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CHAPTER 1

Defining Limits to Biological Reductionism

"If all possible scientific questions are asked, our problem is still not touched at all." Ludwig Wittgenstein

1-1. Introduction

The first half of the twentieth century was the golden age of physics. The second half, from the elucidation of DNA in 1953 to the description of the human genome, was dominated by molecular biology. Many people now believe the most exciting progress in the twenty-first century will be directed toward a rational account of the ultimate scientific mystery, the human mind. From the psychiatric point of view, this will not come too soon. By a major measure of intellectual achievement, the Nobel Prize for physiology and medicine, modern psychiatry has had little impact. Even though mental health is the single most important cause of morbidity and secondary mortality in the world, there have been only two Prizes directed toward matters of psychiatry since they were instituted in 1901. Thus, when the author of a book entitled "Psychiatry, psychoanalysis and the new biology of mind," is billed as "the first American psychiatrist ever to have won the Nobel Prize in physiology or medicine and only the second psychiatrist to have done so in the prize's 102 year history," psychiatrists may at last feel they are coming out of the shadows.

In this chapter, I will examine one author's concept of a single idea in psychiatry. However, the idea dominates modern psychiatry and the writer is extremely influential. Eric Kandel offers the view that "radical reductionism" will convert psychiatry and psychoanalysis into genuinely scientific fields. I will argue instead that reductionism is a restricted model of science which can never account for the entirety of human behavior, and can therefore never form the basis of a general theory for psychiatry. Furthermore, when applied to the field of human mental life, reductionism becomes incoherent.

1-2. Psychiatry and the Prizewinners

The first psychiatric Nobel award was in 1927 when the Austrian neuropsychiatrist, Julius Wagner-Jauregg, was named for his discovery of the effects of malaria-induced fevers on the progression of tertiary syphilis, or general paresis of the insane. He had published his results in 1917 but his interest in the use of artificial fevers in treating psychosis dated from at least 1887, when he was attached to the university clinic in Vienna. He also worked on treating thyroid diseases and cretinism with iodine but this was long before modern biochemistry made accurate measurements of hormones possible. His conviction that fevers could improve psychotic states had no recognizable basis in the physiology of the time. It appears to have been an idea peculiar to his generation but he persisted with it long after everybody else had given it up. His major discovery was fortuitous, in that there were lots of people in mental hospitals with tertiary syphilis but, whatever the matter, Wagner-Jauregg's work is of no interest to psychiatry these days.

The next mention was in 1949 when Antonio Egas Moniz (1874-1955) was jointly honored for his work in psychosurgery. Egas Moniz was a Portuguese professor of neurosurgery who, remarkably, also sat in parliament and, as foreign minister, led his country's delegation to the Versailles conference in 1919. In the mid-1920s, after serving as ambassador to Spain, he returned to medicine and adapted the new techniques of contrast angiography to the brain, quickly gaining an international reputation for his pioneering work. In 1935, he attended a conference in London at which two researchers showed how cutting certain frontal tracts in chimpanzees' brains resulted in increased tractability. Intrigued, he decided to apply this to mental patients. The results of the initial series of twenty patients were considered encouraging and the procedure was widely copied. For example, in England and Wales, over 10,000 leucotomies were performed between 1942 and 1954. The figure was very much higher in the US but, with the advent of powerful tranquillizing drugs, people lost interest in psychosurgery and it soon fell into disrepute. The story of how the operation was championed in the US by Dr. Walter Freeman, and its tragic cost, is recounted in a recent biography [3]. Egas Moniz himself was not a psychiatrist. He was a neurosurgeon who applied his techniques to a psychiatric population, but not without penalty: in 1939, he was shot by a dissatisfied patient. A reviewer at the official website of the Nobel Prize stated: "I think there is no doubt that Moniz deserved the Nobel Prize" [4]. Today, very few psychiatrists would agree.

By contemporary standards, the work which led to these prizes would not meet the most elementary concepts of what constitutes reasoned research, let alone ethical conduct. Thus, when one of the world's outstanding neurophysiologists, whose work is of the very highest intellectual and ethical standards, opines that the brain sciences can lead psychiatry from its intellectual wilderness, he can be sure of a large and eager audience. In his recent autobiography [5], Eric R. Kandel, joint winner of the 2000 Nobel Prize in medicine and physiology, describes how, after graduating from medical school in 1956, he did a year's internship in a general hospital followed by three years basic biological research in the NIMH as an alternative to national service [2, p109]. He then undertook a two year placement as a resident inpsychiatry at Massachusetts Mental Health Center, which is affiliated with Harvard Medical School.

