Sally satel discusses her book brainwashed the seductive appeal of mindless neuroscience at the fourteenth annual book festival at the Walter Washington center in washington d. C. Welcome to the National Book festival. I am Wendi Maloney of the Copyright Office of the library of congress. Please note we are recording this presentation from a web casting. If you ask a question during the presentations then you are giving us permission to include you in the web cast. Please turn off all electronic devices. It is my pleasure to introduce sally satel. Sally satel is a psychiatrist and president scholar at the American Enterprise institute. 19881993 she was an assistant professor at Yale University where she remains a lecturer. Sally satel is the author of many scholarly articles and books including drug treatment the case for coercion and pc md how Political Correctness is corrupting medicine. In brainwashed the seductive appeal of mindless neuroscience, published by basic books in 2013, she and coauthor psychologist scott o. Williamfield revealed how applications of human neuroscience gloss over its limitations and complexities often obscuring the many factors in psychologies that shape our behavior and identity. They analyzed what brain scans and other narrow technologies can or cannot tell us about ourselves and stress the complex nature of free will and personal responsibility. Brainwashed the seductive appeal of mindless neuroscience was a finalist for the 2013 Los Angeles Times book prize in science. Please welcome sally satel. [applause] great to see everyone. Thank you. Apologies about the slide projector. Most of my slides are not very busy. In fact, my first slide is a copy of the cover of the book and to be honest right after we decided on that, i really thought of a better title. I wanted to be 50 shades of gray matter. Not just a play on the popular novel but exclusively meant to evoke the concept of seduction. In this case the seduction into certain beliefs about behavior, that technology is like brain scanning can lead us to and v e epitome of seduction i would say in neuroscience is okay is the brain scan which is now the Signature Technology of modern neuroscience. Someone says the brain scan has replaced the adam as the symbol of science. That is a brain scan and it is quite a wondrous thing. The reason i consider it a perfect storm of seduction is so many forces converge on it. It is absolutely dazzling technology. Not going to go into that, it is very complicated. It is Amazing Technology and like all technologies it promises subject to the and a more scientific gays. It is about the breen. Neuroscience is about the brain which is a masterwork of nature. 80 billion cells or neurons each communicating with thousands of others with more connections than the milky way, just some of them. It is the organ of self and people tend to think it can reveal all kinds of secrets about human nature. It is the visual and we are highly visible primates, not something you can say about genes. Anyone can see a brain scan. Harder to see nucleic acids. Lastly there was an element, almost an element that accompanies brains scans, people tend to think, people not steeped in science or sophisticated in that realm, why should they be . The average person reading of the science times oh my gosh, it is in the brain. It is in the brain. A key phrase. Of course it is in the brain. All thoughts and emotions are in the brain. Where else would the biological correlates of behavior, emotion and thinking be . They are in the brain. You see headlines, political bias and affects the brain activity accompanied by a brain scan. Anxiety is in the brain. Of course it is in the brain. Psychiatrists, these headlines really annoyed me, proof that depression is real because we have a brain scan to show that or anorexia or p. T. Std, now we know this suffering is real. We knew it before. We didnt need a brain scan to tell us that. We need a brain scan to tell us some things. Right now is mainly in the realm of research. There are not that many Clinical Applications that a few in the realm of research and very Good Research but like so much of Research Went it is filtered through the press into the popular media things get distorted. It is seductive in another way. It carries an exculpatory dont blame me, dont blame my brain and also the notion that if x lights up, you hear the phrase lights up, that means there is increased activity in a particular area of the brain. Theres always activity in the brain. If there is not you are dead. If x lights up, then why behavior inevitably happens and that is not the case either and we will be talking a lot about that but you can see why that conceit, x lighting up and why inevitably following it would be so appealing to trial lawyers and indeed there is a whole new field called neuro law which is a looking at the implications of brain science, understanding the criminal mind. It is a really nice story, that Defense Attorneys can tell. My client had this in his brain, he could not control himself, he could not form the intent needed to commit a crime. This was a misreading of narrow imaging. Sometimes without question people do have problems with their brains that renders them legally insane so they are not culpable. All kinds of damages can happen to ones cognitive apparatus rendering people either not culpable at all, or less culpable, lets say so they are not excused but their sentence is mitigated. That happens clearly, but the point is at this point in time, things might change as the technology evolves, we cannot distinguish who those people are, the brain scans. We cant distinguish an impulse that is irresistible from one that was not resisted. This is the key point i want to get to. Another misconception of popular readings of brain scans is the notion that you can actually pinpoint the motions or complex feelings. That is simply not true. In fact, that kind of activity has led to the phrase to accuse oversimplification, the reading of brain images as being akin to narrow phrenology. As if the brain is highly modular and specific areas