Why Addiction Narratives Matter

By Katie Givens Kime

Image courtesy of

Merrimack Repertory Theatre.

“My Higher Power is: Science!” proclaims Sean, a newly recovered alcoholic. “Sean” is the lead character in a comedic play, “The White Chip,” which premiered last year at Merrimac Repertory Theatre outside of Boston, Massachusetts. Written by Sean Daniels, the play dramatizes Daniels’ own near demise from alcoholism, and his experience of recovery. Neuroethics is writ large as the play tells the story of how critically important various addiction etiologies can be for those struggling with alcoholism, or addiction of any sort. In Sean’s case, the etiology is the brain disease model of addiction (BDMA) in a notable combination with the “Higher Power” understanding of 12-step programs, which he credits with saving his life. Behind the curious twists of the play, questions linger: which model of addiction should be presented to those in recovery, when so much conflict exists amongst addiction researchers, clinicians, and recovery care providers? At what point does an effective (potentially life-saving) narrative of addiction etiology supersede the obligation to provide all sides of the controversial matter of addiction modeling?

When Sean “hits bottom,” he has destroyed his career, his marriage, his health, and nearly lost his life while driving drunk. He enters a rehabilitation facility, but struggles with the suggestion that he find a “Higher Power.” Such a practice is reflective of the metaphysical claim central to Alcoholics Anonymous, and every other 12-step program: surrender to a Higher Power of the addict’s understanding, and is perhaps the most significant distinguishing feature separating 12-step methods from other recovery pathways. Perhaps most notable in Sean’s struggle is that he did not see his inability to assent to any sense of a Higher Power as mere philosophical or theological discrepancy. After trying everything, he believed he needed some sort of dramatic internal change, and that his very life hung in the balance.

Finally, Sean meets a different group of A.A. veterans who proclaim to Sean that what he really needs is “Science,” and to understand the chemicals in his brain. The word “brain” occurs 17 times following this scene. In a line that seemingly summarizes Sean’s success in finding sobriety, he says: “People ask me, why did it stick that time? I believed in something larger than myself. My higher power is: science. It’s my faith in science that keeps me sober.” Sean’s Higher Power is the neuromechanisms (“science”) of his own “brain”, which ostensibly has more power than he does, and “wants the best” for him. Britt’s decision to introduce Sean to a particular A.A. group of predominantly Jewish men led to the inner experience/realization that Sean credits with saving his life.

Actors Jeff Binder and Ben Evett in "The White Chip."

Image courtesy of photographer Meghan Moore.

Across medical and social scientific literature, an inverse relationship between spirituality and substance abuse consistently characterizes research findings on recovery from substance use disorders (Geppert et al., 2007; Cook, 2004; Swora, 2004; Dermatis & Galanter, 2016; Ross 2013). Sean’s case is an interesting illustration of this finding, while also mirroring another finding: that the BDMA is immensely prominent in popular and medical discourse, as well as in research funding priorities for addiction.

Notably, the BDMA cannot be traced back to a particular group of scientists, a common thread of articles, or research findings. The most identifiable pivot point for the growth of the BDMA is the former Director of the U.S. National Institute on Drug Abuse (NIDA) Alan Leshner’s landmark 1997 Science cover story, “Addiction is a brain disease, and it matters.” In that essay he argues that addictive drugs “hijack the reward centers of the brain” (p. 45). Within several months of Leshner’s article, Bill Moyers used the phrase “hijacked the brain” in 1998 on a PBS television series on addiction, citing Leshner (Lewis, 2015, p. 17). Several historians and researchers of addiction have noted the way in which “hijack” stayed in the vocabulary of addiction for many years after that (Campbell, 2007, p. 201).

In terms of funding, the BDMA has continued to exert notable influence (Dunbar, Kushner & Vrecko, 2010, p. 3). In 2014, NIDA devoted 41% of its funding to basic neuroscience and a further 17% to the development of novel pharmacotherapies based on basic neuroscience, yet only 24% was devoted to epidemiology, health services, and prevention research (Field, 2015). Some researchers have noted the degree to which the accounts of various neuroscientific teams differ on critically important issues, such as which neuromechanisms are relevant for understanding addiction, and even how such mechanisms operate (c.f. Koob & Le Moal, 2006, p. 18-19). Another sort of response is medical anthropologist Daniel Lende’s call for a neuroanthropological theory of addiction rather than a “brain-driven” theory:

Chemical imbalances and hard-wired pleasure circuits have been prominent public explanations advanced by some biologists for addiction. But the real story is more complex, even at the level of neurobiology. Addiction is not simply a chemistry experiment gone wrong, some poor sap in the ‘laboratory of the street’ mixing the wrong substances inside his brain. The parts of the brain where addiction happens are not single, isolated circuits — rather, these areas handle emotions, memory, and choice, and are complexly interwoven to manage the inherent difficulty of being a social self in a dynamic world. (2012, p. 342)

Along with Lende, others have pointed to the problems with the BDMA as a premise for research and/or public understanding of addiction. A fascinating chain of conversations published in the prestigious journal Lancet Psychiatry made public the debates about the validity and value of the BDMA. A NIDA publication preface by Volkow illustrates NIDA's reliance upon the premises of the BDMA, with bold claims like, “As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior” (Volkow, 2014).

