Book Review from the latest issue of JCS
The Disordered Mind: What Unusual Brains Tell Us About Ourselves
New York: Farrar, Straus and Giroux, 2018, 285 pp. (Hardcover)
Reviewed by Donald Mender
Eric Kandel’s recent book, The Disordered Mind: What Unusual Brains Tell Us About Ourselves, provides a superb, assiduously documented, up-to-date synopsis of neuroscientific progress toward understanding the biology of psychiatric disease. The volume, published with numerous helpful graphics, offers its summary in a compact yet plain spoken form, accessible to both mental health professionals and curious laypersons. Efficiently paraphrased correspondences between brain-based findings and pathological forms of consciousness cogently outline a roadmap of potentially productive answers to some of what David Chalmers (1996) has dubbed ‘easy problems’ commensurable with such correlations. Professor Kandel’s credentials, including not only training in clinical psychiatry but also a Nobel Prize for basic paradigm-shaping research clarifying neuronal mechanisms of learning in non-human nervous systems, lend massive authority to his text.
Except for a few judicious digressions, chapter headings of The Disordered Mind remain roughly in line with internationally established nosologies of mental illness. This communicative strength provides clinically oriented audiences with a conventionally friendly guide through the sometimes unfamiliar terrain of cutting edge basic science.
An introduction invites readers to view destigmatizing progress in biological psychiatry as a route toward greater respect for the individual humanity of psychiatric patients.
Chapter 1 identifies fragility of the self as central to psychopathology. This key issue is framed historically by integrative possibilities in the pioneering paradigms of gross anatomical brain localization, neurohistology, neuronal electrophysiology, synaptic pharmacology, neurocomputation, descriptive psychiatry, psychogenetics, functional brain imaging, and animal models.
Chapter 2 considers empathic deficits comprising the autism spectrum as highly heritable neural dysfunctions with phylogenetic roots, polygenetic transmission, and phenotypic expression in an overly arborized ‘social brain’.
Chapter 3 traces depression to its own specific intracranial ‘circuit’, damaged by stress-like molecular influences and treatable through a mix of pharmacological, electrical, and narrowly targeted psychotherapeutic modalities. Possible mechanisms of biological treatments for mania are tentatively suggested.
Chapter 4 links the cognitive incoherence, psychotic symptoms, social withdrawal, and reduced motivation of schizophrenia to excessive prefrontal pruning and impaired synaptic modulation. Early environmental interventions, timed as buffers against developmental windows of inherited vulnerability, are advocated.
Chapter 5 profiles several common dementias through their differing gross and microscopic neuroanatomical landscapes, genetic risks, preponderant ages of onset, and proximately causal protein deformations.
Chapter 6 explores neural wellsprings of the creative arts in both healthy and ‘disordered’ brains.
Chapter 7 compares the clinical dyskinesias of Huntington’s and Parkinson’s disease in terms of respective macroanatomies, histologies, protein chemistries, and treatment options. The monogenetic origin of Huntington’s chorea, responses of parkinsonian rigidity to electrical brain stimulation, and shared molecular features of both motor disturbances with prion infections are discussed.
Chapter 8 analyses the biology of anxiety disorders, antisocial personality traits, and allied traumatic syndromes through subcortical and cortical sequences of pre-conscious and conscious emotional processing.
Chapter 9 connects addictive behaviours to learned associations, pharmacologically driven by the brain’s reward system and exacerbated by adverse genetic factors.
Chapter 10 examines the compelling case for biological determination of gender identity.
Chapter 11 approaches scientifically elusive aspects of consciousness via a survey of unconscious neural concomitants. Successive research contributions from the time of Helmholtz, James, and Freud through our own era of Baars, Kahneman, and Tversky are catalogued.
The concluding chapter of Professor Kandel’s book forecasts a coming merger of psychiatry with neurology.
All the above details, scaffolded by a straightforward table of contents and served up with engaging stylistic clarity, deliver a coordinated and highly assimilable surface structure of late breaking biomedical discoveries. However, this book review’s intent in the context of an interdisciplinary journal concerned with consciousness studies is not to assess any practical clinical recommendations or proscriptions by Professor Kandel regarding particular psychiatric diagnoses or treatments. Unfortunately, The Disordered Mind must be faulted at a deeper, more abstract philosophical level with direct bearing on consciousness studies. The entire text is haunted by a sustained, problematic implication that future elaborations of the assembled empirical data, plausibly addressing metaphysically ‘easy’ research problems, may ultimately solve the ‘hard problem’ (Chalmers, 1996) of consciousness as well.
