When “neuro” met “ethics”

June 13, 2017

Pär SegerdahlTwo short words increasingly often appear in combination with names of professional fields and scientific disciplines: neuro and ethics. Here are some examples: Neuromusicology, neurolaw, neuropedagogy. Bioethics, nursing ethics, business ethics.

Neuro… typically signifies that neuroscience sheds light on the subject matter of the discipline with which it combines. It can illuminate what happens in the brain when we listen to music (neuromusicology). What happens in the brain when witnesses recall events or when judges evaluate the evidence (neurolaw). What happens in children’s brains when they study mathematics (neuropedagogy).

…ethics (sometimes, ethics of…) typically signifies that the discipline it combines with gives rise to its own ethical problems, requiring ethical reflection and unique ethical guidelines. Even war is said to require its own ethics of war!

In the 1970s, these two words, neuro and ethics, finally met and formed neuroethics. The result is an ambiguous meeting between two short but very expansive words. Which of the two words made the advance? Where is the emphasis? What sheds light on what?

At first, ethics got the emphasis. Neuroethics was, simply, the ethics of neuroscience, just as nursing ethics is the ethics of nursing. Soon, however, neuro demonstrated its expansive power. Today, neuroethics is not only the “ethics of neuroscience,” but also the “neuroscience of ethics”: neuroscience can illuminate what happens in the brain when we face ethical dilemmas. The emphasis thus changes back and forth between neuroethics and neuroethics.

The advances of these two words, and their final meeting in neuroethics, reflects, of course, the expansive power of neuroscience and ethics. Why are these research areas so expansive? Partly because the brain is involved in everything we do. And because all we do can give rise to ethical issues. The meeting between neuro… and …ethics was almost inevitable.

What did the meeting result in? In a single discipline, neuroethics? Or in two distinct disciplines, neuroethics and neuroethics, which just happen to be spelt the same way, but should be kept separate?

As far as I understand, the aim is to keep neuroethics together as one interdisciplinary field, with a two-way dialogue between an “ethics of neuroscience” and a “neuroscience of ethics.” This seems wise. It would be difficult to keep apart what was almost predetermined to meet and combine. Neuroethics would immediately try to shed its neuroscientific light on neuroethics. And neuroethics would be just as quick to develop ethical views on neuroethics. The wisest option appears to be dialogue, accepting a meeting that appears inevitable.

An interesting article in Bioethics, authored by Eric Racine together with, among others, Michele Farisco at CRB, occasions my thoughts in this post. The subject matter of the article is neuroethics: the neuroscience of ethics. Neuroethics is associated with rather grandiose claims. It has been claimed that neuroscience can support a better theory of ethics. That it can provide the basis for a universal ethical theory that transcends political and cultural divides. That it can develop a brain-based ethics. That it can reveal the mechanisms underlying moral judgments. Perhaps neuroscience will soon solve moral dilemmas and transform ethics!

These pretentions have stimulated careless over-interpretation of neuroscientific experiments. They have also provoked rash dismissal of neuroethics and its relevance to ethics. The purpose of the article is to support a more moderate and deliberate approach, through a number of methodological guideposts for the neuroscience of ethics. These include conceptual and normative transparency, scientific validity, interdisciplinary methods, and balanced interpretation of results.

In view of this critical perspective on hyped neuroscientific claims, one could define the article as a neuroethical article on neuroethics. Following the linguistic pattern that I described above, the article is an example of neuroethics-ethics. No, this will not do! We cannot use these two expansive words to specify in neurotic detail who currently happens to advance into whose field.

I choose to describe the article, simply, as a neuroethical paper on neuroethics. I want to see it as an example of the dialogue that can unite neuroethics as an interdisciplinary field.

Pär Segerdahl

Racine, E., Dubljevic´, V., Jox, R. J., Baertschi, B., Christensen, J. F., Farisco, M., Jotterand, F., Kahane, G., Müller, S. (2017). “Can neuroscience contribute to practical ethics? A critical review and discussion of the methodological and translational challenges of the neuroscience of ethics.” Bioethics 31: 328-337.

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The New Yorker features resignation syndrome

March 29, 2017

Pär SegerdahlLast year I wrote a post about resignation syndrome in children in families who are denied asylum in Sweden. I described a hypothesis about the syndrome suggested by Karl Sallin, PhD student at CRB in the field of neuroethics and neurophilosophy.