Actors Isabel Keating, Jeff Binder, and Ben Evett

in "The White Chip." Image courtesy of

photographer Meghan Moore.

Many social scientists refer to the BDMA as the “NIDA paradigm” (Dunbar, Kushner & Vrecko, 2010, p. 3). When challenged on the lack of conclusive evidence for the BDMA, Volkow’s chief defense is a pragmatic one: that the BDMA frees those suffering from addiction from the shame of morality models of addiction, which continue to linger. The loudest response to this argument comes from neuroscientists and others who argue for something along the lines of a “learning disorder” model of addiction. Marc Lewis, a neuroscientist who struggled with drug addiction in his 20s, argues that "the disease idea is wrong...Medical researchers are correct that the brain changes with addiction, but the way it changes has to do with learning and development -- not disease” (2015, p. xi). Lewis’ concerns are reflective of questions raised by other scholars, such as psychiatrist Sally Satel and psychologist Scott O. Lilienfeld (2013, 2014). However, Volkow’s point remains: to claim that addiction is a disease rooted in brain mechanisms seems to carry far more weight with people trying to recover, and those surrounding them.

In “The White Chip,” Sean is an intelligent and accomplished adult – why can’t he just stop? No explanation freed him from his sense of shame and defeat so much as an etiology that incorporated neurological mechanism. Sean incorporated the most important mechanisms into the script of his play, with characters “Lenny” and “Stuart” serving to tell the story of his most important conversations with members of the group:

LENNY: Here’s the truth - Dopamine is the chemical that when it’s released in your brain, you feel great. The drug that’s been in your brain since you were born.

STUART: Your brain is always trying to maintain balance, and therefore the more you drink, the less dopamine your brain releases.

LENNY: Your brain is with you all the times you snuck a drink, so when you say…

STUART: ‘‘I’m quitting, I really mean it this time…really!’’

LENNY: Your brain doesn’t believe you. So, on Day 2 of sobriety you have no alcohol and no dopamine from your brain, because it’s sure the alcohol is coming.

STUART: So, you feel terrible.

LENNY: Your body is signaling you that it needs you to hold up your end of the current destructive bargain.

STUART: So terrible.

LENNY: That spiritual awakening most drunks feel around Day 90 when they look up and suddenly the sky is bluer and everything seems like it’s gonna work out, and they get on their knees and thank god -- that’s chemistry.

STUART: That’s your brain FINALLY believing you that you won’t drink and therefore it releases chemicals into your brain to maintain balance.

LENNY: Yes, you will walk out the door and suddenly feel light and notice trees and children and feel happy to be alive, and that MAY be god, but it is definitely chemistry. Just stop drinking for 90 days and let science save your life.

…LENNY: Don’t worry kid -- most people are dopamine junkies -- they just think it’s free will.

…LENNY: So, to stay sober, you have to fight your own brain. Fight chemistry with reason.

It seems that if Sean’s safety is the top priority, than perhaps any narrative he holds about the etiology of addiction, so long as it keeps him from drinking again, is worth supporting. If this is true, then perhaps NIDA has it right: the BDMA is highly effective at battling the overwhelming social stigma of addiction as a lack of willpower, or some other sort of individual fortitude. On the other hand, critics raise valid concerns about the inaccuracy, or at least unfounded nature, of the concept of addiction as a “brain disease.”

In Sean’s monologue near the end of the play, he proposes several reasons why this formulation of Higher Power as “Science” allowed him to maintain sobriety when all other methods had failed:

SEAN: ... It’s my faith in science that keeps me sober. Though it seems to work for the vast majority, and I never try to talk anybody out of it -- ever ever ever - it does make you think, how many people are like me, and then don’t make it because we lead with God and not with science? Does belief in one exclude the other?

Actor Jeff Binder, playing "Sean" in "The White Chip."

Image courtesy of photographer Meghan Moore.

