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Brainwashed: Neuroscience and Its Perversions

Sally Satel and Scott Lilienfeld have written a new book, Brainwashed: The Seductive Appeal of Mindless Neuroscience. Its purpose is not to critique neuroscience, but to expose and protest its mindless oversimplification, interpretive license, and premature application in the legal, commercial, clinical, and philosophical domains.

The brain is a wondrous thing: “…the three pound universe between our ears has more connections than there are stars in the Milky Way.” Trying to understand how it works and how it generates conscious awareness and subjective feelings is a daunting task. Neuroimaging is one of the tools we are using to study it. Unfortunately, people get so enthusiastic about its possibilities that they are constantly tempted to read more into the images than is really there. This has given rise to a new phrenology that interprets our mental characteristics with pretty colored pictures. We are easily impressed by pictures; after all, a picture is worth a thousand words.

Brain imaging can’t show us what is going on in the mind of the person. It shows areas that have increased oxygen consumption. A spot lights up when a person thinks or acts, but that doesn’t tell us much. Single blobs that light up in the brain have been interpreted as centers for things like love, rewards, hate, and belief in God. This is sometimes referred to as “blobology.” They found an area in one person that lit up when he thought about an actress he loved. That area was thought to be a “reward” center. But it also lit up when he thought of Ahmadinejad! So they did some fancy footwork and rationalized that he believed that the Jewish people would endure and therefore he derived pleasure from the idea that Ahmadinejad would fail. That’s pretty far-fetched. Occam’s razor would suggest that maybe the area that lit up was reacting not to pleasure, but to something else. People tend to read what they want to see into ambiguous patterns like a Rorschach test. Mental functions are rarely limited to a single spot in the brain; multiple areas are involved and interconnected. Researchers are increasingly moving away from blobology and towards pattern analysis where they look at the patterns of activation across the entire brain.

Neuroscience is one of the great intellectual achievements of modern science, and it’s sad to see it perverted and hyped in spasms of “premature extrapolation.” The mind is a result of the actions of neurons, but one can’t use the physical rules of the cellular level to predict activity at the psychological level. Neurobiology deals with brains and physical causes; psychology deals with the mind, with thoughts and motives. This might sound superficially like dualism, but it isn’t; the mind is solely the product of a physical brain, but there is an explanatory ladder with many levels, and it can be counterproductive to put too much emphasis on the lower levels. A marriage counselor could try to improve his understanding of a couple’s problems by doing fMRI scans of their brains, but that would only draw attention away from their thoughts, feelings, and interactions with each other at a level where intervention could be helpful.

Neurodeterminism may replace Freudian determinism (unconscious conflicts and drives determine our thoughts and actions) and Skinnerian determinism (rewards and punishments) to become the next grand narrative of human behavior. The authors ask, “Can we ever fully comprehend the psychological by referring to the neural?” Some people (among them Sam Harris and Michael Gazzaniga) think we can, even hoping that knowledge of the brain will solve all our political and ethical problems, and that government bureaucrats might some day be replaced by neurocrats.

There is a tendency to grant brain-based explanations superiority over all other ways of accounting for human behavior. Understanding the biological basis of pleasure has led some addiction experts to fundamentally rethink the moral and legal aspects of addiction. In the legal world, there is a temptation to shift from blame to biology, relieving the criminal of responsibility for his actions.

Whenever you see a headline “Brain Scans Show…” you should be skeptical. Scans don’t reveal causes, only correlations. In teenagers, there is increased activity in regions associated with aggression when they play violent video games. That doesn’t mean video games trigger violence. Maybe aggressive teenagers enjoy those games more. Maybe parental inattentiveness leads to both more video game playing and more aggressive tendencies. Maybe those areas also light up with excitement and competition. Or maybe there’s another explanation altogether.

