What Can Obama’s BRAIN Do?
by Stanton Peele
People imagine that President Obama’s massive new ($100 million) brain mapping project will unlock the secrets of the brain, including how we act and why we succumb to mental illness and addiction. It won’t.
Two milestones occurred this month: On April 2 President Obama introduced the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) initiative, and April 14 marked the 10th anniversary of the completion of the Human Genome Project. What HAVE we learned about human functioning (behavior, personality traits, mental illness) from mapping the genome? What CAN we learn from mapping the brain?
The President introduced the BRAIN initiative as follows:
None of this will be easy. If it was, we would already know everything there was about how the brain works, and presumably my life would be simpler here. It could explain all kinds of things that go on in Washington. We could prescribe something.
Note the President’s glib references to explaining behavior and correcting it with medications. The President was no doubt joking, even as his comments hit a major chord in America. Indeed, given the kind of concern being expressed over the massive diagnosis and medication of Americans, particularly children (nearly 1 in 5 boys will be diagnosed and treated for ADHD alone), is this funny?
Going beyond these comments, the President then claimed that BRAIN will help us prevent and treat autism, schizophrenia, and post-traumatic stress disorder, along with other disorders. The initiative will not – although it can benefit stroke and traumatic brain injury victims, other conditions the President listed. The former impairments aren’t locked in brain nerve impulses, which the project will be mapping. Moreover, the project’s planners and managers should know this.
Before addressing the BRAIN initiative, let’s return to the mapping of the genome – a similarly massive project whose results are far short (really, in a totally different universe) from what many lay people and popular psychology commentators imagined when that project was initiated. The original Human Genome Project was conceived to map all genes on the human genome in terms of their chemical sequencing and their functions. On April 14, 2003, scientists announced that they had completed compiling the three billion letters of genetic code that comprise the DNA shared by human beings.
As to the function of all this DNA – not so fast. This long and expensive effort (its initial phase cost perhaps $1 billion, or ten times the budget for BRAIN) represented only the creation of a framework from which to pursue further research to explore the meaning of the human genome. Interviewed a decade after the completion of the mapping of the genome, after several more billions had been spent on research, and a quarter century after President Ronald Reagan included the project in his 1987 budget, the director of the National Human Genome Research Institute, Eric Greene, summarized what we have learned.
What about the naysayers who asked, “Where are the cures for diseases that we were promised”?
I became director of this institute three and a half years ago, and I remember when I first started going around and giving talks. Routinely I would hear: “You are seven years into this [this was 20+ years after the project was conceived]. Where are the wins? Where are the successes?”
I don’t hear that as much anymore. I think what’s happening, and it has happened in the last three years in particular, is just the sheer aggregate number of the success stories. The drumbeat of these successes is finally winning people over.
We are understanding cancer and rare genetic diseases. There are incredible stories now where we are able to draw blood from a pregnant woman and analyze the DNA of her unborn child. Increasingly, we have more informed ways of prescribing medicine because we first do a genetic test. We can use microbial DNA to trace disease outbreaks in a matter of hours. These are just game changers. It’s a wide field of accomplishment, and there is a logical story to be told.
Note, first, the disappointed expectations conveyed in the New York Times interviewer’s question. And notice how measured is Greene’s response. Certainly, notice that he makes no claims of uncovering the genetic sources of human personality traits, behavior syndromes, or mental illnesses.
In fact, after a series of disappointments, genetic researchers have abandoned the search for distinct genes that cause schizophrenia, depression, bipolar disorder, alcoholism, drug addiction, etc. No individual genes – or collections of genes – have been identified that determine these conditions, or even a large part of any one of them. Instead, geneticists are now looking for common genetic roots for a variety of mental illnesses (including autism, ADHD, depression, schizophrenia, and bipolar disorder) that manifest in different ways due to additional genetic and environmental influences.
No psychiatric condition has received more attention than depression, since now one in five Americans are reckoned to suffer clinical depression in their lifetimes, a figure that has risen steadily over the last four decades. Our preoccupation with depression has involved research on genetic and other biological markers. It is thus perhaps surprising to learn that, commenting on the diagnostic criteria for depression in the soon-to-be-released (in May, 2013) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the World Federation of Societies of Biological Psychiatry declared in its consensus paper on the question “no biological markers for major depression are currently available for inclusion in the diagnostic criteria.”
One psychiatric condition that has attracted perhaps equal attention to depression is schizophrenia. Schizophrenia is a kind of psychosis marked by a detachment from reality and often by hallucinations, but primarily by the individual’s inability to deal directly with their current, actual circumstances. Severe autism (“autistic disorder”) can be considered a variety of childhood schizophrenia. Schizophrenia, along with autism, has been the object of massive genetic and brain research. We don’t know the causes of these conditions, or certainly how to cure them. As for autism, according to the CDC, “there are likely many causes for multiple types,” and “there is currently no cure.” For schizophrenia, whose incidence of about one in a hundred also is surprisingly common, likewise there is no cure. An advocacy Website, however, while recognizing this reality, nonetheless announced (as of April 29th, 2013): “a cure for schizophrenia could be found . . .by the year 2013.”