of it are involved solely with certain kinds of reactions. Clearly certain parts of the brain are more involved, more heavily in mediating certain kinds of reactions. We know about the amygdala, a famously invoked when we talk about fear reactions but that particular part of the brain figures prominently in processing in novelty or surprise. There is not 1 1 correspondence. Circuitry is where it is and all narrow scientists know this and again, a lot of the problem here is how narrow scientists came to the media. There are wonderful science journalists who know the background and theyre very comfortable and others a little less so and then there is a whole crop of people called neural entrepreneurs who are trying to make a buck from selling things that have to do with education and the lot of fads that one has to be very careful about. So really circuitry is where it is and that is where narrow scientists are focusing most of their energy. How various regions interact with each other. It is the enormously complicated but the m r i is basically a research tool. We are probably one foot into a 10 mile journey in understanding of the brain but nonetheless these brain images have migrated into the publics fear, the promise of decoding of the brain, one can see why politicians are so interested. There are some some Public Relations groups that offer narrow imaging in an attempt to advise their clients about how to make their candidates more appealing. This was from an oped with the New York Times in 2007 where candidates were shown to swing voters and the reactions of those voterss brains were indicative of what the candidate would have to do to appeal to them more. Neuroscience at its most popular and dumbed down. Marketers are very interested. This is a book with a very clever title, buyoff famous mineral marketer trying to tap into the brains of brain scans and other kinds of technologies that will reveal brain based data to tap into the brain to learn what consumers want, like cutting out the middleman and going straight to your brain. Certainly we would love to find a good lie detector. We have a whole chapter on this. This is one of the few with proof of concept, there are no signatures that can distinguish between truth telling and why in but almost impossible at this time to apply in the real world. In a Laboratory Setting with lots of controls it has some fairly good validity. Then there is the question of how we engage the pool of temptation from oreos to cocaine and Defense Attorneys as mentioned before trying to prove their clients whack maligned in tent or even free will. I offer a book to anyone who knows who these two guys are . I think i heard leopold and love. Someone said that. I owe you a book. We devote a chapter to narrow marketing and lie detection, and we try to tease apart what seems promising, technical obstacles and achieving the ultimate goal of being able to infer something about the brain and what are conceptual barriers to doing that and pseudo neuroscience. With that as background, i want to focus on the part of the book that to me, i dont know if i speak for my coauthor scott williamsfilled, one of the most interesting things is the culturally significant implications of our growing ability to explain behavior in neurological terms. In other words the better we get at describing Human Behavior through biology and we are only going to get better at it, how is that going to affect the way we think about human freedom . The freedom to choose our actions . I am going to floor this through addiction. I am an addiction psychiatrist. That is my area of specialty. So i can say with complete honesty that for at least 20 years, 20 years, i have been very, very interested in the way addiction is conceptualize and portrayed to the public. Frankly this is the way it is talked about now. In the media, education will campaign. Pardon me. The water, is over revers. This is your brain literally on cocaine, the new frying pan at. Thanks. Sorry about that. This represents a very legitimate and very interesting sermon. Not interesting in terms of its results, you expect the vote results. Basically this study has two general para don imus. One, you take someone who has a cocaine problem and expose them in the brain scanner, and the m r i, brain scan loses blood flow but they both reflect increased enhanced activity in the brain. Pardon me. You put them in a scanning apparatus and shows them films, those little mirrors in these machines and a person looks at the end they can see a film of people using cocaine. Cocaine paraphernalia, and they experience a subjective desire to use cocaine and their brain will reflect what we call the reward area. Special activation, the desire to use cocaine. When we show the same person up picture of the beach or a meadow or something neutral you dont elicit the same kind of metabolic activity, in this case mainly doberman a chick activity. The other version is what is the cocaine user and what is not . You show them the films of people using and get this reaction, the person who has the cocaine history but not in the person who has never used cocaine as you might expect. It has been replicated a lot. It is great. But the way to describe is this is the brain being hijacked by cocaine. Specifically referring to hijacking the limbic system which is a complex and fairly old brain circuitry. It contains regions, you may have heard the amygdala, the cap could the hippocampus and others. It mediates reward and memory and emotion but the language is that it hijacks the brain, it hijacks this limbic system and the implication, sometimes less an implication and stated out right, is that when someones brain looks like this effectively they are out of control. They can no longer in control over their actions and their drug use is involuntary. The existence is like many experts call addiction a brain disease, a brain disease because they are operating in the context of addiction. There are brain changes in the context of addiction, but still the label brain disease deserves a lot of scrutiny. First, changes in the brain are