An intuitive explanation is that the syndrome is a reaction to prolonged stress and depression. A reaction that is triggered when the family is denied asylum. However, if the explanation is correct, the syndrome should exist on a similar scale also in other countries that receive refugee families. It seems it does not.

To understand what happens to these children, we should, Karl Sallin suggested, see it as a psychological reaction that occurs in the meeting between certain cultures and Swedish cultural conditions. For another peculiarity is the fact that the syndrome occurs mainly in families from certain parts of the world. We are dealing with a culture bound psychopathology, Sallin proposed in Frontiers in Behavioral Neuroscience.

The New Yorker recently wrote about this “Swedish” syndrome, in a long article in which Karl Sallin interviewed.

The article contains a touching description of how one of these children falls ill when the family is denied asylum. For several months, he is confined to bed, not contactable, and he must be tube fed. When the family gets permanent residence, they try to convey this to the boy. After two weeks, he begins to open his eyes. After a further seven weeks, the nasal tube taped to his cheek falls out. Finally, he can return to school and begin to talk about the disease.

The article in The New Yorker emphasizes that the syndrome is a culture-bound psychopathology. However, the tendency seems to be to point out Sweden’s crumbling self-image as the relevant cultural context for the disease. We see “apathetic refugee children” as symbols of our own moral failure to treat them and their families humanely. Therefore, we tube feed them without further treatment, while waiting for the family to hopefully get their residence permit. This creates a culture where children become sick when their families are denied asylum.

This can hardly be the whole explanation, since it then becomes difficult to understand why mainly children from certain parts of the world are afflicted. Moreover, mainly children who come together with their families, rather than unaccompanied refugee children. The cultural dynamics seems to be more complex than the desire to find scapegoats for the syndrome can handle.

Pär Segerdahl

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The brain develops in interaction with culture

November 16, 2016

Pär SegerdahlThe brain develops dramatically during childhood. These neural changes occur in the child’s interaction with its environment. The brain becomes a brain that functions in the culture in which it develops. If a child is mistreated, if it is deprived of important forms of interaction, like language and care, the brain is deprived of its opportunities to develop. This can result in permanent damages.

The fact that the brain develops in interaction with culture and becomes a brain that functions in culture, raises the question if we can change the brain by changing the culture it interacts with during childhood. Can we, on the basis of neuroscientific knowledge, plan neural development culturally? Can we shape our own humanity?

In an article in EMBO reports, Kathinka Evers and Jean-Pierre Changeux discuss this neuro-cultural outlook, where brain and culture are seen as co-existing in continual interplay. They emphasize that our societies shape our brains, while our brains shape our societies. Then they discuss the possibilities this opens up for ethics.

The question in the article is whether knowledge about the dynamic interplay between co-existing brains-and-cultures can be used “proactively” to create environments that shape children’s brains and make them, for example, less violent. Environments in which they become humans with ethical norms and response patterns that better meet today’s challenges.

Similar projects have been implemented in school systems, but here the idea is to plan them on the basis of knowledge about the dynamic brain. But also on the basis of societal decision-making about which ethics that should be supported; about which values that are essential for life on this planet.

Personally I’m attracted by “co-existence thinking” as such, which I believe applies to many phenomena. For not only the brain develops in interaction with culture. So does plant and animal life, as well as climate – which in turn will shape human life.

Maybe it is such thinking we need: an ethics of co-existence. Co-existence thinking gives us responsibilities: through awareness of a mistreated nature; through awareness of our dependence on this nature. But such thinking also transcends what we otherwise could have imagined, by introducing the idea of possibilities emerging from the interplay.

Do not believe preachers of necessity. It could have been different. It can become different.

Pär Segerdahl

Evers, K. & Changeux, J-P. 2016. “Proactive epigenesis and ethical innovation: A neuronal hypothesis for the genesis of ethical rules.” EMBO reports 17: 1361-1364.

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Direct brain communication: a new book

May 17, 2016

Pär SegerdahlImages of the brain, created with advanced technology, are known to most of us. But progress in neuroscience is fast. Less familiar are new technical opportunities to communicate directly with the brain … or however you put it!