In the meantime, the former editor of The New England Journal of Medicine, Marcia Angell, asks why mental illnesses across the spectrum are increasing in a piece in the New York Review of Books entitled, “The Epidemic of Mental Illness: Why?” Angell looks for the motivation in the form of rapidly increasing – and highly profitable – medication of Americans for mental disorders. Schizophrenia, for one, is most often treated with antipsychotic drugs. No one pretends that antipsychotic medications cure psychoses like schizophrenia; they manage them. Angell notes, “The new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US.” And the statins actually make people live longer!
One explanation for the epidemic Angell describes is that we are simply more likely to identify and to label psychiatric conditions. On the other hand, so many more cases of depression and autism are being diagnosed that all of them seem hard to pin on greater awareness and recognition alone. According to the CDC, autism diagnoses are now made in nearly 1 out of 50 boys, whereas in 1980 autism incidence was 1 in 10,000! But Angell, alarmingly, goes so far as to suggest that our modern biological and psychiatric revolution and its pharmacopeia exacerbate the mental illness epidemic: to wit, “the use of antipsychotic drugs is associated with shrinkage of the brain, and that effect is directly related to the dose and duration of treatment.”
Going beyond the possibility of finding genetic sources for particular conditions, the Human Genome Project – more than anything – substantially revised our understanding of how our genes operate, but not in the way we imagined it would. To begin with, there was the remarkable discrepancy between the estimates of the number of genes we have and the actual figure. The consensus (there is still some uncertainty) places this number at fewer than 25,000, a figure lower than all expectations, given that estimates reached 70,000 and higher. One reason for the surprise (nay, amazement) over the <25,000 figure is that the lowly ringworm has 20,000 genes!
It turns out that the overwhelming majority of the DNA on our chromosomes is not organized as specific genes. Initially thought to be “junk,” much of this DNA (referred to as “switches”) is now thought to catalyze processes that then proceed to different genetic outcomes. One expert commented, “The system, though, is stunningly complex, with many redundancies. Just the idea of so many switches was almost incomprehensible.” And its implications still are. Not only do such switches impact the course of genetic development (ontology), but the form and expression of genes are influenced by such random events as the mingling of DNA along the chromosomes during gestation. So too do environmental stimuli impact the expression of genes, including such seemingly casual influences as temperature and light. On top of these factors, interactions leading to different genetic outcomes occur between the mother’s genes and perinatal genes and the genes within the fetus’s genome. Taken together, the picture of the genome that has emerged is one of a seething mass of activity, of change, often unpredictable, and of interactions between different components of the genome and the genome and its environment. The ideal image many people had of the genome as a straightforward template that stamps out human beings in a predictable way was, and is, a fantasy.
After all is said and done, there are no bright neon signs in all of that DNA blaring: “introverted/extroverted,” let alone “schizophrenic,” “autistic,” “bipolar,” et al. After a half-century of genetic research and investigation of the human genome, the summary of what we know about mental disorders is both vague and vast. According to the CDC: “Scientists believe that many mental disorders result from the complex interplay of multiple genes with diverse environmental factors.” Indeed, in many ways, the failure to find straightforward genetic relationships with behavior and mental disorders inspired the clamor for BRAIN. Perhaps, for this reason, the stated goals of BRAIN needed to be more ambitious than were those for the mapping of the genome. Fundamentally, the initiative seeks to measure how brain cells and neural circuits communicate, store, and manage information – that is, how the brain and nervous system convey and use neuroelectrical impulses and neurochemicals.
But an additional goal of the project is to use those technologies to “shed light on the complex links between brain function and behavior.” And, unlike social-scientific and psychological research, conservatives as well as liberals believe brain research is on the right track. BRAIN is perhaps the ONLY issue on which House Majority Leader Eric Cantor backs the President full throttle. Speaking to the conservative American Enterprise Institute, and as expressed in tweets by his communications director, Cantor stated: “Mapping the human brain is exactly the type of research we should be funding, by reprioritizing the $250 million we currently spend on political and social science research into expanded medical research, including the expedited mapping of the human brain. It’s great science.
In other words, “Damn psychology – let’s get right into the brain to figure human beings out.” In this light, it is hard to know exactly what scientists hope for and expect from the project – which might bear little relationship to what is delivered, as in the case of the genome project. The first year of the initiative is devoted to formulating goals and plans. Will the researchers propose to solve mental illnesses and other complex psychiatric-behavioral problems – depression, schizophrenia, post-traumatic stress, autism, crime, learning disabilities, and conflict like that which abounds in Washington – as the President (humorously?) suggested? Can these all be detected, measured, and addressed via neural impulses? Will we, in a decade or so, or several decades, find and resolve the sources of these and other human problems?