Whether or not these beliefs and etiologies about the nature of addiction exclude one another, it is illuminating to hold the example of Sean alongside the stacks of literature and research debating various models of addiction. At its best, neuroethics often takes up the task of performing reflexivity for the field of neuroscience, urging a critical look at the presumptions on which the discipline is based, and the repercussions of them. For addiction, what are the repercussions of what Vidal (2009) notes is the dominating presence of “brainhood” in contemporary discourse, in which the modern self operating principally as a “cerebral subject”? Sean’s case is a fascinating portrait of personifying “science” as an entity, and a trustworthy belief system of sorts, while also viewing his “brain” as an entity simultaneously identical with his self, while also separate. In some ways, Sean’s contradictory view of himself calls to mind what Jan De Vos (2016, p. 26) describes as “the situation of the colourful brain scan engendering an oh-my-god-is-this-what-I-am subject.” In other ways, it is a reminder that we all carry with us, in our views of the world and ourselves, various paradoxes and contradictions.

In the end, what responsibility do clinicians and caregivers have, in providing care and recovery options, to offer multiple models and etiologies of addiction, for people who struggle like Sean? It seems that if saving lives is our top priority, then finding the models that are most compelling for each individual struggling to recover is a worthy consideration.

References



Campbell, N. D. (2007). Discovering addiction?: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press.



Campbell, N. D. (2010). Toward a critical neuroscience of “addiction.” BioSocieties, 5(1), 89–104.



Cook, C. C. H. (2004). Addiction and spirituality. Addiction, 99(5), 539–551.



De Vos, J. & Pluth, E. (2016). Neuroscience and critique: exploring the limits of the neurological turn. Abingdon, UK?; New York: Routledge.



Dunbar, D., Kushner, H. I., & Vrecko, S. (2010). Drugs, addiction and society. BioSocieties, 5(1), 2–7.



Earley, P. H. (2017). RecoveryMind Training: A neuroscientific approach to treating addiction. Las Vegas: Central Recovery Press.



Geppert, C., Bogenschutz, M. P., & Miller, W. R. (2007). Development of a bibliography on religion, spirituality and addictions. Drug & Alcohol Review, 26(4), 389–395.



Dermatis, H., & Galanter, M. (2016). The role of twelve-step-related spirituality in addiction recovery. Journal of Religion and Health, 55(2), 510–521.



Field, M. (2015, February 6). Addiction is a brain disease…but does it matter? Retrieved February 16, 2017, from https://www.nationalelfservice.net/mental-health/substance-misuse/addiction-is-a-brain-diseasebut-does-it-matter/



Hall, W., Carter, A., & Forlini, C. (2015a). Brain disease model of addiction: misplaced priorities? The Lancet Psychiatry, 2(10), 867.



Hall, W., Carter, A., & Forlini, C. (2015b). The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises? The Lancet Psychiatry, 2(1), 105–110.



Khantzian, E. J. (2003). Understanding addictive vulnerability: An evolving psychodynamic perspective. Neuropsychoanalysis, 5, 5–21.



Koob, G. F., & Moal, M. L. (2005). Neurobiology of addiction (1st ed.). San Diego: Academic Press.



Lende, D. H. (2012). Addiction and neuroanthropology. In D. H. Lende & G. Downey (Eds.), The encultured brain: an introduction to neuroanthropology (pp. 339–362). Cambridge, MA: MIT Press.



Leshner, A. I. (1997). Addiction is a brain disease, and it matters. (Cover story). Science, 278(5335), 45–47.



Lewis, M. (2015). The biology of desire: Why addiction is not a disease. New York: PublicAffairs.



O’Connor, R. (2015). Rewire: Change your brain to break bad habits, overcome addictions, conquer self-destructive behavior (Reprint ed.). New York: Plume.



Ross, S. (2013, April). Psilocybin, addiction, and end of life. Presented at the Psychedelic Science Conference, Oakland, CA.



Satel, S. L., & Lilienfeld, S. O. (2013). Brainwashed: the seductive appeal of mindless neuroscience. New York: Basic Books.



Satel, S., & Lilienfeld, S. O. (2014). Addiction and the brain-disease fallacy. Frontiers in Psychiatry, 4.



Spiegelman, E. (2015). Rewired: A bold new approach to addiction and recovery. Hobart, NY: Hatherleigh Press.



Swora, M. G. (2004). The rhetoric of transformation in the healing of alcoholism: The twelve steps of Alcoholics Anonymous. Mental Health, Religion & Culture, 7(3), 187–209.



Szalavitz, M. (2016a). Unbroken brain: A revolutionary new way of understanding addiction. New York: St. Martin’s Press.



