Drug addiction as a mental and social disorder

December 4, 2018

Michele FariscoCan the brain sciences help us to better understand and handle urgent social problems like drug addiction? Can they even help us understand how social disorder creates disorderly, addicted brains?

If, as seems to be the case, addiction has a strong cerebral base, then it follows that knowing the brain is the key to finding effective treatments for addiction. Yet, what aspects of the brain should be particularly investigated? In a recent article, co-authored with the philosopher Kathinka Evers and the neuroscientist Jean-Pierre Changeux, I suggest that we need to focus on both aware and unaware processes in the brain, trying to figure out how these are affected by environmental influences, and how they eventually affect individual behavior.

There is no doubt that drug addiction is one of the most urgent emergencies in contemporary society. Think, for instance, of the opioid crisis in the US. It has become a kind of social plague, affecting millions of people. How was that possible? What are the causes of such a disaster? Of course, several factors contributed to the present crisis. We suggest, however, that certain external factors influenced brain processes on an unaware level, inviting addictive behavior.

To give an example, one of the causes of the opioid crisis seems to be the false assumption that opioid drugs do not cause addiction. Taking this view of opioid drugs was an unfortunate choice, we argue, likely favored by the financial interests of pharmaceutical companies. It affected not only physicians’ aware opinions, but also their unaware views on opioid drugs, and eventually their inclination to prescribe them. But that is not all. Since there is a general disposition to trust medical doctors’ opinions and choices, the original false assumption that opioid drugs do not cause addiction spread and affected also public opinion, especially at the unaware level. In other words, we think that there is a social responsibility for the increase in drug addiction, if not in ethical terms, at least in terms of public policies.

This is just an example of how external factors contribute to a personal disposition to use potentially addictive drugs. Of course, the factors involved in creating addiction are multifarious and not limited to false views about the risk of addiction associated with certain drugs.

More generally, we argue that in addition to the internal bases of addiction in the central nervous system, socio-economic status modulates, through unaware processing, what can be described as a person’s subjective “global well-being,” raising in some individuals the need for additional rewards in the brain. In the light of the impact of external factors, we argue that some people are particularly vulnerable to the pressures of the political and socio-economical capitalistic system, and that this stressful condition, which has both aware and unaware components, is one of the main causes of addiction. For this reason, we conclude that addiction is not only a medical and mental disorder, but also a social disorder.

Michele Farisco

Farisco M, Evers K and Changeux J-P (2018) Drug Addiction: From Neuroscience to Ethics. Front. Psychiatry 9:595. doi: 10.3389/fpsyt.2018.00595


International brain initiatives need cultural awareness

November 12, 2018

Pär SegerdahlToday, billions of research dollars are being invested in developing huge research collaborations about the human brain. Australia, Canada, Japan, Korea and the United States have their own brain initiatives. In Europe, the Human Brain Project has a total budget of around one billion euros over a ten-year period, 2013-2023.

Scientific research is often seen as an activity that transcends cultural differences. However, research about the brain touches such fundamental aspects of human existence that it cannot ignore cultural views. For example, the notion that the brain, as a separate organ, is the locus of human identity, of the self, is not generally embraced. Neuroscientific research touches profound cultural ideas about human life which require careful philosophical and ethical attention.

The international brain initiatives also touch other culturally sensitive issues, in addition to questions about human identity. Ideas about death and brain death, about the use of nonhuman primates in research, about privacy and autonomy, and about mental illness, differ across cultures. For example, a diagnosis that in one culture can be seen as an opportunity to get individual treatment can in another culture threaten to condemn a whole family to social isolation.

Neuroethicists from parts of the world that currently make major investments in neuroscientific research met in Korea to highlight ethical questions on cultural differences, which the international brain initiatives need to address. This in order for the research to be conducted responsibly, with awareness of relevant cultural diversity. The questions that the neuroethicists (among them, Arleen Salles) propose should be addressed are summarized in an article in the journal Neuron.

The authors mention questions about how neuroscientific research could cause stigma in individuals or social groups, and about how cultural notions might bias research design and the interpretation of results. They ask how collecting and storing neural tissue can be viewed in different cultures, and about how we should understand the moral status of robots and computer-simulated brains. They mention questions about how new brain interventions (brain devices and drugs) may affect notions of responsibility and autonomy, as well as issues about drawing boundaries between legitimate and illegitimate uses of neuroscientific techniques. Finally, questions are highlighted about fair access to research results.

How can these questions be addressed and discussed in the international brain initiatives? The authors propose education in neuroethics, as well as dialogue with scholars in the humanities and social sciences, and finally improved communication and interaction with the publics.

Within the European Human Brain Project, four percent of the budget is used for ethics and society. Similar emphasis on ethical reflection would be desirable also in other brain initiatives.

