In my own biased experience, people tend to have general criteria for what sicknesses are within the human range of control, and thus target for blame. I don’t know anyone who believes that cancer is not a disease, but rather a problem of motivation. You’d be hard pressed to find someone who says pneumonia is not an illness, but merely the result of a bad attitude. Then again, why would anyone think that tumors or infections have any foundation in something ‘controllable’, like thinking? Some may say that diseases are out of our control and, for the most part, they affect our bodies, not our thinking. Diseases, they say, are biological. Those with depression, or obsessive-compulsive disorder, or anorexia nervosa can’t be struggling with biological problems. They have thinking problems; their thinking is to blame, because fortunately thinking is something people have control of, right? Most people exert control outside of the physiological constraints of their brains, that is, except for the extreme cases, the “crazies.” With this power of autonomy in mind, we can imagine that people with alcohol dependence would benefit from some motivation; those with depression need to work on their attitude; but it’s those people we see talking to themselves on the streets, or that we imagine in psych wards like in One Flew Over the Cuckoo’s Nest, or in Shutter Island, those people can’t help it. There really is something wrong with them. Robert Sapolsky puts it well, saying, “We have been trained to have a strikingly compassionate thought that is one of the triumphs of our century: ‘It’s not him. It’s his disease.’ We have been taught to draw a line between the essence of a person and the neuropsychiatric disorder that distorts and constrains that essence.”1Indeed.
Yet, after reading Sapolsky’s essay How Big is Yours?1 I’m left feeling pretty confident that the distinction between controllable and uncontrollable mental health isn’t as black and white as I’ve sarcastically described above. What he illuminates is that when people generally acknowledge the extreme cases of mental dysfunction as real, problematic, and deserving of our sympathy, they often fail to look closer at what is causing these mental health problems, and whether these causes have a sort of sliding scale of an effect on how “normal” people think and behave. For example, Seymour Kety of Massachusetts General Hospital headed a team investigating the genetic and home-environment variability in patients with Schizophrenia. They wanted to know if Schizophrenia is heritable (it is), and if adopted (non-biological offspring) were at risk of developing Schizophrenia if the adoptive parent(s) had the disorder. Answering this research question involved many, many interviews with patients and relatives. What was interesting was that interviewing thousands of relatives revealed that though they weren’t often suffering from Schizophrenia themselves, they tended to be quirky. What’s quirky? Well, they were characterized as socially detached, their train of thought was hard to follow, and they tended to display a keen interest in strange things, or magical, fantastical thinking. Think of someone who is really into Dungeons & Dragons, vampire novels, or even strict interpretations of the Bible. A more nuanced characterization of these traits is now diagnosed as schizotypal personality disorder. It makes you wonder if a certain genetic framework is expressed as Schizophrenia, could a “milder” form of this framework be expressed as unconnected thinking and a taste for things magical?
Also interesting is the kind of behavioral changes that result from damage to certain areas of the frontal cortex. Phineas Gage is probably the most cited example: while on the work site, he took an iron rod to the face, through his left frontal cortex, transforming him from a mild-mannered railroad foreman to an aggressive, tactless, and overtly sexual brute. Additionally, similar behaviors are seen in patients who have sustained strokes in the same area of the brain. Less well known is the fact that sufferer’s of Huntington’s disease display social disinhibition associated with damage to the frontal cortex. That term, social disinhibition, is an important one. This kind of brain damage isn’t necessarily producing thoughts or urges that don’t also exist within most of us “normal” people; it’s basically destroying the part of the brain that might normally hold us back from punching every bro that talks too loud in the library, whistling at every yoga-pants-ian at the gym, or telling every wife what she looks like in that dress. It makes you wonder what variations in this brain area lead to the variations we see in human personality. Can you think of any Cosmo Kramers in your cohort of family, friends and acquaintances?
Sapolsky cites a whole list of strange, abnormal and/or disordered human behavioral tendencies that are at least partially founded in our biology: Obsessive-Compulsive Disorder, Tourette’s Syndrome, Temporal-Lobe Epilepsy; he even cites the controversial finding in the 1990s linking homosexual sexual orientation to differences in the size of the third interstitial nucleus, published in the journal Science by Simon Levay*. What Sapolsky tries to get at is not that scientists have published everything there is to know about the biology underlying all human behavior; he isn’t laying out an argument for biological determinism; and he’s not arguing that biological explanations for behaviors draw the line between good and bad, or that they can serve to absolve human responsibility. The fine partnership of biology and psychology is not in the business of excuse-ology. The thing is, is that people are very good at drawing boundaries: in-group versus out-group, us versus them. What I’ve taken from him is that our sciences are getting better at dissolving these lines we like to draw, that with growing scientific understanding, “slowly we will be leaving the realm of them and their disorders. We will be defining instead a biology of us and our strengths and weaknesses, and our potentials and our strengths.” If we must blame people, it shouldn’t be convenient, or simple. Let’s not ignore what we can find out about our nature, just so that we can more freely craft our own versions of which natures are wrong, and which are right.
- Sapolsky, R. M. (1997). The Trouble with Testosterone: and Other Essays on the Biology of the Human Predicament. New York: Simon & Schuster.
*note: The title How Big Is Yours? is in reference to the size of the third interstitial nucleus as a predictor of sexual orientation. This title came to my mind again while watching this great TED talk by Paul Whalen The Uncertainty of it All: Brain Lessons for Anxious Times, who says that research suggests that having “thicker” connections (more axon projections, basically) between the amygdala and the prefrontal cortex is a good predictor of anxiety levels. If anxiety levels were as provocative as homosexuality in men, perhaps another title might have been “How Thick Are Yours?”