Functional magnetic resonance imaging (fMRI) measures oxygen consumption as a proxy for increased neuronal activity. It uses a subtraction technique to compare oxygen consumption during a task to baseline consumption. The data are collected as voxels, a volume designation analogous to the pixels of a 2 dimensional display. A computer filters out background noise and generates an image with color gradations to reflect the likelihood that the results of the subtraction process were not due to chance. The pictures we usually see of scans are not of a single person, but a composite averaging the results of everyone in a study. Defining the task is critical: having teenagers look at color pictures of people rather than black and white completely reversed the findings of one experiment. There are other complications. There is a 2-5 second delay between the activation of neurons and the increase in blood flow. The amygdala lights up in situations of fear but it also lights up in situations of anger, happiness, and even sexual arousal. An area may light up because its neurons are stimulating other neurons, or it might light up because it is inhibiting the activity of other neurons. Sometimes the voxel is too large to register tiny clusters of neurons that have a critical function. There is also the practice factor, where brain circuits operate more efficiently and use less oxygen as the person becomes skilled at a task. Additional mischief comes from statistical errors, as in the famous fMRI scan of a dead salmon “thinking.” And researchers may home in on tiny areas of activation and inadvertently concentrate on chance fluctuations in the data, drawing conclusions that will not be replicable. Another problem is when researchers “learn” something from brain imaging that we already knew by other means; this might be called “neuroredundancy.”

Neuromarketing capitalizes on the fact that consumers are seldom consciously aware of the motives behind their own choices. The more brazen promoters of brain scanning to get insights into consumer behavior are pulling off a “brain scam” on the companies that hire them. Clinicians scan the brains of addicts with the good intention of putting addiction on an equal footing with diseases like Alzheimer’s. But they ignore the reality that quitting is the rule rather than the exception. A survey found that 77% of former drug addicts and 86% of former alcoholics reported no substance abuse problems during the year before the survey. Identifying addiction as a brain disease tends to remove personal responsibility and depicts addicts as helpless.

Neuroscience has made us question the very concept of free will: the unconscious processes of the brain register our decisions before we are conscious of deciding. It has raised questions about individual responsibility and about the morality of blaming or punishing people in a deterministic world. But those are moral and philosophical issues that neuroscience itself can’t resolve.

Daniel Amen

Satel and Lilienfeld briefly mention Dr. Daniel Amen and his Amen Clinic empire. He is a prime example of someone who reads far more into brain scans than is warranted. He thinks single photon emission computed tomography (SPECT) scans are essential to diagnose and treat mental illnesses, addiction, ADHD, and other conditions (a claim not accepted by mainstream psychiatrists and psychologists). He charges patients thousands of dollars to inject them with radioactive compounds and show them pretty colored pictures of their brains, without any credible evidence that it adds to the diagnostic or treatment processes. I have written about him here and here.

Here’s an example of his “proof.” Are you impressed?

An example of Dr. Amen's "evidence"

An example of Dr. Amen’s “evidence”

His latest endeavor is a new book, Unleash the Power of the Female Brain. He reviewed 26,000 SPECT scans of men and women, and concluded that the female brain was more active in 112 of the 128 brain regions he looked at. From the differences in those regions, he concluded that women make better bosses and leaders, are better at memory, empathy, intuition, collaboration, self-control, and “appropriate” worry. Men are only better in 9 areas associated with visual perception, form recognition and object representation; they are better at tracking objects in space. He thinks his findings explain why women have a lower incidence of ADHD, antisocial personality disorder, substance abuse, and incarceration. He offers advice to help women love their brain, overcome mood disorders, optimize brain function, and supercharge it for better health, energy, mood, and sex.

Being a woman, I’d love to believe women are superior to men in so many ways, but I won’t let my wishes interfere with my judgment. I have never found any of Amen’s work credible. He has a great imagination and a lot of enthusiasm, but he’s not much of a scientist.

Conclusion

Neuroimaging is frequently misunderstood and overhyped. Amen’s book belongs in the fantasy and science fiction section of the bookstore. Satel and Lilienfeld’s book belongs in the science-based medicine section. It offers keen insights into what neuroscience can and can’t do, and much food for thought.

Posted in: Book & movie reviews, Neuroscience/Mental Health

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52 thoughts on “Brainwashed: Neuroscience and Its Perversions

  1. Alia says:

    Don’t want to be a nit-picker, but there’s something very wrong with the formatting of this text, Dr Hall. Like clicking Ctrl+C a bit too often.

    1. Pretty sure the text duplication error was mine, a mistake made while I was editing the post last night. My apologies to Harriet for damaging her post. It has now been repaired.

  2. Jason Bosch says:

    You appear to have copy-pasted this post inside itself.

    1. Yes, indeed. There’s probably some neuroscience behind that!

      /@

  3. David Tyler says:

    “Whenever you see a headline “Brain Scans Show…” you shouSally Satel and Scott Lilienfeld have written a new book…”

    This to needs some correction.