Even the unconscious brain is alive. It has been possible to depict responses in the “unconscious” brain to what occurs in its environment. In some cases one has been able to establish communication, where the “unconscious” patient answers yes/no-questions by thinking of one thing if the answer is “yes” and on another thing if the answer is “no.” This activates different parts of the brain. Since researchers/doctors can detect which part of the brain is activated, the patient can answer questions and communicate with the outside world. (Here is an earlier post on this.)

Other examples of this development are new interfaces between brain and computer, where people learn to control a computer, not through the muscles, but via electrodes connected in the brain. People who cannot communicate verbally can thus get computer support. They can also learn to control prostheses. The brain is obviously exceptionally plastic and interactive!

A new anthology, with Michele Farisco and Kathinka Evers from CRB as editors, systematically assesses the philosophical, scientific, ethical and legal issues that this development implies: Neurotechnology and Direct Brain Communication (Routledge, 2016).

The book addresses scientific and clinical implications of the possibility to communicate with patients who may not be quite as unconscious as we thought. Perhaps we should rather talk about altered states of consciousness. But also infant care is discussed, as well as ethical and legal issues about authority, informed consent and privacy.

The book is written for researchers and graduate students in cognitive science, neurology, psychiatry, clinical psychology, medicine, medical ethics, medical technology, neuroethics, neurophilosophy and philosophy of mind. It may interest also healthcare professionals and a broader public fascinated by the mind.

Michele Farisco and Kathinka Evers both work in the European flagship project, Human Brain Project.

(You find more information about the book and about the editors here.)

Pär Segerdahl

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Searching for consciousness needs conceptual clarification

March 15, 2016

Michele FariscoWe can hardly think of ourselves as living persons without referring to consciousness. In fact, we normally define ourselves through two features of our life: we are awake (the level of our consciousness is more than zero), and we are aware of something (our consciousness is not empty).

While it is quite intuitive to think that our brains are necessary for us to be conscious, it is tempting to think that looking at what is going on in the brain is enough to understand consciousness. But empirical investigations are not enough.

Neuroscientific methods to investigate consciousness and its disorders have developed massively in the last decades. The scientific and clinical advancements that have resulted are impressive. But while the ethical and clinical impacts of these advancements are often debated and studied, there is little conceptual analysis.

I think of one example in particular, namely, the neuroscience of disorders of consciousness. These are states where a person’s consciousness is more or less severely damaged. Most commonly, we think of patients in vegetative state, who exhibit levels of consciousness without any content. But it could also be a minimally conscious state with fluctuating levels and contents of consciousness.

How can we explain these complex conditions? Empirical science is usually supposed to be authoritative and help to assess very important issues, such as consciousness. Such scientific knowledge is basically inferential: it is grounded in the comparative assessment of residual consciousness in brain-damaged patients.

But because of its inferential nature, neuroscience takes the form of an inductive reasoning: it infers the presence of consciousness starting from data extracted by neurotechnology. This is done by comparing data from brain damaged patients with data from healthy individuals. Yet this induction is valid only on the basis of a previous definition of consciousness, a definition we made within an implicit or explicit theoretical framework. Thus a conceptual assessment of consciousness that is defined within a well-developed conceptual framework is crucial, and it will affect the inference of consciousness from empirical data.

When it comes to disorders of consciousness, there is still no adequate conceptual analysis of the complexity of consciousness: its levels, modes and degrees. Neuroscience often takes a functionalist account of consciousness for granted in which consciousness is assumed to be equivalent to cognition or at least to be based in cognition. Yet findings from comatose patients suggest that this is not the case. Instead, consciousness seems to be grounded on the phenomenal functions of the brain as they are related to the resting state’s activity.

For empirical neuroscience to be able to contribute to an understanding of consciousness, neuroscientists need input from philosophy. Take the case of communication with speechless patients through neurotechnology (Conversations with seemingly unconscious patients), or the prospective simulation of the brain (The challenge to simulate the brain) for example: here scientists can give philosophers empirical data that need to be considered in order to develop a well-founded conceptual framework within which consciousness can be defined.

The alleged autonomy of empirical science as source of objective knowledge is problematic. This is the reason why philosophy needs to collaborate with scientists in order to conceptually refine their research methods. On the other hand, dialogue with science is essential for philosophy to be meaningful.