The book’s introduction asserts that ‘the biological approach to mind is beginning to unravel the mysteries of… consciousness’. Yet objective evidence, corollary deductions, and predictions of future progress by the author fail to point convincingly toward any final bridge across Joseph Levine’s (1983) ‘explanatory gap’. Professor Kandel, almost as an aside, does concede that ‘my relation to my own consciousness is not like my relation to anybody else’s’ in that ‘I am pretty sure that something similar is going on in you… [only] because I am observing your behavior, not… actually feeling… your’ perceptions. However, after this all too brief first-person nod to the vexing issue of other minds, readers are left with no intuitively causal or formally principled understanding of possible architectonic blueprints, laid out concretely in what the author calls ‘usual’ mechanistic terms, that might subserve the raw subjective experience of apparent conscious interiority. Professor Kandel’s suggested ‘theoretical’ programme of ‘turning on’ and ‘turning off’ consciousness by toggling objectively correlated behaviours of neuronal ensembles begs Thomas Nagel’s (1974) phenomenalist question of ‘what it is like’ to be conscious and sidesteps the challenge, posed decades ago by Herbert Feigl (1967), of a gedanken-experimental ‘autocerebroscope’. The brute private feel of consciousness thus remains schematically untethered to publicly observable biology. Absence of a tether is tantamount to persistence of a mechanistically unsolved hard problem.
Notwithstanding Feigl’s theoretical gadget or, as cited in The Disordered Mind, reticular animal preparations empirically scrutinized by Moruzzi and Magoun, nobody has yet even begun to design from first principles a workable mechanism knitting together neuroscience and the qualitatively subjective immediacy flowing through normal and ‘disordered’ consciousness as a continuum of ‘what it is like’. That is to say, conscious correlates of healthy and impaired brain states have not been ‘explained’ according to some fundamental, algorithmically deep construct. This epistemological difficulty does not burden purely mechanical sorts of pathogenesis: normal and impaired regions of the Frank Starling Curve, a succinct length-tension readout of the heart as a mindless pump, have been successfully reduced to mechanisms as crude as ratchet-like actin/myosin overlap (Hibbard and Jewell, 1982). Pathologies of consciousness, by way of contrast, entail irreducibly mental phenomena, ‘deviant’ in form (e.g. loose associations), content (e.g. delusions and hallucinations), and/or timing (e.g. sleep disturbances). Hence, the hard problem presents a substantive yet insufficiently emphasized paradigmatic stumbling block for biological psychiatrists. The Disordered Mind does not grapple effectively with that affront to mechanistic complacency.
The book appears to fall short in this regard because of a regrettably myopic philosophical foundation, stated at the outset and periodically resurfacing in subsequent metaphysical assertions. The first chapter predictably rejects mainstream neuroscience’s reflex bogeyman — substance dualism — and promotes with rote certainty a glib claim that Descartes ‘had it backward’. The Disordered Mind then goes on to extol as its chosen alternative: a mixed, mostly monistic stew, unsystematically blending features of eliminative materialism, naturalistic intentionality, computational functionalism, and emergent complexity. This ostensibly enlightened melange of quasi-reductionist perspectives, supplemented by Darwinian insights, is attributed to a ‘school’ of philosophers ‘such as’ Patricia Churchland (1986) and John Searle (1998), whose mutual divergences are ignored, and whose mutually convergent disagreements with the likes of Chalmers, Levine, and Nagel are left critically unexamined.
One additional philosophical blind spot further compromises the metaphysics of Professor Kandel’s book. The focus at issue is self-consciousness. Subjective continuities of consciousness, binding memories over time and sensory modalities across space (Crick, 1994), arise within the framework of first-person epistemology. The Disordered Mind seems implicitly to advance an unwarranted conclusion that a unified sensorium necessarily entails self-consciousness, socially iterated as orders of intentionality in projected ‘theories of mind’. Thus, tenable epistemic distinctions between the subject as a source of consciousness and selves as objects of consciousness are not engaged.
All the aforementioned conceptual elements combine to promote the author’s presumptive 1) search for a neurobiology of consciousness in globally distributive properties of the healthy human self’s neural networks, 2) conclusions about the biological basis of consciousness from correlations between dysfunctional phenomenal experiences and underlying malfunctions in brain ‘circuitry’, and 3) expectation of future leaps beyond ‘easy problems’ to the hard problem of consciousness through research methods refined from existing techniques like functional brain imaging, genetic probes, and animal models. Each of these three agendas has indeed harvested empirical findings that shed a restricted kind of light, valuable in its own way, on the ‘easy problem’ of consciousness in relation to neuropsychiatric health and disability. Yet each agenda has also remained mired within limitations of older embedding paradigms.