  4. duggansc says:

    The other thing that really bugs me about the neuro-scanning industry is the frequent “OMG! There’s a part of the brain that activates in religious people and stimulating it makes people feel like God exists! Religion must be a scam!” meme, although that might be just over-represented in douche Facebook posts. Somehow, they very seldom argue that the fact that stimulating the visual cortex produces images means that all sight is a lie…

    1. duggansc says:

      Sorry. I really shouldn’t browse Facebook in the morning… people get me too angry.

      The other concern, of course, is that eventually (if not already) people will start using these “discoveries” as health or career factors. Remember when graphology was being used to determine employee trustworthiness? And some companies probably still issue Myers-Briggs tests to try to figure out which pigeonhole to put you in personality-wise. What happens if they decide a certain brain pattern means you’re likely to embezzle funds? Can you get barred from working at a psychiatric hospital if your brain scans indicate you might have a violent temper? Scary stuff in my opinion.

      1. “The other concern, of course, is that eventually (if not already) people will start using these “discoveries” as health or career factors. ”

        Just had to reschedule an MRI because the insurance company initially denied it due to the doctor using the wrong word on the requisition. (needed to say “suspect labial tear” instead of “suspect rotor cuff tear”). In other words, these aren’t a trivial expense. I’m thinking the cost, risks and inconvenience of an MRI would be prohibitive as a tool to screen for employment. Unlike silly personality tests, handwriting analysis, phrenology, etc.

        Hopefully luck is on our side in this one.

        1. duggansc says:

          At least for now… there was a time when a lot of our blood tests such as the drug tests were horribly expensive and now, they sell them over the counter. Ultrasounds used to be expensive too and now there are kiosks. Of course, that brings its own risk in that quality control, and thus quality, may suffer, leading to spurious results.

          1. Too true – but the delay before a technology becomes affordable can be used to inform the public about the problems with the test and or research and to set up guidelines (rules, laws) for appropriate use. For instance, when genetic testing became available, there was a lot of public discussion on the appropriate and inappropriate use of those tests, privacy concerns, etc. Because of this, some entities, who would have liked to use information from genetic tests for screening (insurance companies and employers) were barred from doing so with GINA (in the U.S.)

      2. Also – Employers don’t have unlimited rights on tests they can require. Here’s a kinda interesting rundown of legal considerations

  5. WilliamLawrenceUtridge says:

    Can you get barred from working at a psychiatric hospital if your brain scans indicate you might have a violent temper?

    Not to mention the brain scan might indicate you have a violent temper…and completely miss the fact that you have spent your life consciously controlling that temper (the inhibition mentioned by Dr. Hall). Or that the light-up of “temper” could be more “this other guy is angry and has a bad temper, I should calm him down”.

    Reminds me of Gattaca, a movie I always enjoyed despite most people seeming to view it as terrible.

  6. windriven says:

    I will be interested to revisit Edelman’s Theory of Neuronal Group Selection in light of advances in fMRI. We have a such a long way to go to understand the formation of consciousness at its most basic. Those who would gaze at fMRI images and announce insights into thoughts and emotions are as delusional as those who proclaim homeopathy a cure for anything.

  7. Good to see an article on this book. I’m a big fan of Scott Lilienfield, not only because of his skeptical approach but also because I find he give such understandable well reasoned explanations for his arguments. I believe that I heard an interview with the authors talking about this book on Science Friday (NPR) awhile back. If anyone is interest they can just search the title of the book and “NPR”.

  8. Alia says:

    A friend of mine, who works in a research lab, likes to point to another weakness of all this neuroscience testing, fMRI and other experiments. And that is – research subjects are usually not representative. They are either people suffering from various neurological disorders (“we’ve got a guy with aphasia here, quick, let’s test his brain”) or students. Yes, when you work at a university and you need to enroll subjects for your research, who is the easiest to find? And then you read a description of a study “The subjects were 20 healthy males and females aged 19-26″.

  9. daedalus2u says:

    I would like to offer a slight correction. fMRI BOLD does not measure O2 consumption, what it measures is O2 concentration. It provides a signal based on the differential magnetic susceptibility of oxyhemoglobin and hemoglobin (ferrous Hb without the O2). HbO2 is diamagnetic, Hb is paramagnetic. fMRI BOLD measures the differential magnetic susceptibility of the brain and so infers blood flow changes with a sub-second time constant. What it is really measuring is nitric oxide levels because it is NO (at sub nM/L levels) that triggers the vasodilation that causes the differential blood flow that fMRI measures.