Szalavitz, M. (2016b, June 25). Can you get over an addiction? New York Times. Retrieved from http://www.nytimes.com/2016/06/26/opinion/sunday/can-you-get-over-an-addiction.html



Trujols, J. (2015). The brain disease model of addiction: challenging or reinforcing stigma? The Lancet Psychiatry, 2(4), 292.



Vidal, F. (2009). Brainhood, anthropological figure of modernity. History of the Human Sciences, 22(1), 5–36.



Volkow, N. D. (2014). Preface: How science has revolutionized the understanding of drug addiction. In Drugs, brains, and behavior: The science of addiction. Washington, DC: National Institute on Drug Abuse.



Volkow, N. D., & Koob, G. (2015). Brain disease model of addiction: why is it so controversial? The Lancet Psychiatry, 2(8), 677–679.

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Kime, K.G. (2017). Why Addiction Narratives Matter. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/03/why-addiction-narratives-matter.html

M[Emory] Enhancement and its Implications

By Shweta Sahu

Imagine a situation in which you suffer from severe anterograde amnesia, a form of short term memory loss, and can’t recall information presented to you even 7 seconds before-- let alone being able to remember the one thing you went to Target to buy, but forgot. Such is the case of Clive Wearing, a man known for his lack of short term memory. His wife notes, “you ask him a question and he’ll give you an answer but while he’s giving me the answer, he’s already forgotten the question. That’s how short it is.” He himself notes “the brain has been totally inactive—day and night the same—no thoughts at all.” Though this is one of the most severe cases of amnesia observed, it underscores how crucial memory is not only to every day functioning, but also for one’s sense of self. Autobiographical memories and the ability to recall these emotional and important events are an integral component of one’s identity. These events, in turn, get tied into personal narratives that our personalities are built on. In the case of Mr. Wearing, he is stuck in this personality because of the damage to his hippocampus and closely related brain regions, an area of the brain necessary for transferring information from short term to long term memory. As a result, he reports that he feels like he is dead and is constantly waking up into a new reality.

Video courtesy of YouTube

Realizing how significant memory is one thing, but the ability to recover or enhance memory is another. At our recent Neuroethics and Neuroscience in the News event, Dr. Inman, a postdoctoral fellow at Emory Department of Neurosurgery discussed “memory enhancement through brain recording and stimulation, and the implications of brain prosthetics for memory, identity, and autonomy.” In particular, his work focuses on patients with treatment-resistant epilepsy. These patients also often suffer from memory impairment and are often willing to participate in research while they are in the hospital to help localize the location where their seizures start.

Dr. Inman conducts research by recording and stimulating through electrodes directly embedded of the brain. Brain stimulation has been used since as early as the 1900’s to treat intractable neurological diseases. There are two general forms of brain stimulation: invasive (such as deep brain stimulation [DBS] and electrocorticography [ECoG]) and noninvasive (including transcranial direct current stimulation and transcranial magnetic stimulation).

The current state of affairs:

A 2012 study conducted by Suthana et al suggested that stimulation of the entorhinal cortex results in enhancement of spatial memory. However, a more recent study performed by Jacobs et al refuted this claim, and found that memory was in fact impaired when the entorhinal cortex was stimulated. The study done by Jacobs et al is part of a larger project by DARPA (Defense Advanced Research Projects Agency) entitled RAM (Restoring Active Memory), the goal of which is to create an implantable device, similar to a pacemaker for the brain, that can restore an individual’s memory post traumatic brain injury.

Image courtesy of Pew Research Study

Seeing as human memory enhancement is the goal, it’s not unreasonable to consider the implications of these technologies in a general public of consumers already eager to experiment with a number of cognitive enhancers from pill and drinks to wearable technologies. A recent study surveyed the “public opinion on the future use of brain implants” and revealed that as of March 2016, Americans were more accepting of an implanted device if its effects were temporary and controllable. Moreover, the study also found that Americans were especially reluctant to enhance cognitive function beyond natural abilities, as 67% said that an implanted device for improved cognition and concentration would be taking technology too far.

Dr. Inman indicates that scientists are still trying to figure out what’s happening in the brain during memory creation and which paradigms of stimulation result in which clinically-meaningful enhancement effects, as well as, any potential side effects. Furthermore, Inman states that in his current work stimulating brain regions involved in emotional memory enhancement, they have been able to enhance memory for basic objects by stimulating during learning one day and showing better memory of the previously stimulated objects the next day. Studies like this suggest that there is promise in the field, but there are still many studies to be done and to fully understand before we can apply these kinds of techniques as therapies for memory disorders.

Where are we heading?

