Guntrip, and Ronald Fairbairn [object-relations], as well as Margaret Mahler, Alice Miller, and others - the list could go on for pages), psychoanalysis stopped being about drive theory and unconscious desires. Rather, it moved into the realm of human relationships, thus the umbrella term for modern systems of Relational Psychoanalysis, which includes intersubjective systems theory (Robert Stolorow, Donna Orange, and others).

Neuroscience offers more support for these relational models than Ramus seems to be aware of in his short paper below. Allan Schore, Daniel Stern, and Nancy Chodorow have done extensive research on infant development that demonstrates the central nature of relational neurobiology in mental health.

Full Citation:
Ramus, F. (2013). What's the point of neuropsychoanalysis? The British Journal of Psychiatry, 203, 170–171. doi: 10.1192/bjp.bp.113.127217

What’s the point of neuropsychoanalysis?

Franck Ramus

Summary

Neuropsychoanalysis is a new school of thought attempting to bridge neuroscience and psychoanalysis. Yet few neuroscientists and psychiatrists would have heard of it if it had not recently received public support from notable neuroscientists. The present paper discusses whether such support is warranted.

Declaration of interest:
None

According to Panksepp & Solms, ‘Neuropsychoanalysis seeks to understand the human mind, especially as it relates to first-person experience. It recognizes the essential role of neuroscience in such quests. However, unlike most branches of neuroscience, it positions mind and brain on an equal footing’ [1].  In a landmark 1998 paper framed as a challenge to psychoanalysts, Kandel further stressed that psychoanalysis had an essential part to play in such a legitimate enterprise:

‘As a result of advances in neural science in the last several years, both psychiatry and neural science are in a new and better position for a rapprochement, a rapprochement that would allow the insights of the psychoanalytic perspective to inform the search for a deeper understanding of the biological basis of behavior’ [2].

Fifteen years later, one can only be delighted to see that some psychoanalysts have taken up the challenge, embracing the scientific method and attempting to put Freudian hypotheses to rigorous test, as attested by a recent special issue of the Psychoanalytic Review in honour of Kandel [3]. In the conclusion of this special issue, this rapprochement between psychoanalysis and neuroscience is called ‘a natural alliance’ by Damasio [4], and is further celebrated by LeDoux [5].  As noted by LeDoux in an earlier book, ‘Freud was right on the mark when he described consciousness as the tip of the mental iceberg’ [6].  Indeed, Freud’s theory ‘still stands as perhaps the most influential and coherent view of mental activity that we have' [7]. Thus, the stage is set for Carhart-Harris & Friston (and many others) to explore ‘the notion that Freudian constructs may have neurobiological substrates’, by attempting ‘to demonstrate consistencies between key Freudian ideas and recent perspectives on global brain function’ [8].  Of course, all the quoted authors are well aware that psychoanalysis has until now been on shaky ground, and show remarkable caution in their displays of support. They insist that its claims should be put to empirical test, and that indeed the time is ripe thanks to the progress of neuroscience, a position that appears entirely reasonable and harmless. Or is it?

First of all, it may be argued that the attribution of many enduring and important insights and concepts (such as unconscious processing) to Freud is largely erroneous. Although Carhart-Harris & Friston [8] do an admirable job of synthesising a great deal of neuroscientific data and linking it with the ‘free energy principle’ framework, why attempt to systematically associate almost every neuroscientific concept or finding with a quote from Freud? Certainly, it is of historical and epistemological interest to trace modern ideas back to their precursors; Freud may have had genuine insights about the functioning of the mind. At least if it can be shown that these ideas really originated from Freud, rather than being borrowed shamelessly from predecessors without appropriate credit (e.g. the idea of unconscious processes from Janet [9] and many others [10]). Carhart-Harris & Friston’s main focus, the id and the ego, can be traced back to Plato’s distinction between passions and reason, via countless intermediaries. But these authors do not seem to seek any other source than Freud, a curious form of historical scholarship. Armed with exclusively Freudian literature and with a liberal use of analogy and metaphor, there is no doubt that ‘consistencies’ can be found. But what does this mean for modern neuroscience and psychiatry? Do empirical studies of the default-mode network, of the emotional brain or of psychiatric disorders benefit in any way from the free association of cognitive and neuroscientific concepts with psychoanalytical ones? Is the history of ideas well served in the process? Kandel’s latest book [7] reveals, if anything, that there is no other justification for constantly going back to Freud than nostalgia for the Viennese 1900s and admiration for an inspirational writer.