    Acute changes in blood flow measured by fMRI probably are related to O2 consumption in some way because there is no other known mechanism for regulating blood flow in the brain, so if a brain region is going to consume relatively more O2, blood flow has to be increased to it via some mechanism. However the effects of different fMRI BOLD activation are (very likely) not mediated through increased O2 consumption (they are more likely mediated through NO signaling). O2 consumption is regulated by individual cells a lot more precisely than blood flow can possibly be regulated. Blood flow is to a volume which contains many (millions?) cells. Each of those cells regulates O2 consumption through myriad pathways (mitochondria, P450 enzymes, NADPH oxidase, MAO, etc.), the details of which matter, and which details cannot be reflected in the fMRI BOLD signal.

    Essentially all neurodegenerative disorders are characterized by reduced blood flow in the brain, but that reduced blood flow precedes and accompanies the neurodegeneration. My own hypothesis is that the neurodegeneration is caused by the reduced blood flow, not the other way around. Because there is no separate blood flow regulating mechanism (other than NO-mediated vasodilation), using the signal that fMRI BOLD measures allows the brain to self-allocate resources quite precisely.

    If a region of the brain is not used as much, it will get less blood via the fMRI BOLD mechanism and so physiology can cause that region to eventually shrink, leaving more resources (blood and brain volume) for the other regions which are (in theory) more active. However, that depends on the mechanism for the reduced blood flow. If it is due to reduced activity, that is one thing, but if it is reduced due to low basal NO/NOx levels, that will tend to reduce blood flow even at the same neural activity.

    The usual way of doing fMRI BOLD scans is to take an “average” over the whole brain, and then look at deviations from that average. That presupposes that the “average” is sufficient to sustain the brain over the averaging time. My hypothesis is that the “problem” in the neurodegenerative disorders is that the “average” isn’t quite enough, so the brain self-ablates, which is a normal part of resource allocation.

    According to this hypothesis, the degeneration isn’t due to reduced O2 consumption, or even due to any sort of “damage”, but simply due to the operating point of the regulation of the perfusion of the brain being slightly off.

    Other than that slight quibble about mechanisms, Harriet is quite correct, the inferences being drawn are nonsense.

  10. WilliamLawrenceUtridge says:

    And that is – research subjects are usually not representative. They are either people suffering from various neurological disorders (“we’ve got a guy with aphasia here, quick, let’s test his brain”) or students. Yes, when you work at a university and you need to enroll subjects for your research, who is the easiest to find? And then you read a description of a study “The subjects were 20 healthy males and females aged 19-26″.

    Neither of which is bad when you’re at the hypothesis-generating stage. In fact, one could argue these are better populations because (in the former case) they have unique illustrative features and (in the latter case) they are slightly more homogeneous than the population at large, ergo better control of variables.

    Once you are at the hypothesis-testing phase, particularly when trying to generalize to the population however…

    1. Alia says:

      I agree with you that it’s useful at the hypothesis-generating stage, but all too often such preliminary results are then generalised to whole population, as in “research shows that…” or “scientists found out that…”. Especially in popular media.

  11. Joao says:

    I think this article oversimplifies the merits of neuroimaging and brain mapping effords. Not that I expect to see in the images the unambiguous answer to qualia, free-will, and such. But it does provide a parallel line of investigation and may support or suggest new hipoteses. Things like testing if the activated are is inibiting or exciting other are in principle testable and may be very interesting in the light of psycology. And we may get even further down the line in the future and get to the neuron level. Or maybe not. But predicting it wont be revealing of important inner-workings is premature.

    1. Harriet Hall says:

      I didn’t predict that neuroimaging won’t be revealing of important inner workings. You have read something into my article that I didn’t say.

      1. Joao says:

        No, not explicitly. But I understood it was aiming that way. Glad to see it clarified.

  12. angorarabbit says:

    It bears repeating that, like all new technologies, there are appropriate and inappropriate uses. fMRI and the like have been extraordinarily useful. For example, in my own area, studies reveal the counter-intuitive finding that those with fetal alcohol spectrum disorders have increased brain oxygen flow and expanded recruitment of subregions as compared with controls during a problem-solving task. Current thinking is this reflects the brain “working harder” and/or inappropriate regional recruitment. Or both. Additional research is warranted. Regardless, it has advanced our thinking on strategies to improve outcomes for those affected.