We won’t – BRAIN can’t, no more than could the genome project. Personality traits, human behavior, and psychopathology just don’t exist at the level of biochemistry. They entail all of lived experience, our social settings, and the behavior and impact of our relationships with those around us. Even the most committed biological determinists recognize the impact on children of deprivation and abuse. Children without material or emotional supports, who have parents whose behavior is abusive or otherwise damaging to them, are more susceptible to any of a variety of bad outcomes – mental illness, addiction, and antisocial behavior. These nonspecific manifestations of abuse cannot be related to genes or to specific brain impulses – how could they be?
It is always worthwhile to hark back to past predictions in the area of neurological determinism. To take one, Richard Restak declared in 1977 in relation to the discovery of the first major family of neurochemicals, the endorphins: “It’s hard to leave out the exclamation points when you are talking about a veritable philosopher’s stone – a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction and, among other mental illnesses, schizophrenia” (emphasis added). This halcyon projection was made by a highly respected neuroscientist more than 35 years ago – just when depression and autism began their precipitous climbs.
As for addiction, let me start with five assertions – all of which are clearly true:
- the meaning of addiction changes (as it has, for example, with cigarettes)
- the meaning of addiction is currently changing
- addiction is being more readily diagnosed
- addiction diagnoses and treatment will grow rapidly during the next ten years
- we will never “cure” addiction
Let’s begin with the fact that addiction diagnoses had already increased by 70 percent over the first decade of the new century (2000-2009). Meanwhile, the DSM-5 has eliminated the concept of “abuse” as opposed to “dependence.” That is, like all the other conditions in DSM-5, “substance abuse disorders” are now divided into “mild,” “moderate”, and “severe” forms. Forms of what, we may ask – are they all expressions of addiction? Also, for the first time, a non-substance use category for addiction is included. For the time being, this expansion of recognized addictive objects is limited to gambling, but it will surely grow into other areas, including sex, eating, video games, et al. Almost assuredly, the proposed changes in definition will increase the number of diagnosed addicts.
In any case, consider this projected jump in addiction treatment solely for substances over the next ten years, based on the passage of the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA):
The ACA will impact nearly every aspect of substance abuse treatment, affecting clients, providers, and payers. . . .62.5 million people will receive more substance abuse coverage through MHPAEA and the ACA, with 32.1 million gaining substance abuse benefits for the first time.
That’s nearly 100 million Americans who will receive greater addiction coverage or will be covered for the first time! And, incidentally, how many of these people will be treated by permanently altering the chemistry or structure of their brains? To judge by how they are treated currently – by the 12 steps of AA, which remains the dominant addiction therapy in America, but also by cognitive behavioral therapies (e.g., social skills training, social network therapy, motivation enhancement, community reinforcement) that have risen rapidly as “evidence-based” treatments – people will not have their addictions treated through direct interventions with their brains.
As for my assertion that we will never cure addiction – I actually have no evidence. I’ll simply leave that question open for readers to consider. Do you think brain research will eliminate substance addiction, even as addiction diagnoses have risen substantially over the last decade and as the most rapidly growing forms of drug addiction involve painkillers and other prescription medications developed by medical science? Thus, the lead sentence in a New England Journal of Medicine article is “Prescription opioid abuse is an epidemic in the United States.” This growth in addiction is occurring without even considering the rapid expansion of addiction diagnoses beyond substance abuse.
Let’s turn away from disorders listed in psychiatric manuals to ask whether brain research will show us how to increase intelligence. This is the domain of the brain as much as, or more so than, mental illness and addiction are. We surely need this sort of effort. Recall that the United States has dropped steadily in its educational position in the world. In 1983, the National Commission on Excellence in Education authored A Nation at Risk: The Imperative For Educational Reform. Once alerted to the emergency of our failing education system, how have we fared? Surely all that we have learned about the human brain and cognition in the intervening 30 years has allowed us to leap ahead. In fact, all agree, the US has gone downhill: we now rank 17th in education in the world.
If BRAIN can help with intelligence, we would have a direct link to the brain, a shortcut, to allow us to become smarter. Achieving intelligence this way, we can eliminate the dull – seemingly impossible – necessity of actually creating a better educational system, one with better teachers who receive better support from their schools and communities, have more motivated students, use better teaching techniques, and gain more help from parents. BRAIN’s succeeding in improving intelligence without changing the education system and children’s environments is the exact parallel of imagining that it will reduce mental illness and addiction without improving the worlds that human beings grow up and live in. Neither one is possible.