Dr. Inman remarks that how the media describes new technologies is important for how the public understands these technologies and, consequently, how the consumer market responds. That brings the question then, to where the field of memory enhancement and brain-computer-interfaces (BCI) are headed? Whether it’s some Harry Potter “pensieve”-like thing where we can directly enable others to visualize our memories or whether its controlling a robot with a brain cap scenario, we are certainly going to come across ethical issues of “to enhance” or “not to enhance,” with strong arguments for both. What I mean by ethical issues is more than just if cognitive enhancement is worth the potential risks, but rather, I want to consider questions such as: (1) if we have the ability to enhance, should we enhance, (2) through the use of cognitive therapy, would we be “altering an individual” and “eroding their character,” (3) an individual’s physical safety (4) efficacy; (5) non-physical harms such as threats to autonomy and authenticity, (6) what is the difference between implicit coercion and responsibility in the case of enhancement, (7) would quality of life would be better post enhancement? Could it be that history may repeat itself with BCI in a similar manner as with cognitive enhancement? I predict we will continue to encounter similar conflicts as we come across with currently available therapies, whether it be do-it-yourself tDCS or non-prescribed (and theoretically illegally used) Adderall or Ritalin.

Where should we draw the line?

Image courtesy of Google Images

As was the issue with nootropics and cognitive enhancement, we will most likely come across familiar therapy versus enhancement blurred lines debate with memory enhancement. Several points of view exist in this debate, take, for example, the beliefs of physicians who prescribe these enhancements/ therapies for the general public. As an aspiring physician myself, I’m not sure where I stand. One professional mandate of medicine is “do no harm.” Maurice Bernstein, MD, says that in transforming physicians from healers to enhancers has the potential to “degrade” this standard. Furthermore, Howard Brody, MD, PhD, a family practice physician and bioethicist, agrees with this sentiment, adding that “one of a physician's ethical duties is to avoid disproportionate risks of harm that are not balanced by the prospect of compensating medical benefits." On the other hand, these opinions can be directly contrasted with the wants and views of the general public. A proponent of enhancement and author of Liberation Biology: The Scientific and Moral Case for the Biotech Revolution, Ronald Bailey, argues that disease is a state of dis-ease. He further states, “if patients are unsatisfied with some aspect of their lives and doctors can help them with very few risks, then why shouldn't they do so?" Of particular interest to the military are concerns for veterans with traumatic brain injury (TBI). This debate is uniquely complicated as veterans who are exposed to high personal and emotional risk during their active duty careers. Are we (as recipients of their protection and sacrifices) not responsible for returning them back to their set point or enhancing their capabilities to that beyond the typically accepted ‘norm’ to ensure greater safety to our civilians and warfighters alike? Many veterans who have seen unimaginably gruesome events and themselves sustained moral injuries. Moreover, if they do receive some type of brain chip or alternate implant, can we allow them to keep these implants after their service? If a brain chip was implanted for warfighters in the line of duty have they earned it or is it even rightful for them to have one? Not only that, but also consider, if this is a physical implant, then it is a part of you* or is it considered to be military property?

When asked if he himself would get a brain chip, Dr. Inman replied “No—I don’t need to have brain surgery and I work just fine without it… I believe we are developing this for therapy not enhancement of a normal, healthy function.” Clearly, there are those who feel otherwise, but the answer for most probably isn’t so black-or-white. Where do you stand?

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Sahu, S. (2017). M[Emory] Enhancement and its Implications. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/03/memory-enhancement-and-its-implications.html

What is Feminist Neuroethics About?

By Ben Wills

Ben Wills studied Cognitive Science at Vassar College, where his thesis examined cognitive neuroscience research on the self. He is currently a legal assistant at a Portland, Oregon law firm, where he continues to hone his interests at the intersections of brain, law, and society.

As the boundaries of what may be considered “neuroethics” extend with the development of new kinds of technologies and the evolving interests of scholars, its branches encounter substantial structures of adjacent scholarship. “Feminist neuroethics” is a multidimensional construct and a name that can be afforded both to approaches that fall within the bounds of mainstream neuroethics and metatheoretical challenges to the scope and lines of debate within neuroethics. While acknowledging that scholarship at the intersections of academic feminism/gender studies, feminist science studies, ethics, and neuroscience is much more substantial and diverse than I’m considering here, my modest aim in this post is to highlight how the label “feminist neuroethics” has been used to look at what scholars consider important for neuroethics. In so doing we can see what scholars in these fields see as worth highlighting when identifying their work as such.