Pär Segerdahl

Global Neuroethics Summit Delegates. 2018. Neuroethics questions to guide ethical research in the international brain initiatives. Neuron 100, October 10, 2018.  https://doi.org/10.1016/j.neuron.2018.09.021

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Sharing a blog post on consciousness

August 29, 2018

Michele Farisco at CRB has written an interesting post for the BMC blog on medicine. He says that “whereas ethical analyses of disorders of consciousness traditionally focus on residual awareness, there may be a case to be made for the ethical relevance of the retained unawareness.”

Interested to read more? Here is a link to the post: On consciousness and the unconscious.

Pär Segerdahl

We recommend readings - the Ethics Blog


Read this interview with Kathinka Evers!

April 26, 2018

Through philosophical analysis and development of concepts, Uppsala University contributes significantly to the European Flagship, the Human Brain Project. New ways of thinking about the brain and about consciousness are suggested, which take us beyond oppositions between consciousness and unconsciousness, and between consciousness and matter.

Do you want to know more? Read the fascinating interview with Kathinka Evers: A continuum of consciousness: The Intrinsic Consciousness Theory

Kathinka Evers at CRB in Uppsala leads the work on neuroethics and neurophilosophy in the Human Brain Project.

Pär Segerdahl

We recommend readings - the Ethics Blog


Prepare for robot nonsense

February 26, 2018

Pär SegerdahlAs computers and robots take over tasks that so far only humans could carry out, such as driving a car, we are likely to experience increasingly insidious uses of language by the technology’s intellectual clergy.

The idea of ​​intelligent computers and conscious robots is for some reason terribly fascinating. We see ourselves as intelligent and conscious beings. Imagine if also robots could be intelligent and aware! In fact, we have already seen them (almost): on the movie screen. Soon we may see them in reality too!

Imagine that artifacts that we always considered dead and mechanical one day acquired the enigmatic character of life! Imagine that we created intelligent life! Do we have enough exclamation marks for such a miracle?

The idea of ​​intelligent life in supercomputers often comes with the idea of a test that can determine if a supercomputer is intelligent. It is as if I wanted to make the idea of ​​perpetual motion machines credible by talking about a perpetuum mobile test, invented by a super-smart mathematician in the 17th century. The question if something is a perpetuum mobile is determinable and therefore worth considering! Soon they may function as engines in our intelligent, robot-driven cars!

There is a famous idea of ​​an intelligence test for computers, invented by the British mathematician, Alan Turing. The test allegedly can determine whether a machine “has what we have”: intelligence. How does the test work? Roughly, it is about whether you can distinguish a computer from a human – or cannot do it.

But distinguishing a computer from a human being surely is no great matter! Oh, I forgot to mention that there is a smoke screen in the test. You neither see, hear, feel, taste nor smell anything! In principle, you send written questions into the thick smoke. Out of the smoke comes written responses. But who wrote/generated the answers? Human or computer? If you cannot distinguish the computer-generated answers from human answers – well, then you had better take protection, because an intelligent supercomputer hides behind the smoke screen!

The test is thus adapted to the computer, which cannot have intelligent facial expressions or look perplexed, and cannot groan, “Oh no, what a stupid question!” The test is adapted to an engineer’s concept of intelligent handling of written symbol sequences. The fact that the test subject is a poor human being who cannot always say who/what “generated” the written answers hides this conceptual fact.

These insidious linguistic shifts are unusually obvious in an article I encountered through a rather smart search engine. The article asks if machines can be aware. And it responds: Yes, and a new Turing test can prove it.

The article begins with celebrating our amazing consciousness as “the ineffable and enigmatic inner life of the mind.” Consciousness is then exemplified by the whirl of thought and sensation that blossoms within us when we finally meet a loved one again, hear an exquisite violin solo, or relish an incredible meal.

After this ecstatic celebration of consciousness, the concept begins to be adapted to computer engineering so that finally it is merely a concept of information processing. The authors “show” that consciousness does not require interaction with the environment. Neither does it require memories. Consciousness does not require any emotions like anger, fear or joy. It does not require attention, self-reflection, language or ability to act in the world.

What then remains of consciousness, which the authors initially made it seem so amazing to possess? The answer in the article is that consciousness has to do with “the amount of integrated information that an organism, or a machine, can generate.”

The concept of consciousness is gradually adapted to what was to be proven. Finally, it becomes a feature that unsurprisingly can characterize a computer. After we swallowed the adaptation, the idea is that we, at the Grand Finale of the article, should once again marvel, and be amazed that a machine can have this “mysterious inner life” that we have, consciousness: “Oh, what an exquisite violin solo, not to mention the snails, how lovely to meet again like this!”

The new Turing test that the authors imagine is, as far as I understand, a kind of picture recognition test: Can a computer identify the content of a picture as “a robbery”? A conscious computer should be able to identify pictorial content as well as a human being can do it. I guess the idea is that the task requires very, very much integrated information. No simple rule of thumb, man + gun + building + terrified customer = robbery, will do the trick. It has to be such an enormous amount of integrated information that the computer simply “gets it” and understands that it is a robbery (and not a five-year-old who plays with a toy gun).

