The Mind and the Brain

When he speaks of “reality” the layman usually means something obvious and well-known, whereas it seems to me that precisely the most important and extremely difficult task of our time is to work on elaborating a new idea of reality. This is also what I mean when I always emphasize that science and religion
must
be related in some way.

—Wolfgang Pauli, letter to M. Fierz, August 12, 1948

It is interesting from a psychological-epistemological point of view that, although consciousness is the only phenomenon for which we have direct evidence, many people deny its reality. The question: “If all that exists are some complicated chemical processes in your brain, why do you care what those processes are?” is countered with evasion. One is led to believe that…the word “reality” does not have the same meaning for all of us.

—Nobel physicist Eugene Wigner, 1967

Epigraph

Acknowledgments

Introduction

 
1.
The Matter of Mind

 
2.
Brain Lock

 
3.
Birth of a Brain

 
4.
The Silver Spring Monkeys

 
5.
The Mapmakers

 
6.
Survival of the Busiest

 
7.
Network Remodeling

 
8.
The Quantum Brain

 
9.
Free Will, and Free Won’t

10.
Attention Must Be Paid

Epilogue

Notes

Searchable Terms

About the Authors

Other Books by Jeffrey M. Schwartz, M.D.

Copyright

About the Publisher

This book has a virtual, third coauthor: Henry Stapp, whose research into the foundations of quantum mechanics provided the physics underpinning for JMS’s theory of directed mental force. For that, and for the countless hours he spent with the authors explaining the basics of quantum theory and reviewing the manuscript, we owe our deepest gratitude.

For more than a decade the Charles and Lelah Hilton Family provided donations to support the academic career of JMS at UCLA.

Scores of scientists and philosophers gave tirelessly of their time to discuss their research or review the manuscript, and often both. Our heartfelt thanks to Floyd Bloom, Joseph Bogen, David Burns, Nancy Byl, David Chalmers, Bryan Clark, Almut Engelien, John Gabrieli, Fred Gage, Eda Gorbis, Phillip Goyal, Ann Graybiel, Iver Hand, J. Dee Higley, William Jenkins, Jon Kaas, Nancy Kanwisher, Michael Kozak, Patricia Kuhl, James Leckman, Andrew Leuchter, Benjamin Libet, Michael Merzenich, Steve Miller, Ingrid Newkirk, Randolph Nudo, Kevin Ochsner, Don Price, Alvaro Pascual-Leone, John Piacentini, Greg Recanzone, Ian Robertson, Cary Savage, John Searle, Jonathan Shear, David
Silbersweig, Edward Taub, John Teasdale, Max Tegmark, Elise Temple, Xiaoqin Wang, Martin Wax and Anton Zeilinger. We thank Christophe Blumrich for the care he took in producing the compelling artwork and, most of all, Judith Regan, Susan Rabiner, and Calvert Morgan for their commitment to this project. To those whom we have forgotten to mention (and we know you’re out there), our apologies.

Every Tuesday, with the regularity of traffic jams on I-405, the UCLA Department of Psychiatry holds grand rounds, at which an invited researcher presents an hour-long seminar on a “topic of clinical relevance.” One afternoon in the late 1980s, I saw, posted on a bulletin board at the Neuropsychiatric Institute, an announcement that stopped me cold. One of the nation’s leading behavior therapists was scheduled to discuss her high-profile and hugely influential work with obsessive-compulsive disorder (OCD), the subject of my own research as a neuropsychiatrist. OCD is a condition marked by a constant barrage of intrusive thoughts and powerful urges, most typically to wash (because patients are often bombarded with thoughts about being dirty and contaminated with deadly pathogens) and to check (because of irresistible urges to make sure an appliance has not been left on, or a door left unlocked, or to satisfy oneself that something else is not amiss). I had a pretty good idea of what to expect—the speaker was widely known in medical circles for her application of rigorous behaviorist principles to psychological illnesses. “Rigorous,” actually, hardly did the behaviorist approach justice. The very first paragraph of the very first paper that formally announced the behaviorist
creed—John B. Watson’s 1913 classic, “Psychology as the Behaviorist Views It”—managed, in a single throw-down-the-gauntlet statement, to deny man’s humanity, to dismiss the significance of a mind capable of reflection, and to deny implicitly the existence of free will: “The behaviorist,” declared Watson, “recognizes no dividing line between man and brute.”

Rarely in the seventy-five years since Watson has a secular discipline adhered so faithfully to a core principle of its founder. Behaviorists, ignoring the gains of the cognitive revolution that had been building momentum and winning converts throughout the 1980s, continued to believe that there is no need for a therapist to acknowledge a patient’s inner experiences while attempting to treat, say, a psychological illness such as a phobia; rather, this school holds that all desired changes in behavior can be accomplished by systematically controlling relevant aspects of a patient’s environment, much as one would train a pigeon to peck particular keys on a keyboard by offering it rewards to reinforce correct behavior and punishments to reverse incorrect behavior. The grand rounds speaker, faithfully following the principles of behaviorist theory, had championed a particular method to treat obsessive-compulsive disorder known as “exposure and response prevention.”