    It’s great to look “under the hood” but of course caution is essential when interpreting findings. And, of course, if someone can make a buck of something, they’ll do their darnedest to exploit it.

  13. angorarabbit says:

    “Identifying addiction as a brain disease tends to remove personal responsibility and depicts addicts as helpless.”

    Sorry but I really have to respond to this. I don’t think (I hope) that the implication is either/or. My concern is the uninformed reader won’t understand the situation is more complex and an interaction between genes and environment. Or as I like to say, “genes load the gun but environment pulls the trigger.” There is a substantive and well-documented literature revealing strong genetic links with addiction risk. In my own area, these genetic links are so compelling that they are driving drug-discovery and treatment strategies that are now in clinical practice.

    Those of us studying this area DO think of it as a brain disease because, like diabetes or other disorders, there are both genetic and environmental components. The genetic components are real – this is one reason why addictive behaviors can run in families. It is about more than merely will-power, which is why most folks (let’s pick on college students) don’t become raving alcoholics post-graduation. There is growing awareness that treatments work best when both environmental and physiological factors are considered.

    I hope that the book’s authors are not trying to say that addiction is merely a weakness. Given their background they ought to appreciate the scientific complexities of our current understanding on addiction.

    1. Harriet Hall says:

      The book’s authors are definitely not classifying addiction as merely a weakness. They are warning against over-simplified conclusions based on brain imaging.

    2. Joao says:

      Even if it were only a weakness, how can we blame people for being weak? Do they really choose to be weak? I dont think so.

  14. Ken Hamer says:

    That “outcomes” image reminds me of another: http://static.fjcdn.com/pictures/your_47a996_805569.jpg

    1. windriven says:

      I’d prefer a more Seussian take with ham ;-)

  15. Marion says:

    Having read only the title of this article, and the first 2 paragraphs,
    all I can say to Harriet Hall is:
    THANK YOU, THANK YOU & again THANK YOU
    for addressing neuroscience and the many false extrapolations people of all types of political opinion make from it.

    I am a big fan of neuroscience investigation. I know I will have disagreements with many of the SBM proponents and contributors here. Not because I have any evidence to support my claims (I don’t). But, because I see my speculations as being consistent at least with previously established science. (SBM proponents would simply choose not to speculate, as is not only their right to do, but actually is the right thing for them to do – as scientists.)

    But, whatever disagreements I would have with Sam Harris or SBM advocates would be trivial compared to the vicious fights I have had with the pseudoscience crowd, or the psychology crowd – i.e. those who assert their speculations as absolute proven fact.
    By the “psychology” crowd, I mean every troll, every blogger, every commentator on the internet, in the media, who throws around psychological causes in political attacks on their political and legal opponents. These pompous self-righteous commentators are the ones I hate the most.

    For example, the most common, and most enraging one, are those self-rigtheous ones who call commtting or attempting suicide a “mental sickness”, rather than an optimal choice among all choices available to them, just as all decision-making is. The worst insult is calling those who do it “selfish”, when in fact ALL decisions made for one’s benefit, such as maximizing wealth, are selfish. So, singling out suiciders as “selfish” is, as all cherrypicking is, logically inconsistent.

    1. Calli Arcale says:

      THIS. My mom was fond of saying that suicide is selfish, as if this would somehow be a discouragement against anyone attempting it, though there was also a not-so-subtle implication of “they’re just doing it for attention; they’re not really wanting to die” in there. Things is, of COURSE it’s selfish. And a deeply depressed person might be thinking that it’s about damn time they did something for themselves for a change and just teleported themselves the hell off this planet, so to speak. And maybe they do want attention, and up until this point, nothing has seemed to work, so either they’re making the only statement they have left or they’re just plain giving up on attention and ending the pain of it. Since when is trying to guilt a depressed person about that supposed to help? “Buck up; people are counting on you!” Yeah, they probably know that. Reminding them of being a continual failure at their responsibilities is not likely to improve things. And if the person saying this is one of the people they’re responsible for, well. Selfish knows selfish, I guess.

      It’s always irritated the hell out of me when people pontificate about how selfish or attention-seeking a depressed person or a suicide victim is/was. And I’m very glad to hear you talk about it, Marion.

