Brain Teasers

How I Rescued My Brain: A Psychologist’s Remarkable Recovery from Stroke and Trauma
by David Roland
Scribe, 2014, 305 pages, $29.99

The Biology of Desire: Why Addiction is Not a Disease
by Marc David Lewis
Scribe, 2015, 256 pages, $29.99

The rise of neuroscience has been described by both critics and cheerleaders as filling the gap left by the decline of theology and philosophy. Increasingly, it is the language of the brain and psychology that modern educated Westerners use in attempts to make sense of their experiences.

The fiercest critics include the British medical writer Raymond Tallis, who in his much-feted book Aping Mankind scathingly calls such trends “neuromania”. He laments the tendency to reduce all aspects of mind and behaviour to neuronal activation and the firing of microscopic cells.

Neuro-scientific findings are applied to a plethora of subjects, from neuro-marketing, which allows advertisers to highlight sections of the brain that fire in response to products and tailored messages, to neuro-ethics, in which ethical ideas are assessed by using brain imaging to determine people’s moral leanings when they are asked to deliberate on dilemmas.

All these emerging pseudo-disciplines are covered commonly in the press. The articles will often be accompanied by colourful brain scans, which have been described by the British writer Matt Crawford as a “fast acting solvent of critical faculties”.

Into this growth field come two recent books, one by an Australian psychologist, David Roland, who outlines his experience of having a stroke and mental illness, and one by Canadian psychologist and former heroin abuser Professor Marc Lewis who writes about his views on addiction theory.

Roland begins his book disoriented in hospital. His wife, who had found him wandering the house at dawn, is by his side. Initial scans do not reveal a stroke and he is sent to a psychiatric clinic, which is the beginning of his journey from psychological healer to patient. Roland writes, “I’ve finally lost it. I’ve had a mental breakdown.”

For several years, his life has been under pressure, from a recently deceased father to a troubled marriage and a distressed property portfolio. He visits a psychologist, whose expertise is in post-traumatic stress, who lo-and-behold diagnoses Roland with post-traumatic stress disorder. The trauma Roland has experienced is the vicarious one from engaging with many patients who themselves have been traumatised. Roland identifies strongly with this and writes in detail about prior patients of his, varying from prisoners who had committed brutal murders to sexually abused children. He then starts interpreting any kind of adversity in his life, from dealing with financial difficulty to having an argument with his wife, as a potential trigger to his past trauma. He is not impressed with a psychiatrist he consults for an insurance evaluation who suggests he may not have a traumatic syndrome and his dwindling finances and marital strain are likely to be the key factors in his psychological decline. The psychiatrist, correctly in my opinion, tells him that the notion of vicarious trauma is not accepted for the diagnosis of PTSD.

But Roland is wedded to the diagnosis and stops seeing the psychiatrist who disagrees with him. A stroke is confirmed months later, which leads him to further investigations and treatments. The value of the book lies in Roland’s outline of the variety of psychological treatments he searches out and experiences, from undergoing MRI scans to undertaking cognitive behavioural therapy with his psychologist, to practices such as mindfulness and applying cognitive exercises to improve memory and concentration. He even describes an encounter with the Dalai Lama, who whispers a message in his ear, although we are not told what it was. With each step Roland outlines technical information in an accessible, readable way such as describing the concept of self as an aggregation of brain states.

His journey of psychological discovery occurs while his marriage is breaking down and his financial life is untangling, mired in debts and imminent bankruptcy. The book is weighed down at times by Roland’s writings about his property failures and difficulties maintaining his marriage.

For a book about psychology and from a practising therapist, there is a lack of reflection on underlying personality factors that may have contributed to his decline, especially given that his problems began well before the stroke. For example, his wife responds, when asked about Roland’s recent difficulties, that she felt there were problems in intimacy and communication many years ago and that they had barely improved. Roland attributes his problems entirely to his recent diagnoses and laments his wife’s lack of understanding of his traumatic syndrome and depression. There is even a time when he is unable to control his temper and messes up the kitchen before suggesting it was all to do with the excessive firing of his amygdala, the brain centre that regulates responses to fear and outside threats.

But his memoir corresponds well with the times, where mental health is a growing part of discourse and a sense of greater human vulnerability has been cultivated. While this has been positive to causes such as reducing mental health and disability stigma, it may have had negative effects on our beliefs surrounding autonomy and responsibility, and psychological harm is being used in a range of political debates varying from workplace relations to racial discrimination.