Second, psychoanalysis seems to provide no additional insight to already existing concepts in cognitive psychology and neuroscience. Just like Kandel [2], Panksepp & Solms [1] convincingly argue that there is a need for a dedicated level of description for the mind, i.e. for thoughts, feelings, and all other mental states, distinct from biological levels of description. But in so doing, are they not just rediscovering psychology? The case for the importance of a cognitive level of description for any proper understanding of the mind/brain, and for its conceptual independence from the biological level has already been made long ago by Marr [11], and has been couched in more modern terms by Morton & Frith [12,13] with their causal modelling framework. It may be that some scientists in molecular and cellular neuroscience need to be reminded of the limitations of a purely reductionist biological approach, and of the essential contribution of cognitive science to the understanding of the brain. But psychoanalysis is the last thing they need. The science of the mind already exists, and that is psychology. For most contemporary psychologists, psychoanalysis is only one school of psychology: an outdated one, whose hypotheses were either trivial or untestable, or proved wrong. And the new science of the mind/brain (including subjective feelings, emotions and social relations) already exists: it is to be found at the thriving interface between psychology and neuroscience. Thus, all the ideas that Panksepp & Solms attribute to neuropsychoanalysis are fine, but are already mainstream within cognitive, social, and affective psychology and neuroscience. So, what is the point of renaming these successful scientific endeavours ‘neuropsychoanalysis’? Is this not just an attempt to rehabilitate psychoanalysis by giving it a fashionable prefix and by attributing it the merits of other disciplines?

This is not merely a futile dispute about a word. Psychoanalysis is not just a harmless set of ideas that may be used as a source of inspiration and philosophical musings. In order to realise that, it may be useful to recall the situation of countries where it still constitutes the core of psychology and psychiatry and leads both theoretical thinking and clinical practice. In France, for example, psychoanalytically trained child psychiatrists reject international classifications of mental disorders in favour of their own idiosyncratic one [14]; delay the diagnosis of autism or substitute it with psychoanalytic diagnoses such as ‘infantile psychosis’; delay or prevent any form of educational intervention; practice instead analytical forms of psychotherapy whose efficacy is not supported by any empirical evidence (including highly questionable ones such as packing [15]); put the blame on parents for the neuro-developmental disorders of their children; and may even sue a filmmaker who dares to expose their ideas about autism [16]. In a context of increasing challenges to their authority, French psychoanalysts relish any overt sign of interest for psychoanalysis from a world-renowned neuroscientist. Such declarations are then instrumentalised in the hope of delaying any evolution of French psychiatry and psychology for a few more years, forming new obstacles on the path to evidence-based psychiatry. Patients pay dearly for that.

I have no doubt that the respected neuroscientists mentioned above condemn all these abuses and show indefectible commitment to evidence-based psychology and psychiatry. But they should think twice before making any statement that may be interpreted as a rehabilitation of psychoanalysis (unless they have stunning new data to reveal, of course). They should be aware of all the consequences of unduly preserving the popularity of psychoanalysis. They should be aware that they will be unwittingly enrolled in the support of dismal diagnostic and therapeutic practices, at the expense of patients, albeit in distant places.

If psychoanalysis is to be rehabilitated, this will have to be on the basis of its own merits. It is not enough for empirical research to tackle the influence of early life experiences, the neural correlates of unconscious processing, or the decoding of dream content using neuroimaging, to support psychoanalysis as such, even if Freud happened to use the same words. What is needed is to show that (1) certain central psychoanalytical concepts (such as the Oedipus complex, psychosexual development stages or the symbolic meaning of dreams) can now be sufficiently precisely defined to make clear, testable predictions, that some of these predictions are indeed correct, and that they are not better explained by other, simpler theories; or that (2) psychoanalytical theories of the causes of certain mental disorders are correct and make more accurate predictions than alternative theories; or perhaps that (3) psychoanalytical therapies have proven some efficacy for certain disorders, for reasons specific to psychoanalytical concepts. But none of the authors cited here has provided any hint that this is the case. Merely finding inspiration in Freud’s writings and making vague analogies between psychoanalytical concepts and neuroscientific findings will not do.

Franck Ramus, PhD, Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Superieure, EHESS, CNRS, Paris, France. Email: franck.ramus@ens.fr

First received 8 Feb 2013, final revision 17 May 2013. Accepted 5 Jun 2013

References

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