  16. Marion says:

    It’s odd: rarely have I felt so rather ambiguous about the outcome of a scientific inquiry. But, that’s how I feel about whether neuroscience research will prove free will or prove determinism. Rather ambiguous, although I have had a slight preference that free will is the truth, so I am a little disappointed that neuroscience research is leaning towards determinism.

    Contrast that with the P vs NP problem in computational math and logic. I really really STRONGLY want it to be proved that P=NP, because think of all the massively large problems that we would be able to solve quickly then.

    1. …and some of the crazy new ones we invent as a result. :-)

  17. Stephen H says:

    Has anyone given that salmon a title yet? Could we call it, perhaps, the Salmon of Doubt?

  18. Thomas says:

    “Being a woman, I’d love to believe women are superior to men in so many ways, but I won’t let my wishes interfere with my judgment.”
    The second part of this sentence is a true mark of intelligence, but the first one seems weird to me, from a moral point of view. Being a man, I personally don’t care whether science would show that men are superior in this or that. There are probably differences between the two genders, even in terms of superiority for this or that, but I don’t see how it should bring pride or satisfaction; those are (would be) merely facts. Or maybe you think of your own gender as you think of your favorite football team, and *love* it when they win the game…

    1. Harriet Hall says:

      It would not seem so weird to you if you had read my book “Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon.” http://www.amazon.com/Women-Arent-Supposed-Fly-Memoirs/dp/0595499589 In it, I describe living through an era when women were only grudgingly accepted in male-dominated fields like medicine, aviation, and the military. I spent much of my early life being bombarded with ideas about male superiority, and it would be delightful to learn that they got it backwards. It’s called REVENGE.

      1. Chris says:

        Ah, yes. The good ol’ days. One of my favorite comments was from some guy who declared he was never going to fly again because Boeing actually hired women engineers!

  19. Ella says:

    I agree that “neuro-imaging determinism” in brain science has some significant problems, and Daniel Amen’s “empire” is a real turn off because of my own distaste for profit-seeking in health care. But I have found his 6-Type ADD theory useful and applicable in big picture ways, especially in regards to pharmacological approaches to helping people with this disorder. I say big picture because I think that outside of his basic categories and suggestions for treatment, he ends to oversimplify, overgeneralize and certainly, overly promote his own products as remedies.

    His original work described six very recognizable trait clusters in patient’s presenting with attention, memory, organization, mood and impulsivity issues that were commonly all lumped together as “ADHD/ADD”. He did a decent job explaining how co-morbid disorders that manifest as over or under functioning in different areas of the brain–which can be seen in his scans– can impair a patient’s response to traditional stimulant drugs and may quite possibly make their symptoms worse. I have found that in a lot of situations, “ADHD/ADD” is not a disorder, it’s a symptom of other underlying imbalances that must be corrected. I believe that brain scans should not be routinely used at this time in scientific history, as they are expensive, possibly harmful to patient’s and ripe for misinterpretation. I also don’t agree with some of his generalizations regarding sex differences in the brain, having scanned his latest book.

    But since I don’t want to throw the baby out with the bath water, I take from Amen all the good–which I have seen work in actual patient’s— and reject the rest.

    1. Harriet Hall says:

      You say you believe Amen’s 6 categories of ADD are valid, and you say you have found them helpful, but have there been any scientific tests, or are you asking us to accept testimonial evidence?

      1. Ella says:

        Yes. For example, we do know that certain areas of the brain correlate with certain diagnoses and therefore responses to medications. For example, temporal lobe hyperactivity correlates with anger outbursts and sudden mood shifts in many people. As a result, if they have co-morbid ADD symptoms, but do not address the moods swings with the use of a mood stabilizing drug (such as the newer anti-seizure medications) they may actually become more irritable, angry and possibly violent if only treated with stimulants for the ADD.

  20. Harriet Hall says:

    Ella, that is nonresponsive. You merely repeated one example of Amen’s speculations and assertions instead of offering evidence based on scientific studies. How were the 6 categories validated? Where is the evidence from controlled studies showing that this categorization actually improves clinical outcomes.

    1. Ella says:

      Well, if I am appearing to be “non-responsive” it has more to do with the fact that this forum is not supposed to be an academic seminar, it’s a comment section. My aim was to be brief as opposed to providing for you the specific research evidence out there to support the ideas that Amen espouses regarding “types”.