At the time of his appointment, American psychiatry was almost totally dominated by psychoanalytic concepts. His description of his training in psychiatry shows how things have changed over the years: "We saw only a limited number of patients ... In those days, residents did not work very hard ..." He continued:

"Few of (our supervisors) thought in biological terms, few were familiar with psychopharmacology, and most discouraged us from reading the psychiatric or even the psychoanalytic literature because they thought we should learn from our patients and not from books ... We learned next to nothing about the fundamentals of diagnosis or the biological underpinnings of psychiatric disorders ... a rudimentary introduction to the use of drugs ... often discouraged from using drugs in treatment because ... it would interfere with psychotherapy" [5, p153-155].

While in psychiatry, he was able to conduct original research in hypothalamic neuroendrocrine cells in goldfish but he subsequently "... left psychoanalysis because it was unconcerned with biology" [2, p387]. He did not sit his examinations and has never practiced as a psychiatrist. Eric Kandel's prize was for his basic neurophysiological research on sea slugs. While he is a renowned and esteemed member of the Columbia University Dept. of Psychiatry, it is stretching credibility for psychiatrists to claim that his award reflects credit on this profession. He cannot claim that his undoubted expertise in normal sea slug neurophysiology qualifies him as an expert on disturbed human minds, not the least because sea slugs don't seem to have much in the way of minds.

1-3. Psychiatry and Biology

Kandel's book consists of eight papers and essays published between 1978 and 2001, together with an introduction, an afterward and invited commentaries by eight eminent figures in the fields of neurophysiology and psychiatry. The longest of the papers is a joint review but the rest are Kandel's. The theme of the book is that "radical reductionism" will "transform psychoanalysis into a scientifically-grounded discipline." He looks to the brain-based neurosciences " ... to create a unified view, from mind to molecules ... (a) new biology of mind ..." This "unified psychoanalytic and biological perspective" can provide "a new science of the mind" from which would emerge "... a great unification into one intellectual framework of behavioral psychology, cognitive psychology, neuroscience and molecular biology." The means of uniting the disparate fields of "biologic and psychologic explanations of behavior" is by explicating the "biology of human mental processes." In essence, this means using molecular and genetic biology to provide "a new level of mechanistic understanding," confirming that "the basis for the new intellectual framework for psychiatry is that all mental processes are biological ..."

This credo is repeated throughout this particular book, as well as his autobiography [5] and both of his large and highly influential texts. Biological investigation of the brain will allow us to "... understand the physical mechanisms of mentation and therefore of mental disorders." He emphasizes that the proper means of investigating the mind is by reductionist biology. He sees no limits to the capacity of biology to explain human behavior: "All the behavioral disorders that characterize psychiatric illness ... are disorders of brain function. The task of neural science is to explain behavior in terms of the activities of the brain." Biology can transform psychiatry and psychoanalysis, turning them into a unitary scientific endeavor.

He defines mind as "the complete set of operations of the brain." Without exception, this definition places any and all mental states squarely within the explanatory scope of the reductive biological sciences: "If the neural representation of a sequence like a birdsong can be successfully analyzed, why should a sequence like a sentence be, in principle, less tractable to a neurobiological analysis?" [5, p400]. This includes mental pathology, which will be explained at the same level of function as psychoactive drugs, namely subcellular chemistry: "... we will join radical reductionism, which drives biology, with the humanistic goal of understanding the human mind, which drives psychiatry." If drugs work at the subcellular level, then that is the level where the primary pathology lies [2, pxxii].

In the main, the commentaries are supportive although Steven Hyman, a neurobiologist, warned that knowing everything about the component parts of the brain does not explain the whole of the brain's output. This amounts to a statement that the mind is an emergent phenomenon which cannot be explained by reductionism. Judith Rapoport wondered whether it was appropriate to try to reconcile biology and psychiatry. The last paragraph of the major essay (p316) suggests that reductionism might not answer all questions about human behavior: "Some might believe that all that is scientific about the study of life is illuminated at all levels from the molecular to the behavioral by what we know about DNA. But others might believe that there are issues about what it means to be a living being that are really not explained by the most detailed account of DNA." This comment is not typical of the views in the rest of the book.

Essentially, Kandel's collection of essays expresses the hope that reductive biologism will lift psychiatry out of its doldrums, probably by a "super theory" of psychoanalysis. This optimism has been called promissory materialism, which is an ideological stance, not a valid empirical theory. It is materialism in the sense that it promises answers to the most profound questions about the nature and state of the universe, using only the evidence of the senses and elementary reasoning. That is, there is nothing in the universe that the senses cannot perceive, meaning nothing beyond matter and energy, each of which is sufficient unto itself and requires nothing more than itself for its existence. In this view, all materialism is promissory materialism just because it says: Wait a while, all will be revealed by the ordinary processes of enquiry (or, as we would now say, of science). Promissory materialism is a very easy doctrine to hold as it says we don't have to worry about any really difficult questions because, when a suitable technology emerges, they will all turn out to be a simple matter of matter and energy. Thus, any intellectual effort now will be a waste of time, if not completely barking up the wrong tree. Materialists often point to historical examples of how a widely accepted theory was shown to be nonsense by the march of science. Examples include the theory of phlogiston and the vitalism of Galvani and Bergson.