The phrase “feminist neuroethics” is young, first used (to my knowledge) in peer-reviewed literature by philosopher Peggy DesAutels in her 2010 article on “Sex differences and neuroethics,” published in Philosophical Psychology (though see Chalfin, Murphy, & Karkazis, 2008 for a close antecedent). She writes that, having found herself considering the ethics of neuroscience, the neuroscience of ethics, and sex/gender differences, her “overlapping approach could neatly be summarized as feminist neuroethics” (p. 96, emphasis original).

Image courtesy of The Blue Diamond Gallery.

DesAutels makes two arguments. First, reviewing the neuroscience literature, she finds it likely that sex/gender differences in certain physical and cognitive domains exist. If so, she argues, such differences ought to inform ethical theory and our understanding of moral behavior. (Left unsaid here, but discussed by DesAutels in other work (e.g., DesAutels, 2015), is the well-established point that ethics as a field has privileged approaches that culturally align with masculinity). On the other hand, if sex/gender differences have been simplified or overstated in neuroscience, this suggests that the research and its representation in the media may themselves contain bias on the basis of sex/gender. In this first piece on feminist neuroethics per se, DesAutels clearly ties feminist neuroethics to issues regarding putative sex/gender differences.

Following DesAutels (2010), “feminist neuroethics” as a label and an identity has been used relatively sparingly. I found two hubs of work explicitly calling themselves “feminist neuroethics.” The first is a special issue of Neuroethics devoted to neuroscience and sex/gender, with contributions from members of the NeuroGenderings network on sex/gender and neuroscience. The guest editors, Isabelle Dussauge and Anelis Kaiser, divide the entries into three sections: (1) proposals of a feminist and gender sensitive neuroscience, (2) alternative accounts of the brain from outside the neurosciences, and (3) reviews of neuroscientific claims concerning gender (Dussauge & Kaiser, 2012). The first section includes articles on difference as it is and can be considered in sex/gender neuroscience (Roy, 2012) and how neuroscience might integrate gender knowledge in a deep way (Nikoleyczik, 2012). The second section includes Cynthia Kraus’s (2012) argument for foregrounding the tensions between gender studies and neuroscience as a path for interdisciplinary headway and Sigrid Schmitz’s (2012) critique of how neuroeconomics reinforces gender norms while relying on a “new neuro-determinism.” It also includes a discussion of the ethics inherent in necessarily reductive fMRI images (Fitsch, 2012) and a demonstration by Cordelia Fine (2012) of how the epistemic and social authority of neuroscience contributes to a feedback loop where neuroscientific data showing sex/gender differences, on the one hand, and gendered behavior and beliefs in society at large, on the other, reinforce each other. In the third section, Catherine Vidal (2012) continues along themes similar to Fine’s and shows how specific research in three behavioral science subdisciplines (skills in language and mathematics, testosterone and financial risk-taking behavior, and moral cognition) overemphasizes sex differences. Rebecca Jordan-Young and Raffaella Rumiati (2012) argue that plasticity and variability ought to replace “hardwired” as prevailing metaphors for neuroscience, and illustrate ethical consequences of the failure to do so. 

Image courtesy of Wikipedia.

The other site of feminist neuroethics, so-named, is from the comprehensive 2015 Springer Handbook of Neuroethics, which dedicates a four-entry section to “feminist neuroethics.” Here, Robyn Bluhm (2015) discusses how feminist philosophy of science and neuroethics intersect, for example by bringing the idea that science is never value-free – a key insight of feminist philosophy of science – to neuroimaging research on sex/gender differences and other topics. DesAutels (2015) traces the rise of feminist ethics in response to the shortcomings of standard philosophical ethics, and suggests that, versus male/female, oppressor/oppressed is a binary that better cuts nurture at its joints. In this section the intersection of critical race theory and cognitive neuroscience through the concept of implicit bias is also addressed (Jacobson & Langley, 2015), and Cordelia Fine and Fiona Fidler (2015) show how null-hypothesis statistical testing (from whence comes the (in)famous p < .05) leads researchers to over-identify sex/gender differences. Fine and Fidler suggest an estimation approach using effect sizes and confidence intervals as a specific remedy.

The above articles contain a great diversity of topics that demonstrate a broad scope of how “feminist neuroethics” as a label has been used describe scholarship. Upon inspection, however, the strongest theme running through this microassortment of literature is clearly sex/gender differences. Some of the questions asked include: what the nature and scope of putative sex/gender differences might (or might not) be, which questions about sex/gender are important and why, how these questions are being answered by scientists and ethicists alike, and the ethical significance of sex/gender research and findings. Clearly, given this emphasis so far, feminist neuroethics finds this topic to be important. We should keep listening. 