Exposure and response prevention, or ERP, was a perfect expression of behaviorist tenets. In ERP therapy sessions as routinely practiced, the OCD patient is almost completely passive. The therapist presents the patient with “triggers” of varying intensity. If, for instance, an OCD patient is terrified of bodily secretions and feels so perpetually contaminated by them that he washes himself compulsively, then the therapist exposes him to those very bodily products. The patient first ranks the level of distress various objects cause. Touching a doorknob in the therapist’s office (which the patients believes is covered with germs spread by people who haven’t washed after using the bathroom) might rate a 50. Touching a paper towel dropped in the sink of a public rest room might rate a 65; a sweaty T-shirt, 75; toilet seats at a gym, 90; a dollop of
feces or urine, 100. Presenting one of these triggers constitutes the “exposure,” the first half of the process. In the second half, the “response prevention,” the therapist keeps the patient from reacting to the trigger with compulsive behaviors—in this example, washing. Instead of allowing him to run to a sink, the therapist waits for the intensity of the patient’s distress to return to preexposure levels. During this waiting period, the patient is typically quite passive, but hardly calm or relaxed. Quite the contrary: patients suffer unpleasant, painful, intense anxiety in the face of the triggers—anxiety that can take hours to dissipate.

The theoretical basis of the approach, to the extent that there is one, involves the rather vague notion that the intense discomfort will somehow cause the symptoms to “habituate,” much as the intense feeling of cold one feels after jumping into the ocean fades in a few minutes. During these treatment sessions, if a patient asks about the possible risks of exposure and response prevention he is usually rebuffed for “seeking reassurance,” which supposedly undermines the efficacy of the treatment. And yet examples abound in which the risks endured by patients were only too real. In the United States, therapists in the forefront of developing these techniques have had patients rub public toilet seats with their hands and then spread—well, then spread whatever they touched all over their hair, face, and clothes. They have had patients rub urine over themselves. They have had patients bring in a piece of toilet paper soiled with a minuscule amount of their fecal material and rub it on their face and through their hair during the therapy session—and then, at home, contaminate objects around the house with it. In other cases, patients are prevented from washing their hands for days at a time, even after using the bathroom.

To me, this all seemed cruel and distasteful in the extreme—but it also seemed unnecessary. At the time, my UCLA colleague Lewis Baxter and I had recently begun recruiting patients into what was probably one of the first organized, ongoing behavior-therapy groups in the United States dedicated solely to the study and treat
ment of OCD. The study would examine, through the then-revolutionary brain imaging technique of positron emission tomography (PET), the neurological mechanisms underlying the disease. The group therapy sessions held in conjunction with the study would allow us to offer treatment to the study participants, of course. But the therapy sessions also presented what, to me, was an intriguing opportunity: the patients whom Baxter and I would study for clues to the causes of OCD might also tell us something about the relative efficacy of different treatments and treatment combinations. Our UCLA group had decided to study the effects of both drug and behavior therapy. I wasn’t interested in doing research on the first of these, but I was extremely curious about the effects of psychologically oriented drug-free treatments on brain function. I didn’t have much competition: by the late 1980s drugs were where the glamour was in major academic research centers. My offer to lead the behavior-therapy research group was accepted gladly.

I was becoming increasingly convinced of what was then a heresy in the eyes of mainstream behaviorists: that a patient undergoing behavior therapy need
never
do anything that a normal, healthy person would object to doing. I believed, too, on the basis of preliminary clinical research, that OCD might be better treated by systematically activating healthy brain circuits, rather than merely letting the pathological behaviors and their associated circuits burn themselves out, as it were, while the patient’s distress eventually dissipated in a miasma of pain and anxiety.

My quest for an alternative treatment grew in part from my discomfort with exposure and response prevention treatment, which is based on principles gleaned almost solely from research on animal behavior. The difference between the techniques used in animal training and those applied to humans was negligible, and I had come to suspect that, in failing to engage a patient’s mental faculties, behavior therapy was missing the boat. Treatments based on
the principles of behaviorism denied the need to recognize and exploit the uniquely human qualities that differentiate humans from animals. If anything, such treatments are imbued with an obstinate machismo about not doing so; the behaviorists seemed to take a perverse pride in translating their work directly from animals to humans, allowing their theoretical preconceptions to displace common sense.

But exposure and response prevention, with its visits to public toilets and patients’ wiping urine-impregnated paper over themselves, was claiming success rates of 60 to 70 percent. (Only years later would I discover that that percentage excluded the 20 to 30 percent of patients who refused to undergo the procedure once they saw what it entailed, as well as the 20 percent or so who dropped out.) Clearly, any alternative would face an uphill battle.