Professor Marc Lewis makes stronger challenges to the disease model of mental health, with a particular focus on the notion of addiction, in his excellent book The Biology of Desire. He correctly suggests that medicine has perhaps gone too far in attempting to reduce the shame of addiction by enthusiastically promoting the medical model and regarding gambling and alcoholism as entirely brain diseases. He argues strongly that this outlook in fact hurts addicts by reducing their sense of empowerment. Lewis’s account is particularly interesting given his history of heroin addiction, which he dealt with in a previous book, Memoirs of an Addicted Brain. He has attracted critics from the liberal establishment, including being called a “zealot” in a review in the Washington Post.

The psychiatrist and writer Theodore Dalrymple wrote that nobody in history cured more people of addiction than Chairman Mao when he enforced the death penalty for heroin use. While Dalrymple, author of many fine books including one on addiction called Romancing Opiates, was being cheeky his comment highlights a key difference between addiction and other illness. Nobody suffering from tuberculosis or pneumonia has recovered after receiving threats of punishment. Furthermore, most addicts who do recover do so without receiving any formal treatment.

Lewis’s training is in developmental psychology and he taught in Canada for two decades but now works in the Netherlands. He argues in his book, illustrated through case studies, that while addicts’ brains do change, particularly with regard to pathways controlling reward and pleasure, categorising addiction as primarily a brain disease fails to take account of the plasticity of the brain. The brain is always changing and the changes in addicts are a result of learning pathways being hijacked. Addiction is more bad habit than disease.

An Australian entrepreneur is enamoured with what he calls the “clarity, power and potential” of amphetamines and how it enables him to work longer hours. A compassionate social worker and devoted wife builds a secret life around the consumption of prescription opiates. A socially awkward Irishman starts drinking to facilitate interaction with others, then social situations become primarily a place to drink, and then drinking becomes the reason to stay in his apartment for days on end. Lewis argues cogently that each of these sufferers has a psychic wound that the substance or habit helped them negotiate but the habit itself soon became self-perpetuating and often served to worsen the original wound. The addiction and its structure either confer meaning to one’s life or exist to disguise the absence of such meaning. He hints at this spiritual dimension of the affliction when he writes that addiction is a “vivid instance of the role of suffering in individual growth”.

Each case highlights a particular part of the brain and illustrates how its function, be it emotion, impulse, desire or automatic behaviour, is converted to the single goal of consuming the addictive substance. Desire is particularly central and Lewis writes that “addiction can only be beaten by the alignment of desire with personally derived, future- oriented goals”, something the medical model is ill equipped to accomplish, according to Lewis, because treatment tends to occur in institutional settings where there are long waits.

Lewis writes persuasively that while the brain is built to learn and change it is also wired to build pathways for repetitive behaviour, from brushing our teeth to riding a bike, so that we don’t have to think about all our actions consciously. Addiction is like a confidence trick in which the victims are our brains, which he illustrates through good metaphors. He writes:

I’ve compared addictions and love affairs and have shown they share many psychological and neurological features. Both addictions and love affairs are ignited by attraction—highly rewarding until they cause more trouble than they’re worth.

However, in arguing so persuasively about alterations to the brain, Lewis weakens his case that medical models are not necessary to explain addiction. It is precisely because the brain changes in fundamental ways that an aspect of appropriate treatment may require physiological modification, through anti-craving medications for example.

But his book is readable, entertaining and important, especially as debates about drugs and addiction are at the forefront of public policy, be it the legalisation of marijuana or antagonism towards the “war on drugs”. Furthermore, there has perhaps never been a time where novelty has been cheaper or more available, varying from fatty foods to internet pornography, so the problem of addiction is only likely to increase.

The success of both these books is a testament to the popular interest in neuroscience but also to its potential as a political fault line. Debates about vulnerability, disability and the law all increasingly lean on brain research. In spite of its great promise, the field is still a long way from providing a unifying theory of behaviour and action. If considered like travel guides, one book may be considered a pleasant stroll around the brain with a charismatic and occasionally annoying tour guide, whereas the second is perhaps a gritty bushwalk with a stubborn but highly knowledgeable leader.