The first agenda, tending toward emergentism, rests on the formidable bottom-up computing power of neural networks (Hertz, Krogh and Palmer, 1991), mathematically adapted from venerable formalisms of statistical mechanics. Despite these underpinnings, one may reasonably doubt the rigour of pertinent analogies between, on one hand, emergence of macroscopic physical properties like temperature from microscopic physical properties like molecular velocities, and, on the other hand, ‘emergence’ of consciousness from interneuronal dynamics. Moreover, parallels between the brain and today’s silicon webware and between mind and the latest cloud software might raise suspicions of trendy reification. The history of psychobiology is littered with timely but flawed hypostases (Mender, 2010b); examples include the alleged neural ‘hydraulics’ of Freudian libido and Sherrington’s loom-like conception of the brain. Many such images have derived from the zeitgeist of contemporaneously dominant productive technologies, which for the youthful Freud were driven by steam engines and in Sherrington’s heyday were heavily represented by industrial textile machines. We can justifiably ask whether neural computationalism is just another economically inspired metaphor, perhaps falsely fetishizing one more fashionable gizmo as a supposedly perennial fountainhead of human subjectivity. Notions of digital computation by the brain may fall out of favour during our civilization’s next episteme, when new inventions, including post-digital computers dependent on quantum logic, move as replacement fetishes from the outer wings of scientific drama to techno-idolatry’s pulpit.
The second agenda, inferring normal localization of function from ‘glitches’ in neural networks or their genetic seeds, has grown ever more subtle through computational enhancement. Nevertheless, all inferences to a harmonious brain and body from the disruptive effects of pathological ‘lesions’, whether these pathologies are grossly visible or require microassays, constitute a single static overall investigative strategy, basically unchanged since the days of Broca and Wernicke. The downside of localizing approaches, offsetting their legitimate aspects, is made plain by a thought experiment. Imagine that a person possessing no technical acquaintance with refrigeration encounters an air conditioner for the first time. Out of curiosity, the neophyte opens the air conditioner’s cover and removes a single wire. The air conditioner then starts to whine, and the novice infers that the function of the wire is to suppress the whining. One must ask how meaningfully such a naïve conclusion might help in reconstructing from scratch the air conditioner’s molar operation, including nonlinear synergies among components. Similarly, discrete biological lesions, irrespective of their scale, may have negligible value in reverse-engineering the diffuse neural basis of a consciousness whose global form they distort.
The third agenda, wagering that refinements of brain scans, molecular genetics, and non-human experimentation will take us from ‘easy’ neurobehavioural correlations to ‘hard’ neuro-experiential explanations, might prove to be an enterprise of misplaced faith. A definitive shift from correlative data to true mastery of the hard problem may require not mere evolution of science but a thoroughgoing revolutionary leap. In the past, scientific revolutions have exacted a heavy destabilizing price in assaults on centres of established authority (Mender, 2010a). During the Renaissance, this cost translated into heliocentric astronomy’s disenthronement of the human subject’s geocentric home. More recently, physics has had to endure the indignity of demotion from the potential omniscience of Newtonian observation to epistemic constraint by Heisenberg’s uncertainty principle. One should ask what unanticipated flavour of culturally extant self-esteem might be threatened by a satisfactory solution of the hard problem. Perhaps the scientific method itself, admirably employed with consummate skill by Professor Kandel, will be unmasked as fully germane only in limiting cases, like ‘effective theories’ of particle physicists. We cannot yet clearly conjure the larger context of a more comprehensive methodological successor, transcending both naturwissenschaften and geisteswissenschaften to mend the Cartesian cut without ontological reduction.
Chalmers, D.J. (1996) The Conscious Mind: In Search of a Fundamental Theory, New York: Oxford University Press.
Churchland, P. (1986) Neurophilosophy: Toward a Unified Science of the Mind-Brain, Cambridge, MA: MIT Press.
Crick, F. (1994) The Astonishing Hypothesis: The Scientific Search for the Soul, New York: Touchstone.
Feigl, H. (1967) The ‘Mental’ and the ‘Physical’, Minneapolis, MN: University of Minnesota Press.
Hertz, J., Krogh, A. & Palmer, R. (1991) Introduction to the Theory of Neural Computation, Redwood City, CA: Addison-Wesley.
Hibbard, M. & Jewell, B. (1982) Calcium- and length-dependent force production in rat ventricular muscle, Journal of Physiology, 328, pp. 523–540.
Levine, J. (1983) On leaving out what it’s like, in Davies, M. & Humphreys, G. (eds.) Consciousness: Psychological and Philosophical Essays, Oxford: Blackwell.
Mender, D. (2010a) De-centering the subject of DSM, Bulletin of the Association for the Advancement of Philosophy and Psychiatry, 17 (2), pp. 67–-69.
Mender, D. (2010b) Final comment, Bulletin of the Association for the Advancement of Philosophy and Psychiatry, 17 (2), pp. 69–70.
Nagel, T. (1974) What is it like to be a bat?, Philosophical Review, 83 (4), pp. 435–450.
Searle, J. (1998) Mind, Language and Society: Philosophy in the Real World, New York: Basic Books.