References



Bluhm, R. (2015). Feminist philosophy of science and neuroethics. In Handbook of Neuroethics. https://doi.org/10.1007/978-94-007-4707



Chalfin, M. C., Murphy, E. R., & Karkazis, K. a. (2008). Women’s neuroethics? Why sex matters for neuroethics. The American Journal of Bioethics?: AJOB, 8(1), 1–2. https://doi.org/10.1080/15265160701829038



DesAutels, P. (2010). Sex differences and neuroethics. Philosophical Psychology, 23(1), 95–111. https://doi.org/Doi 10.1080/09515080903532266



DesAutels, P. (2015). Feminist Ethics and Neuroethics. In Handbook of Neuroethics (pp. 1421–1434). Dordrecht: Springer Netherlands. https://doi.org/10.1007/978-94-007-4707-4_155



Dussauge, I., & Kaiser, A. (2012). Neuroscience and Sex/Gender. Neuroethics, 5(3), 211–215. https://doi.org/10.1007/s12152-012-9165-5



Fine, C. (2012). Explaining, or Sustaining, the Status Quo? The Potentially Self-Fulfilling Effects of “Hardwired” Accounts of Sex Differences. Neuroethics, 5(3), 285–294. https://doi.org/10.1007/s12152-011-9118-4



Fine, C., & Fidler, F. (2015). Sex and Power: Why Sex/Gender Neuroscience Should Motivate Statistical Reform. In Handbook of Neuroethics (pp. 1447–1462). Dordrecht: Springer Netherlands. https://doi.org/10.1007/978-94-007-4707-4_156



Fitsch, H. (2012). (A)e(s)th(et)ics of Brain Imaging. Visibilities and Sayabilities in Functional Magnetic Resonance Imaging. Neuroethics, 5(3), 275–283. https://doi.org/10.1007/s12152-011-9139-z



Jacobson, A. J., & Langley, W. (2015). A Curious Coincidence: Critical Race Theory and Cognitive Neuroscience. In Handbook of Neuroethics (pp. 1435–1446). Dordrecht: Springer Netherlands. https://doi.org/10.1007/978-94-007-4707-4_157



Jordan-Young, R., & Rumiati, R. I. (2012). Hardwired for Sexism? Approaches to Sex/Gender in Neuroscience. Neuroethics, 5(3), 305–315. https://doi.org/10.1007/s12152-011-9134-4



Kraus, C. (2012). Critical Studies of the Sexed Brain: A Critique of What and for Whom? Neuroethics, 5(3), 247–259. https://doi.org/10.1007/s12152-011-9107-7



Nikoleyczik, K. (2012). Towards Diffractive Transdisciplinarity: Integrating Gender Knowledge into the Practice of Neuroscientific Research. Neuroethics, 5(3), 231–245. https://doi.org/10.1007/s12152-011-9135-3



Roy, D. (2012). Neuroethics, Gender and the Response to Difference. Neuroethics, 5(3), 217–230. https://doi.org/10.1007/s12152-011-9130-8



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Wills, B. (2017). What is feminist neuroethics about? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/03/what-is-feminist-neuroethics-about.html

Neuroeconomics and Reinforcement Learning: The Concept of Value in the Neuroscience of Morals

By Julia Haas

Julia Haas is an Assistant Professor in the Department of Philosophy at Rhodes College. Her research focuses on theories of valuation and choice.

Imagine a shopper named Barbara in the pasta aisle of her local market.  Just as she reaches for her favorite brand of pasta, she remembers that one of the company's senior executives made a homophobic statement. What should she do? She likes the brand's affordability and flavor but prefers to buy from companies that support LGBTQ communities. Barbara then notices that a typically more expensive brand of pasta is on sale and buys a package of that instead. Notably, she doesn't decide what brand of pasta she will buy in the future.

Barbara’s deliberation reflects a common form of human choice. It also raises a number of questions for moral psychological theories of normative cognition. How do human beings make choices involving normative dimensions? Why do normative principles affect individuals differently at different times? And where does the feeling that so often accompanies normative choices, namely that something is just right or just wrong, come from? In this post, I canvass two novel neuroethical approaches to these questions, and highlight their competing notions of value. I argue that one the most pressing questions theoretical neuroethicists will face in the coming decade concerns how to reconcile the reinforcement learning-based and neuroeconomics-based conceptions of value.

One popular approach to the problem of normative cognition has come from a growing interest in morally-oriented computational neuroscience. In particular, philosophers and cognitive neuroscientists have turned to an area of research known as reinforcement learning (RL), which studies how agents learn through interactions with their environments, to try and understand how moral agents interact in social situations and learn to respond to them accordingly. RL research suggests that human choice depends on several distinct decision systems, where each decision system relies on a different computational algorithm to calculate 'value.' Roughly, value is calculated in terms of how much reward is associated with certain actions over time. Learned value assignments then underwrite choice and, where applicable, action selection.