We need a conceptual strategy for clarifying the theoretical framework of neuroscientific inferences. This is what we are trying to do in our CRB neuroethics group as part of the Human Brain Project (Neuroethics and Neurophilosophy).

Michele Farisco

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Resignation syndrome in refugee children – a new hypothesis

February 22, 2016

Pär SegerdahlThere has been much discussion about the so-called “apathetic children” in families seeking asylum in Sweden. You read that right: in Sweden, not in other countries. By all accounts, these children are genuinely ill. They do not simulate total lack of willpower; like inability to eat, speak and move. They are in a life-threatening condition and show no reactions even to painful stimuli. But why do we have so many cases in Sweden and not in other countries?

Several hundred cases have been reported, which in 2014 led the Swedish National Board of Health and Welfare to introduce a new diagnosis: resignation syndrome. The “Swedish” syndrome appears to be a mystery, almost like a puzzle to crack. There are asylum seeking families all around the world: why does this syndrome occur to such an extent in a single country?

If you want to think more about this puzzling question, I recommended a new article in Frontiers in Behavioral Neuroscience, with Karl Sallin (PhD student at CRB) as first author. The article is long and technical, but for those interested, it is well worth the effort. It documents what is known about the syndrome and suggests a new hypothesis.

A common explanation of the syndrome is that it is a reaction to stress and depression. The explanation sounds intuitively reasonable, considering these children’s experiences. But if it were true, the syndrome should occur also in other countries. The mystery remains.

Another explanation is that the mother attempts to manage her trauma, her depression and her needs, by projecting her problems onto the child. The child, who experiences the mother as its only safety, adapts unconsciously and exhibits the symptoms that the mother treats the child as if it had. This explanation may also seem reasonable, especially considering another peculiarity of the syndrome: it does not affect unaccompanied refugee children, only children who arrive with their families. The problem is again: traumatized refugee families exist all around the world. So why is the syndrome common only in Sweden?

Now to Sallins’ hypothesis in the article. The hypothesis has two parts: one about the disease or diagnosis itself; and one about the cause of the disease, which may also explain the peculiar distribution.

After a review of symptoms and treatment response, Sallin suggests that we are not dealing with a new disease. The introduced diagnosis, “resignation syndrome,” is therefore inappropriate. We are dealing with a known diagnosis: catatonia, which is characterized by the same loss of motor skills. The children moreover seem to retain awareness, even though their immobility makes them seem unconscious. When they recover, they can often recall events that occurred while they were ill. They just cannot activate any motor skills. The catatonia hypothesis can be tested, Sallin suggests, by trying treatments with known responses in catatonic patients, and by performing PET scans of the brain.

The question then is: Why does catatonia arise only in refugee children in Sweden? That question brings us to the second part of the hypothesis, which has some similarities with the theory that the mother affects the child psychologically to exhibit symptoms: really have them, not only simulate them!

Here we might make a comparison with placebo and nocebo effects. If it is believed that a pill will have a certain impact on health – positive or negative – the effect can be produced even if the pill contains only a medically inactive substance. Probably, electromagnetic hypersensitivity is a phenomenon of this kind, having psychological causes: a nocebo effect.

The article enumerates cases where it can be suspected that catatonia-like conditions are caused psychologically: unexpected, unexplained sudden death after cancer diagnosis; death epidemics in situations of war and captivity characterized by hopelessness; acute or prolonged death after the utterance of magic death spells (known from several cultures).

The hypothesis is that life-threatening catatonia in refugee children is caused psychologically, in a certain cultural environment. Alternatively, one could say that catatonia is caused in the meeting between certain cultures and Swedish conditions, since it is more common in children from certain parts of the world. We are dealing with a culture bound psychogenesis.

Sallin compares with an outbreak of “hysteria” during the latter part of the 1800s, in connection with Jean-Martin Charcot’s famous demonstrations of hysterical patients, and where colorful symptom descriptions circulated in the press. Charcot first suggested that hysteria had organic causes. But when he later began to talk about psychological factors behind the symptoms, the number of cases of hysteria dropped.

(Perhaps I should point out that Sallin emphasizes that psychological causes are not to be understood in terms of a mind/body dualism.)