I don't trust promissory materialism. It presupposes empirical answers to the really difficult questions about life and experience when nobody has ever established whether those questions are susceptible to empirical analysis. The history of science shows that there have been enough mistakes over the years for the uncommitted to retain a deep sense of skepticism about anybody who claims that "science will deliver the goodies." Nonetheless, I would be prepared to listen to anybody who wanted to argue the case for promissory materialism, but that is the one thing materialists will never do: argue a case. Their doctrine is all about not arguing cases. Theirs is the policy of "Just you wait and see." Take Kandel's sentence: "If the neural representation of a sequence like a birdsong can be successfully analyzed, why should a sequence like a sentence be, in principle, less tractable to a neurobiological analysis?" If what he says is true, then this sentence is itself of the same order and nature as a bird squawking in a tree. His sentences might be psittacine, but I firmly believe there is something in this particular sentence of mine that, in principle, a parrot could never understand. In passing, it is worth noting that promissory materialists often present their case as a series of rhetorical questions, just as Kandel did. For them, the answer is blindingly obvious and doesn't need a response, as time will fill in the details. If only life were so easy. ...

However, assuming there might be some value in his plan, several questions immediately declare themselves.

1-4. Psychiatry and Psychoanalysis

First, of all the available theories of mind, why would anybody choose psychoanalysis?

Kandel's autobiography shows that his commitment developed very early in his career: "I entered medical school (in 1952) dedicated to becoming a psychoanalyst and stayed with that career plan throughout my internship and residency in psychiatry ... I (was) convinced that psychoanalysis had a promising future" [5, p44, p155]. Yet, despite his unrewarding experiences as a training resident in the early 1960s, his emotional commitment remains as fresh as ever: "This decline (in influence) is regrettable, since psychoanalysis still represents the most coherent and intellectually satisfying view of the mind" [2, p64]. He does not indicate that only a tiny minority would now hold this view [8,9]. He repeats the old error that Freud wrote a "metapsychology" (he actually wrote a metaphysical psychology) then suggests that, while "(w)e do not yet have an intellectually satisfying biological understanding of any complex mental processes ..." a biologically-rejuvenated psychoanalysis might provide it [2, p67-9]. This juxtaposition of uncompromising reductionism and irreducible metaphysics is logically flawed.

A closer reading of his most recent works indicates an unreconciled tension between biologism and the belief that humans are something rather special. As his autobiography makes clear, Kandel retains a firm religious commitment. Throughout his scientific work, he repeatedly insists that biology will eventually explain the mind yet he does not indicate how biology can explain whatever it is that religions celebrate. If the expression of religious beliefs is a matter of mind at work, and the whole of the mind can be reduced to matters of genes and proteins acting at the synapse, then where does God fit in? I suggest his long-standing interest in psychoanalysis is a way of saying: "... and yet I believe there is something more to us than just chemicals."

He might argue that this is taking things too far but the justification lies in his own work: "An ultimate aim of neuroscience is to provide an intellectually satisfying set of explanations, in molecular terms, of normal mentation, perception, motor coordination, feeling, thought and memory ... (and) ... neurological and psychiatric diseases" [2, p193]. In a paper entitled "Genes, Brains and Self-Understanding," delivered in 2001, six months after his Nobel award, Kandel stated: "We already know that not only psychiatric disorders but almost all long-standing patterns of behavior — from wearing bow ties to being socially gregarious — show moderate to high degrees of heritability" [2, p381]. Because religious expression is unquestionably a "long-standing pattern of behavior," he must therefore believe that it will necessarily be explained by reductive biologism. However, since belief in God is a central part of many organized religions, especially Abrahamic, it inevitably follows that belief in God can be explained "in molecular terms." This case can be generalized, in that every living person has at least one belief which he or she regards as absolutely fundamental to daily life. It may be religion, politics, cosmology, anything, but the essential point is that, even at great personal cost, the individual will claim to hold it as a moral question, i.e. of freely choosing between right and wrong. There is, however, no conceivable, non-question-begging, deterministic model of freedom of choice. It is on this point, which we can call the 'supreme belief' test, that all biological models of mind will founder: either the person concedes his most prized beliefs (religion, politics, football club, scientific reductionism, etc.) are a matter of genetically-determined brain molecules, and therefore not his moral choice, or he must accept a non-biological model of mind, meaning reductionism can't explain everything about humans. They can't have it both ways.

(Continues…)

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Excerpted from "Humanizing Psychiatry"
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Copyright © 2010 Niall McLaren, M.D..
Excerpted by permission of Loving Healing Press, Inc..
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