The trolley problem, image courtesy of Wikimedia Commons.

Perhaps the most prominent RL theory of normative choice, presented by psychologist Fiery Cushman (2015), proposes that moral behaviors depend on one of the three systems typically identified in RL, what is known as the habit-based system. For example, Cushman suggests, American tourists frequently continue to tip in restaurants abroad, even when there is no local custom for doing so (2015, 59). More formally, one of the advantages of Cushman's view is that it may explain why participants provide surprisingly inconsistent responses to what is known as the trolley problem.

Typically, in switch versions of the trolley problem, people support the killing of a single individual in order to save five others, but find it difficult to endorse the harm of one agent in footbridge versions of the problem, where the harm is more ‘hands on.’ Since a purely numerical assessment favors the saving of five people rather than one in both cases, Cushman reasons, people’s tendency to resist harming the single agent in the footbridge version is “the consequence of negative value assigned intrinsically to an action: direct, physical harm” (2015, 59). That is, Cushman suggests, participants’ responses to the footbridge version of the dilemma may be underwritten by the model-free decision-system: since directly harming others has reliably elicited punishments in the past, this option represents a bad state-action pair, and leads people to reject it as an appropriate course of action.

A second approach to Barbara’s example comes from a branch of behavioral economics known as neuroeconomics. Like their RL-research counterparts, neuroeconomists employ the concept of ‘value’ to help explain how choices between multi-faceted alternatives are possible. In the context of neuroeconomics, however, value specifically refers to the ‘worth’ of a given commodity or action as computed by the agent - that is, it refers to subjective values. Correspondingly, within the framework of neuroeconomic research, understanding what takes place in choice amounts to uncovering how humans and other animals compute subjective value.

Extending this approach to the problem of normative choice, Shenhav and Greene (2010) asked participants undergoing fMRI to imagine scenarios in which they could save a group of individuals at the expense of leaving a single individual to die. For example, they invited participants to evaluate the moral acceptability of saving a group of skydivers with faulty parachutes at the expense of letting a single skydiver with a faulty parachute die. The number of skydivers in the group and the probability of the group’s survival varied from trial to trial (see Figure 1) (see Shenhav and Greene 2010, supplemental materials). Consistent with traditional economic and utilitarian models, they found that many of the study’s participants found it morally acceptable to sacrifice the life of one individual in order to prevent a greater loss of life. Interestingly, Shenhav and Greene also found that participants’ ratings of moral acceptability were correlated with degrees of activation in their posterior cingulate cortex and ventromedial prefrontal and medial orbitofrontal cortices, i.e., with brain activations relatively similar to those seen in instances of valuing physical goods (2010, 671, Table 1 (expected value)).

Figure 1: Shenhav and Green argue that "Average

moral acceptability ratings across trial value space

reveal a graded behavioral sensitivity to 'expected

moral value'" (669).

The RL and neuroeconomic approaches thus seem to overlap in several important ways. Both theories take value as a fundamental unit of choice. Both traditions also recognize that neurons in the OFC are responsible for encoding value in the brain (Padoa-Schioppa and Schoenbaum 2015). But the views diverge when it comes to characterizing when and how value is computed. In RL, value is something that is often learned gradually over time; by contrast, in neuroeconomics, it is suggested that subjective value is calculated online, i.e., at the time of choice. Consequently, it is not clear whether and how RL's algorithms can be used to model subjective valuation in neuroeconomic choice. This is a shame, because neuroeconomics could benefit from RL's strong computational foundations, and RL could benefit from the many incisive behavioral and neuroscientific experimental paradigms on offer in neuroeconomic research.

Increasingly, researchers in the two independent fields recognize the need to collaborate and find common conceptual and empirical ground. These kinds of conversations would benefit the field of neuroethics, too. Both of these intersecting disciplines will help up make sense of Barbara’s case in the years to come. In other words, it would help us gain a better understanding of the brain’s role in our moral experiences: How do my past learning experiences and present choice environment influence my future moral choices? What is the difference between something that just ‘feels wrong’ and something that has good reasons for being thought of as immoral? And – perhaps most importantly - how can I shape my own neural moral ‘values,’ as well as the neural moral values of those around me, to try and make more consistent decisions over all? The concept of value may turn out to be the basic unit of the neuroscience of morality.

Want to cite this post?



Haas, J. (2017). Neuroeconomics and Reinforcement Learning: The Concept of Value in the Neuroscience of Morals. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/03/neuroeconomics-and-reinforcement_7.html