      And look: I’m not saying he came up with the ideas, rather, I am saying that if one is a practicing professional in the field of mental health or psychiatry, it is generally accepted science that different disorders can be attributed to different activity patterns in the brain. We DO have excellent evidence, both clinically and physiologically validated, that separate disorders require quite different medications, but that many also have a component of “ADD/ADHD” symptoms that were we to only address those pharmacologically, would either not respond or might be exacerbated. Have you ever treated a PTSD veteran with a CBI? He or she can present to you by saying: ” I feel like I am scattered, I can’t concentrate, can’t finish anything. I am disorganized and unfocused.” I have seen some who were prescribed Ritalin or Strattera by primary care physicians inexperienced with neurobiology who decided they have ADD/ADHD–which was really just a secondary diagnosis. Depression, Anxiety, Temporal Lobe disorders were also a problem with these patients and when a second drug was added that addressed these aspects of their disorders, they improved remarkably.

      Amen is a genius only in that he merely “cashed in” on something good psycho-pharmacologists and neuropsychologists have known for a long time–and learned from a combination of scientific research and yes, personal experience.

      1. Harriet Hall says:

        We all know that different disorders cause different activity patterns in the brain and that separate disorders require different medications, also that a patient can have multiple disorders and can improve when a second drug is added. The question is whether Amen’s 6 categories have been validated and if there are any controlled studies showing that using those 6 categories improves clinical outcomes. I am not asking for an academic seminar. It would be sufficient to provide a reference to a peer-reviewed study to answer each question. I suspect you can’t do that, so are obfuscating with generalities.

        1. AlisonM says:

          Amen has not published any studies. He charges almost $4,000 for an initial consultation and has multiple office branches. Surely, the profits provide all the evidence he needs.

  21. Ella says:

    Harriet, I find it not only rude in this informal setting, but quite odd for someone who wrote an editorial that was almost completely composed of opinion, conjecture and sweeping generalities, to demand I produce “peer-reviewed studies” to back up my statements. I was not “obfuscating”, I was offering my personal point of view. And by the way, I wouldn’t have bothered to state this before now, but this critique was written so poorly as to make me think a high school student produced it for Psych class. Won’t be putting much stock in your work in the future.

    1. WilliamLawrenceUtridge says:

      Dr. Hall’s original article was a general commentary on an entire field and some of the problems that infect nearly every study and reporting of results, based in part on Satel and Lilienfeld’s book. You raised a specific point about a specific alleged clinical entity or theoretical framework.

      You may present your personal point of view, that doesn’t mean it will be respected, particularly when it’s essentially an anecdote – that you found it (personally) useful. This is a blog about science-based medicine, personally finding something useful is unlikely to be convincing.

      1. Ella says:

        “This is a blog about science-based medicine, personally finding something useful is unlikely to be convincing.”

        So, you’re saying that all my discussions with professional colleagues in which they and I exchange our insights, based on our own experiences and the sum of our educations–without whipping out our “Up to Date” downloads and waving them at each other’s faces– have been essentially as valid as voodoo in terms of scientific merit?

        I find it quite interesting that when someone’s personal opinion included glowing praise for Hall’s assertions, there was no concern about them providing a “peer-reviewed journal” article to back up their opinion. This is about someone, Hall, who does not like to be contradicted and particularly perceived that in my comments, which they were not. And now we are stuck at the “digging in” stage of the pointless argument. Give me a break.

        “Science based blog’? Not quite, if this is what it will be composed of.

        1. WilliamLawrenceUtridge says:

          Not as valid as voodoo, but useful only for hypothesis-generating. Your opinion regarding the scientific merit of a topic is only as valid as your understanding of the best and most up-to-date scientific evidence.

          To bring it back to the original point – you found the 6-type ADHD classification (or whatever) to be useful. Can you point to any evidence supporting it? Or are you using it merely as a heuristic for personal use?

          How is asking for scientific proof of a concept not “science-based”?

          Also, if you find it displeasing to be here, you are not obligated to stay.

        2. “So, you’re saying that all my discussions with professional colleagues in which they and I exchange our insights, based on our own experiences and the sum of our educations–without whipping out our “Up to Date” downloads and waving them at each other’s faces– have been essentially as valid as voodoo in terms of scientific merit?”

          I think you’re making a logical error. Are all these conversations with your peers done purely on experience and not referencing *supposed* to be hypothesis validating? If so, what kind of statistical power would they have? If you don’t know or can’t put a useful bound on the statement then consider what “I found it useful” means if you’re not asserting that 6-types had some predictive power.

