Audio [MP3] | Video [YouTube]
Grove Auditorium, Magdalen College, Longwall Street, Oxford
3 November 2015, 6-8pm
i. The mechanistic explanations of neuroscience pose, in a new form, an age-old challenge to our ineluctable experience of the freedom of our ideas and intentions and their causal efficacy.
a. This is not simply an academic debate
b. This collision plays out with real consequences in systems of criminal justice and in psychiatry.
i. Courts have resisted expansion of mechanistic explanations because Western justice is based on a concept of moral agency that requires freedom of choice and action.
ii. Nonetheless, increasingly sophisticated mechanistic understandings are slowly gaining traction
ii. Psychiatry poses a more complex case: Mechanistic explanations of thought, emotion, and behavior have been both welcomed and reviled.
a. Mechanistic explanations have been seen as a path to better understanding and treatments and as freeing the mentally ill from unfair attributions of moral weakness.
b. Others see the same explanations as dehumanizing.
c. By offering new views on strange and frightening behaviors neurobiology has been seen as destigmatizing. Conversely neurobiology has been seen to create a picture of a hopelessly different brain, thus contributing to new forms of stigma.
d. Proponents and antagonists of neurobiology in psychiatry give very different answers to the central questions of how a person came to be a certain way and what can be done to make things better.
iii. Psychiatrists are not immune to the cognitive distortions invited by intuitive Cartesian dualism.
a. Too often conditions that are simplistically attributed to genetic or other strong biological causes are falsely seen through a filter of determinism and hopelessness: “you can’t change your genes”. Conditions attributed simplistically to lived experience are seen, often falsely, as more malleable.
b. Conditions ascribed to biological causes are often wrongly thought to be treated best with medicines or neuromodulation. Conditions ascribed to lived experience are often thought to be treated best with psychotherapy.
iv. The credibility of psychiatry has been damaged by premature claims of mechanistic understandings and by closed minded resistance to the implications of genetic and neurobiological discoveries.
a. Unyielding theoretical stances put patients at risk of poor clinical decision-making
b. The use of patients as theoretical cudgels was illustrated by some notorious cases and, in the U.S., law suits during the 1970’s and 1980’s.
v. Currently clinical pragmatism has become increasingly dominant in psychiatry, to the benefit of clinical care.
a. However, emerging science is significantly disconnected from the clinic.
b. Moreover, the theoretical underpinnings of psychiatry remain weak, dealing poorly with the intersection of mechanistic views with human intuitions and experience. I will address this weaknesses in the third lecture.