Book of the Month: The 21st Century Brain
Authors: Chris Nunn
Journal: Journal of the Royal Society of Medicine (2005)

Steven Rose, a neuroscientist specializing in memory and developmental biology, has a gift for explaining his subject in clear prose. After forty-five years in the field and nearing retirement, he sums up in The 21st Century Brain1 his views on where neuroscience has got to already and where he fears it may go in the future. The book thus falls into two parts.

The account of the brain today rehearses material already familiar from a multitude of books published over recent years. The most useful information, I thought, was on memory—a subject that ought to be central in any picture of mind or brain but which often gets treated almost as an optional add-on. What's more original than the factual content is the spin that Rose puts on the material. He's very against the dichotomies (nature/nurture, etc.) that pervade so much of the thinking. As for evolutionary psychology or behavioural genetics, those currently 'in' subjects, well... evolutionary psychology, he says, often amounts to nothing more than a collection of Just So stories, while behavioural genetics commits a category error whenever, as commonly occurs, it treats the genetics alone as having primacy over complex genetic/behavioural/environmental/cultural interactions. Another Steven (i.e. Steven Pinker, author of How The Mind Works) is his particular bete noire here.

The arguments are cogent, and I was pleased to find Rose sharing my amazement that evolutionary psychology is ever regarded as more than an amusing parlour game. Though it is almost entirely an armchair exercise, strong conclusions about our supposed 'human nature' have been drawn from it. But Rose does rather overdo his case against behavioural genetics. Early in the book, for instance, he can be read as saying that any attribution of modularity to mind is mistaken; but later, he happily recounts evidence showing that mind must be modular in some respects. The messages that he probably wanted to convey earlier were that modularity does not arise solely from genetically determined hard-wiring but through interaction of wiring rules with physical and social environments. Also, modularity is not the whole story about mind. One can only agree with him on both these points. So far so good. What about his views on the future, though?

He is less concerned about where neuroscience will go than about the uses that may be made of it. He says that neuroscience 'segues into neurotechnology'. The scene is set through description of the half-baked or plain wrong suppositions that underpin much past and current psychiatric treatment. His examples include the notions that depression is a serotonin deficiency disease treatable with Prozac, that schizophrenia is a dopamine excess disease needing dopamine blockade, and that 10% of American children have dopamine deficiency requiring Ritalin. In reality the supposed 'diseases' are ill-defined and arise from complex causes, most of which are social (at least in the case of attention-deficit hyperactivity disorder). Simplistic treatments are generally far from curative and have unpredictable effects on complex neural systems, often manifest in nasty consequences.

Going further back, he touches on the medical fashion for severing people's frontal lobes from the rest of their brains (lobotomy). An even better example, which Rose does not mention, has to do with the pre-World War II concept that chronic mental illness might be due to 'focal sepsis'. As a consequence many asylum inmates were quickly relieved of their teeth, tonsils, adenoids and even their appendices too. Some American surgeons threw in the whole colon for good measure, but doing this resulted in such horrific post-operative morbidity and mortality that few followed their lead. Will the future be like the past, is Rose's implicit question, the answer being 'yes'. What then can we look forward to?

One interesting point is that the rush to unwise treatment is driven not only by the commercial pressures and medical imperialism that he describes but also by the more pardonable urge to do something for the appalling weight of suffering that exists out there. New treatments often do seem beneficial in some patients irrespective of what is done. Double-blind trials should in theory obviate this difficulty, but in practice they prove temperamental or unreliable guides. Hence, fashionable new treatments quickly become established before their downsides have become manifest. Beneficence detached from sound knowledge of the brain, Rose might have said, can be just as harmful as the activities of those popular scapegoats the marketing departments of drug companies. Indeed the two often work in concert to produce absurdities.

So we can expect more of the same. People will fasten prematurely on new techniques or theories to promote treatments that will turn out to be mixed blessings at best. Moreover, the military and the police will continue to research means of disabling people, controlling their thoughts or detecting their lies. Much of this is pie in the sky, Rose points out. A good example cropped up as I was writing this review. News came that one of Sony's divisions has applied for a patent on a technique to create virtual-reality experiences by beaming ultrasound into people's brains. But even assuming the company did not fry or scramble their customers' brains in the process, or convert their glia into gliomas, how could they ever achieve the necessary precision? Pictures of brain scans in books look very nice, but they are usually averaged pictures. In the real world every brain differs from every other in anatomy and in the way function is distributed across the anatomy.

Rose is pessimistic about the uses that may be made of future neuroscience. I am less pessimistic. He and I are in agreement that no purely neural 'mind control' technique is likely to come close to the efficiency of methods used by Nazis and Communist parties in the past. Social factors have far more influence than physical ones on what we think and how we behave. However, he puts less weight than I would on the fact that increasing knowledge of the brain and body has on the whole reduced the chances of very nasty treatments coming into vogue. The same applies, to a lesser extent, to means of control. To put it crudely, if one is going to take a useless treatment, better diazepam than the older phenobarbitone; if one is going to be shot, better with a taser than with a Colt 45. And ameliorations such as these depend on progress in the underlying science and technology. He is not even particularly optimistic for the prospects of what is often considered one of the most promising future techniques—the use of (neuro)genetics to predict which treatment is going to benefit a patient and do no harm. His reasons for gloom are, first, that the more targeted a treatment, the smaller the number to whom it will apply so the less incentive companies will have to develop it; second that, in psychiatry at least, there is scant prospect that precise genetic causes will be identified.

In the final chapter Rose calls for establishment of ethical bodies that will oversee neuroscience, akin to those that concern themselves with genetic engineering. I am not so sure this is a good idea. Interventions of this sort commonly generate confusion, impede progress, or end up having the opposite effect to that intended. As Rose himself points out, governments tend simply to ignore recommendations they don't like. Surely what we need are more people like Rose, not to pontificate over ethics but to tell us what the brain is really like and to let us know when our thinking about it has gone awry. In The 21st Century Brain he has made an excellent start.