When I walked alone into the grand rounds auditorium that afternoon, I had a pretty clear idea of the techniques the speaker had applied to her OCD patients. Still, it was a welcome opportunity to hear directly from an established behaviorist about her methods, her theories, and her results. The audience settled down, the lights dimmed, and the speaker began. She had the tone and demeanor of someone on a mission. After explaining her diagnostic techniques—she was well known for a detailed questionnaire she had developed to pinpoint patients’ fears, obsessions, and compulsions—she launched into a description of the behavioral treatment she used in the case of one not-atypical OCD sufferer. When this patient hits a bump in the road while driving, she explained, he feels he has run over someone and so looks obsessively in the rearview mirror. He frequently stops the car and gets out or drives around for hours looking desperately for a body he anxiously worries must be lying, bleeding and dying, on the pavement. She reported, with what I would come to recognize as her trademark self-assurance, that the key to her treatment of this case was…removing the rearview mirror from the car! Just as she made germ-
obsessed patients touch toilet seats until their distress evaporated, she had this hit-and-run-obsessed patient drive without his mirror until his urge to check for bodies in the road behind him “habituated.”

I was aghast. The potential danger she put the patient in was astonishing—but this apparently made not a whit of difference. The prevailing view among behaviorists was that normal standards of judgment and taste could be set aside during behavioral interventions. I already had qualms about how mechanistic the treatment based on behaviorist principles was, how in thrall to problematic dogma and, indeed, to the cult of scientism itself, which has been described by Jacques Barzun as “the fallacy of believing that the method of science must be used on all forms of experience and, given time, will settle every issue.” Imagining the implications of a mainstream treatment that called for a patient to drive around without a rearview mirror, I found it hard to focus on the rest of the talk.

But what I had heard had triggered an epiphany. From then on, I decided, I would commit myself to finding a way to spare OCD patients (as well as patients with other mental disorders) from unnecessary, irresponsible, even brutal treatment by experts who pride themselves on ignoring what patients are feeling, or indeed whether they are even conscious. Surely there is something deeply wrong, both morally and scientifically, with a school of psychology whose central tenet is that people’s conscious life experience (the literal meaning of the word
psyche
) is irrelevant, and that the intrinsic difference between humans and “brutes” (as Watson had candidly put it) could be safely ignored. I became determined to show that OCD can be effectively treated without depriving patients of rearview mirrors, without forcing them to touch filthy toilets, without ordering them to use the bathroom without washing their hands afterward—without, in short, forcing them to do anything dangerous, unsanitary, or just plain ridiculous. There is no need to suspend common sense and simple old-fashioned
decency to use behavioral interventions successfully, I reasoned, as I walked back to my office. By applying a new and scientifically testable method that would empower OCD patients actively and willfully to change the focus of their attention, I just might help them learn to overcome their disease. But I had a hunch that I might achieve something else, too: demonstrating, with the new brain imaging technology, that patients could systematically alter their own brain function. The will, I was starting to believe, generates a force. If that force could be harnessed to improve the lives of people with OCD, it might also teach them how to control the very brain chemistry underlying their disease.

What determines the question a scientist pursues? One side in the so-called science wars holds that the investigation of nature is a purely objective pursuit, walled off from the influences of the surrounding society and culture by built-in safeguards, such as the demand that scientific results be replicable and the requirement that scientific theories accord with nature. The gravitational force of a Marxist, in other words, is identical to the gravitational force of a fascist. Or, more starkly, if you’re looking for proof that science is not a social construct, as so-called science critics contend, just step out the window and see whether the theory of gravity is a mere figment of a scientist’s imagination.

That the findings of science are firmly grounded in empiricism is clear. But the
questions
of science are another matter. For the questions one might ask of nature are, for all intents and purposes, without end. Although the methods of science may be largely objective, the choice of what question to ask is not. This is not a shortcoming, much less a fault, of science. It is, rather, a reflection of the necessary fact that science is, at bottom, a human endeavor. Running through both psychiatry and neuroscience is a theme that seemed deeply disturbing to me almost from the moment I began reading in the field as a fifteen-year-old in Valley Stream, Long Island, when my conviction that the inner working of the mind was the only
mystery worth pursuing made me vow to become a psychiatrist. What disturbed me was the idea that free will died with Freud—or even earlier, with the materialism of the triumphant scientific revolution. Freud elevated unconscious processes to the throne of the mind, imbuing them with the power to guide our every thought and deed, and to a significant extent writing free will out of the picture. Decades later, neuroscience has linked genetic mechanisms to neuronal circuits coursing with a multiplicity of neurotransmitters to argue that the brain is a machine whose behavior is predestined, or at least determined, in such a way as seemingly to leave no room for the will. It is not merely that the will is not free, in the modern scientific view; not merely that it is constrained, a captive of material forces. It is, more radically, that the will, a manifestation of mind, does not even exist, because a mind independent of brain does not exist.