not a signifier of past policy. Learning italian changes the brain. There is much plasticity involved with learning. Alzheimer s the brain. But addiction is not like learning an italian. Language lessons dont take the quality of a compulsion like the crack habit nor is it like alzheimer is with its own inexorable progression to dimension which is beyond control of the sufferer. The changes in alzheimers disease render the patient resistant to any rewards or sanction. If you said to your grandmother i am going to give the 1 million if your memory doesnt deteriorate or i am going to shoot you if your memory deteriorates, it wont matter. The brain changes of addiction, thank goodness, do not impair the capacity to be featured. I realize that might sound a little strange or it might sound not strange at all, not people who use drugs can see the suspicions they have every day, no more or less vulnerable. In any case going into the lab, we know that rewards and sanctions can and do modify the course of behavior. Which is the essence of behavior can be modified to behave from its consequences but that sounds too theoretical so let me give you an example. These are vietnam vets. In june of 1971 president nixon became panicked that there would be a flood of veterans from Southeast Asia coming back to the inner city and further inflame the heroin epidemic in big cities that were already underway. He was afraid of this because at least half of all g is had tried opium and heroin in vietnam war where it was very abundance. 15 to 20 may have actually been addicted so he was very concerned. They instituted a program called operation golden flow where everyone happy in a cup and if it wasnt if it was positive, you werent leaving vietnam. To make a long story short almost everyone passed the test, everyone who was using this passed the test. The few who didnt were given an extra week to clean up, then they came back to the united states. Then a researcher at the university of washington named the robins followed these people for three years and was expecting to see higher rates of addiction and once they were back home, if they would resume their habit, but only 12 had used in the three years that they had come back and that was very very surprising but also very encouraging and frankly it is what lies at the heart of recovery and reasonable Public Policy for addiction which is the intelligent use of sanctions and rewards which we can make good use of in the criminal Justice System. I wont get into legalization, taking the system as we find it to the extent that we can divert people from incarceration because of nonviolent drug crimes and put them in drug courts. We have been doing that for years and these courts are based on the principles of behavior which is swift, certain but not severe sanctions can shape behavior and drug courts have been going on for quite a while and quite successful. The point is if you just focus at the level of the brain, just talk about the nucleus and the hippocampus, i apologize. [coughing] you would not think about shaping behavior. When you are told something is a brain disease you think it is involuntary. How do drug addicts work with patients so they dont crave . We come up with strategies to allow them to what is called self binding, wasted basically put barriers between themselves and their drugs. You probably heard the common one, stay away from people, places and things. Thanks so much. Deposit your paycheck. Dont have money available. I had a patient who used to shoot up. Every time he looked at his arms where he had tracks it would stimulate a sense of craving. He would wear long sleeve shirts all the time or find himself too arraus. Avoid boredom. This is the kind of thing people have to do. The point is this involves motivation. This involves conscious engagement. If we focus too much at the level of the brain when wont Pay Attention to these things. It is a kind of ulysses phenomenon where patients where patients bind themselves not to the mast in this case but create barriers to their use, to recognize situations of vulnerability like hearing the siren song of cocaine but restraining yourself in some ways. Okay. So addiction is a good example in this discussion of what scott and i call narrow centrism and that is one of the problems with the way neuroscience has been popularized. Narrow centrism is the idea that Human Behavior can be best explained by looking primarily at the brain. That somehow that level of analysis gives you the most authentic, true, reliable, understanding of the behavior. Probably true if you have alzheimers disease. Posttraumatic stress disorder know, depression no. Problems with the narrow centric view is you emphasize medication too much. I am not against medication. To think this is the answer in and of itself is clearly not true. You downplay the importance of psychology, behavior, we cant afford to lose the mind in the age of brain science. When i refer to mind i am talking about feelings, thoughts, desires, tensions, memories, subject to the. I dont want you to think we are falling into any kind of do a dozen track. The mind is wholly dependent upon the brain, no questions there, it is all subjective experience, mediated through the brain, no brain, no consciousness that it is important to realize the physical rules from one level of analysis. I apologize. You can see that very well. Basically breaking all levels of analysis down starting from the environment and ending up with genes. It could end up in quantum physics. That is we cant yet use physical rules on the Cellular Level to predict activity at the psychological level. If you want to understand if you are reading a book and went to understand what the text means you dont subject the ink to chemical analysis. That is not the levels that is going to inform you about the meaning of the book. The important thing is questions are answered better as one or more of these levels. Others are answered at others. They are not right or wrong. Does addiction affect the brain . Of course it does. If we stay at that level we are going to miss a lot. It