It remains to be examined exactly how meeting Swedish conditions contribute to psychologically caused catatonia in children in certain refugee families. But if I understand Sallin correctly, he thinks that the spread of symptom descriptions through mass media, and the ongoing practice of treating “children with resignation syndrome,” might be essential in this context.

If this is true, it creates an ethical problem mentioned in the article. There is no alternative to offering these children treatment: they cannot survive without tube feeding. But offering treatment also causes new cases.

Yes, these children must, of course, be offered care. But maybe Sallin, just by proposing psychological causes of the symptoms, has already contributed to reducing the number of cases in the future. Assuming that his hypothesis of a culture bound psychogenesis is true, of course.

What a fascinating interplay between belief and truth!

Pär Segerdahl

Sallin, K., Lagercrantz, H., Evers, K., Engström, I., Hjern, A., Petrovic, P., Resignation Syndrome: Catatonia? Culture-Bound? Frontiers in Behavioral Neuroscience 29, January 2016

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The challenge to simulate the brain

October 7, 2015

Michele FariscoIs it possible to create a computer simulation of the human brain? Perhaps, perhaps not. But right now, a group of scientists is trying. But it is not only finding enough computer power that makes it difficult: there are some very real philosophical challenges too.

Computer simulation of the brain is one of the most ambitious goals of the European Human Brain Project. As a philosopher, I am part of a group that looks at the philosophical and ethical issues, such as: What is the impact of neuroscience on social practice, particularly on clinical practice? What are the conceptual underpinnings of neuroscientific investigation and its impact on traditional ideas, like the human subject, free will, and moral agency? If you follow the Ethics Blog, you might have heard of our work before (“Conversations with seemingly unconscious patients”; “Where is consciousness?”).

One of the questions we ask ourselves is: What is a simulation in general and what is a brain simulation in particular? Roughly, the idea is to create an object that resembles the functional and (if possible also) the structural characteristics of the brain in order to improve our understanding and ability to predict its future development. Simulating the brain could be defined as an attempt to develop a mathematical model of the cerebral functional architecture and to load it onto a computer in order to artificially reproduce its functioning. But why should we reproduce brain functioning?

I can see three reasons: describing, explaining and predicting cerebral activities. The implications are huge. In clinical practice with neurological and psychiatric patients, simulating the damaged brain could help us understand it better and predict its future developments, and also refine current diagnostic and prognostic criteria.

Great promises, but also great challenges ahead of us! But let me now turn to challenges that I believe can be envisaged from a philosophical and conceptual perspective.

A model is in some respects simplified and arbitrary: the selection of parameters to include depends on the goals of the model to be built. This is particularly challenging when the object being simulated is characterized by a high degree of complexity.

The main method used for building models of the brain is “reverse engineering.” This is a method that includes two main steps: dissecting a functional system at the physical level into component parts or subsystems; and then reconstructing the system virtually. Yet the brain hardly seems decomposable into independent modules with linear interactions. The brain rather appears as a nonlinear complex integrated system and the relationship between the brain’s components is non-linear. That means that their relationship cannot be described as a direct proportionality and their relative change is not related to a constant multiplier. To complicate things further, the brain is not completely definable by algorithmic methods. This means that it can show unpredicted behavior. And then to make it even more complex: The relationship between the brain’s subcomponents affects the behavior of the subcomponents.

The brain is a holistic system and despite being deterministic it is still not totally predictable. Simulating it is hardly conceivable. But even if it should be possible, I am afraid that a new “artificial” brain will have limited practical utility: for instance, the prospective general simulation of the brain risks to lose the specific characteristics of the particular brain under treatment.

Furthermore, it is impossible to simulate “the brain” simply because such an entity doesn’t exist. We have billions of different brains in the world. They are not completely similar, even if they are comparable. Abstracting from such diversity is the major limitation of brain simulation. Perhaps it would be possible to overcome this limitation by using a “general” brain simulation as a template to simulate “particular” brains. But maybe this would be even harder to conceive and realize.

Brain simulation is indeed one of the most promising contemporary scientific enterprises, but it needs a specific conceptual investigation in order to clarify its inspiring philosophy and avoid misinterpretations and disproportional expectations. Even, but not only, by lay people.

If you want to know more, I recommend having a look at a report of our publications so far.

Michele Farisco

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