Believing in the test thus assumes that we swallowed the adapted concept of consciousness and are ecstatically amazed by super-large amounts of integrated information as: “the ineffable and enigmatic inner life of the mind.”

These kinds of insidious linguistic shifts will attract us even more deeply as robotics develop. Imagine an android with facial expression and voice that can express intelligence or groan at stupid questions. Then surely, we are dealing an intelligent and conscious machine!

Or just another deceitful smoke screen; a walking, interactive movie screen?

Pär Segerdahl

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New concept of consciousness challenges language

January 31, 2018

Pär SegerdahlA few weeks ago, I recommended an exciting article by Michele Farisco. Now I wish to recommend another article, where Farisco (together with Steven Laureys and Kathinka Evers) argues even more thoroughly for a new concept of consciousness.

The article in Mind & Matter is complex and I doubt that I can do it justice. I have to start out from my own experience. For when Farisco challenges the opposition between consciousness and the unconscious, it resembles something I have written about: the opposition between human and animal.

Oppositions that work perfectly in everyday language often become inapplicable for scientific purposes. In everyday life, the opposition between human and animal is unproblematic. If a child tells us that it saw an animal, we know it was not a human the child saw. For the biologist, however, the idea of ​​the human as non-animal would be absurd. Although it is perfectly in order in everyday language, biology must reject the opposition between human and animal. It hides continuities between us and the other animals.

Farisco says (if I understand him) something similar about neuroscience. Although the opposition between consciousness and the unconscious works in everyday language, it becomes problematic in neuroscience. It hides continuities in the brain’s way of functioning. Neuroscience should therefore view consciousness and the unconscious as continuous forms of the same basic phenomenon in living brains.

If biology talks about the human as one of the animal species, how does Farisco suggest that neuroscience should talk about consciousness? Here we face greater linguistic challenges than when biology considers humans to be animals.

Farico’s proposal is to widen the notion of consciousness to include also what we usually call the unconscious (much like the biologist widens the concept of animals). Farisco thus suggests, roughly, that the brain is conscious as long as it is alive, even in deep sleep or in coma. Note, however, that he uses the word in a new meaning! He does not claim what he appears to be claiming!

The brain works continually, whether we are conscious or not (in the ordinary sense). Most neural processes are unconscious and a prerequisite for consciousness (in the ordinary sense). Farisco suggests that we use the word consciousness for all these processes in living brains. The two states we usually oppose – consciousness and the unconscious – are thus forms of the same basic phenomenon, namely, consciousness in Farisco’s widened sense.

Farisco supports the widened concept of consciousness by citing neuroscientific evidence that I have to leave aside in this post. All I wish to do here is to point out that Farico’s concept of consciousness probably is as logical in neuroscience as the concept of the human as animal is in biology.

Do not let the linguistic challenges prevent you from seeing the logic of Farisco’s proposal!

Pär Segerdahl

Farisco, M., Laureys, S. and Evers, K. 2017. The intrinsic activity of the brain and its relation to levels and disorders of consciousness. Mind and Matter 15: 197-219

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The unconscious deserves moral attention

January 10, 2018

Pär SegerdahlLast autumn, Michele Farisco wrote one of the most read posts on The Ethics Blog. The post was later republished by BioEdge.

Today, I want to recommend a recent article where Farisco develops his thinking – read it in the journal, Philosophy, Ethics, and Humanities in Medicine.

The article will certainly receive at least as much attention as the blog post did. Together with Kathinka Evers, Farisco develops a way of thinking about the unconscious that at first seems controversial, but which after careful consideration becomes increasingly credible. That combination is hard to beat.

What is it about? It is about patients with serious brain injuries, perhaps after a traffic accident. Ethical discussions about these patients usually focus on residual consciousness. We think that there is an absolute difference between consciousness and unconsciousness. Only a conscious person can experience well-being. Only a conscious person can have interests. Therefore, a patient with residual consciousness deserves a completely different care than an unconscious patient. A different attention to pain relief, peace and quiet, and stimulation. – Why create a warm and stimulating environment if the patient is completely unaware of it?

In the article, Farisco challenges the absolute difference between consciousness and unconsciousness. He describes neuroscientific evidence that indicates two often-overlooked connections between conscious and unconscious brain processes. The first is that the unconscious (at least partly) has the abilities that are considered ethically relevant when residual consciousness is discussed. The other connection is that conscious and unconscious brain processes are mutually dependent. They shape each other. Even unconsciously, the brain reacts uniquely to the voices of family members.

Farisco does not mean that this proves that we have an obligation to treat unconscious patients as conscious. However, the unconscious deserves moral attention. Perhaps we should strive to assess also retained unconscious abilities. In some cases, we should perhaps play the music the patient loved before the accident.

Pär Segerdahl

Farisco, M. and Evers, K. The ethical relevance of the unconscious. Philosophy, Ethics, and Humanities in Medicine (2017) DOI 10.1186/s13010-017-0053-9

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