          1. Harriet Hall says:

            Yes. How valid were the Medieval bloodletters’ “discussions with professional colleagues in which they exchanged their insights, based on their own experiences and the sums of their educations”? The most important lesson of science is that we mustn’t assume something works before we have submitted it to controlled testing.

        3. WilliamLawrenceUtridge says:

          Ella, Harriet’s comment has prompted me to follow-up. I genuinely believe people have little conception of how deceptive memory and experience can be. Have you ever heard of Mistakes were made (but not by me) by Carol Tavris and some other guy? It spends large amounts of time discussing the failings of memory and consciousness. Memory is deceptive, extraordinarily so, and self-confirming. Elizabeth Loftus has dedicated her career to investigating memory and its failings. The order events happens becomes scrambled. Details are added and removed. Some are created wholesale (the satanic panic of the 80s is an example of this).

          It’s unfortunate, but the human mind is simply terrible at providing an objective record of events, and is also terrible at objectively assessing theories that we believe in. That is why the careful record keeping of medicine and science is quite vital towards progress.

          It is from this position that Dr. Hall (and myself) approach personal experience and how it contributes to science.

  22. Ella says:

    Again, I find it incredibly wierd that given the immense amount of pure opinion and conjecture Hall spouts in her original post here, that she or anyone else would have the hypocrisy to pretend that somehow my references to personal professional practice are completely inappropriate due to lack of scientific proof. I could cut and paste sentance after sentence Hall writes that literally sounds, AGAIN, like the poorly written product of a high school student assigned to write a persuasive essay against neuroimaging–generalizations, globalizations, biased statements, and unclear points. Which now, she is trying unsuccessfully, to obfuscate by pretending to holier-than-thou adherence to some self definition of “scientific methods”. What exact conrolled testing did Hall submit as evidence for the statements “Scans don’t reveal causes, only correlations. In teenagers, there is increased activity in regions associated with aggression when they play violent video games. That doesn’t mean video games trigger violence. Maybe aggressive teenagers enjoy those games more. Maybe parental inattentiveness leads to both more video game playing and more aggressive tendencies. Maybe those areas also light up with excitement and competition. Or maybe there’s another explanation altogether.” How is this an example of proving the validity of one’s statements?

    It is not that I find it “displeasing” here at this site, it’s totally with Hall, and now you, her apologist. So we have come to the point where the “digging in” stage of the pointless argument has tunneled all the way downn a rabbit hole of absurdity.
    At this point, “

    1. WilliamLawrenceUtridge says:

      Style aside, which is always subjective, can you understand that personal experience can be deceptive? That memory can betray? The necessity of careful controls? Can you understand why we might not give personal experience and even expertise a great deal of weight?

      Dr. Hall’s point is actually rather spot-on; brain scans are correlative without further manipulation. That’s rather the point – a brain scan does not prove causation, only that on an aggregate basis, different exposures lead to, on average, across time and person, changes in blood flow. Dr. Hall’s statements are a series of alternative hypothetical explanations for these correlative changes,and presents them as alternative explanations – in contrast with the definitive conclusions found in many press releases or Dr. Amen’s statements that present correlations as cause. She’s not presenting them as definitive and valid – merely illustrating that the explanations offered are only one possibility among many. She’s not trying to prove anything, she’s providing reasons to suggest why it’s not proof.

      I hope that clarifies things.

    2. “Scans don’t reveal causes, only correlations. In teenagers, there is increased activity in regions associated with aggression when they play violent video games. That doesn’t mean video games trigger violence. Maybe aggressive teenagers enjoy those games more. Maybe parental inattentiveness leads to both more video game playing and more aggressive tendencies. Maybe those areas also light up with excitement and competition. Or maybe there’s another explanation altogether.”

      Next time you might consider a shorter cite or be specific about the portion of the cite you are referring to. For all I know you’re arguing that we need to say, from first principles how correlations aren’t necessarily causative.

      Assuming you’re talking about Hall’s list of candidates for explaining a particular instance of neuroimaging. The list is collectively exhaustive and, at least in my interpretation doesn’t attempt to statistically weight the predictive power of a single element. What other than first-order logic is required to demonstrate the validity of said statement?

      Compare this with Harriet Hall’s concern over your use of “I found it useful”. At least, where I stand that list is not collectively exhaustive and seems to place predictive power on a single element.

      So those two things are not comparable. QED.

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