In the kingdom of the mind

As a junior medical student I walked the waxed, antiseptic-smelling corridors of Sydney’s Royal North Shore Hospital dressed in an oversized lab coat. One of the first patients I was encouraged to see was a middle-aged woman from the Central Coast. A retired schoolteacher, she had been transferred after an unusual heart attack. As I began my examination, I felt an atypical collapsing pulse on her wrist, and remembered that the textbooks called this a water hammer. When I placed my stethoscope on her chest there was a rapidly rising and falling whoosh across the left side of her sternum, the aortic area of the heart. She had a damaged valve in an uncommon location.

But before I heard the so-called heart murmur, a term that made me think of bodily organs whispering sweet nothings, it was clear, even to a novice, that something else was unusual. When I asked her to remove her hospital gown, she did so with great enthusiasm, revealing her droopy, ageing breasts. I was taken aback, not yet accustomed to the power of my professional status. I felt awkward standing next to her husband, who muttered dryly, ‘How come you’re never like that with me?’

I mentioned the experience to one of her treating doctors, more as an amusing anecdote than because of any clinical significance. Although the registrar laughed, something also clicked and he ordered a barrage of tests. A week later he told me that my encounter had led to the discovery of a tiny lesion in the frontal section of her brain, perceptible only on expensive MRI scans. It was probably the result of a small stroke that occurred around the time of her heart attack. Barely perceptible, it had subtle effects on her interactions, particularly her social inhibitions.

I remember the episode clearly, even though it was early in my training. It focused my interest on our essentially social nature - how the vast bulk of our brain exists to process and react to social information; how primed it is to recognise, interpret and respond to the input of others, which lays down patterns governing behaviour. I have always been interested in the extent to which we are individual or collective beings, and how feeling is as fundamental as thinking.

In the decade and a half since that consultation, the study of the brain and how it regulates behaviour has become one of the most fertile fields of discovery. Barely a week goes by without a declaration of the relevance of neuroscientific findings to everyday life. A picture of a brain scan in pixel-busting Technicolor usually accompanies these proclamations, often connected to announcements from new disciplines with the prefix ‘neuro’.

Neuro-marketing allows advertisers to pinpoint the parts of the brain that light up in response to particular products or tailored messages. Neuro-economics looks at how we make economic decisions and their relation to brain functioning. Even some philosophers have embraced neuro-ethics, in which ethical principles are examined using brain scans to determine people’s moral intuitions when they are asked to deliberate on classic dilemmas. France has become the first country in the world to devote a government department to looking at the policy implications of our burgeoning knowledge of neuroscience, led by Associate-Professor Olivier Oullier.

My own field, psychiatry, has benefited enormously. While the specialty was once the bastard child of medicine - lacking prestige and credibility - a growing interest in mental health and the way brain chemistry affects our emotions has lifted it into the mainstream. During the 2010 federal election Australian of the Year Professor Patrick McGorry and the Brain and Mind Institute’s Professor Ian Hickie became two of the most prominent doctors in the country. While this goes some way to making up for years of neglect, it also suggests a growing expectation of a marriage of the biological and social sciences.

In my lifetime, three and a half decades, more has been learnt about the brain than in the whole of human history. We now know there are more than one hundred billion nerve cells, and each of them has many thousands of synaptic connections - channels of chemical communication - with its neighbours. We know an increasing amount about the anatomy of the different functional centres that make up the brain, their varying responsibilities, how they execute their duties and even how they evolved. We are beginning to understand how memory, which lies at the core the subjective self, is dependent upon the strength of the cell networks formed by our experience, thoughts and feelings.

We could even be on the verge of a new Enlightenment - one in which the concept of the individual autonomously making rational decisions is usurped by a new, more complex understanding of the forces that shape human nature. This process may be accelerated by the global financial crisis and the frailties of our systemic assumptions that it exposed.

It is rare to hear about human nature in discussion of politics, yet it is the foundation of the underlying conflict. Debates about human nature have often been restricted to criminality and other social pathologies, as if only bad people failed to conform to the behavioural model of modern economics. But most policymakers agree that whether addressing business regulation or competition in schools, Homo economicus served well enough: given choice, people will act in their own interest, and by so doing make the system work better for everyone. This is a useful, but flawed, shortcut to understanding human behaviour.

The most influential thinkers of the earlier Enlightenment were consumed by the question of how to balance reason with the primitive and softer elements in our nature. Adam Smith’s greatest influence, David Hume, was adamant that reason ‘ought only to be the slave of the passions’. For Hume, emotions drove people to apply reason, to satisfy basic desires for food or sex, or more complex behaviours such as curiosity and ambition.

Smith, too, offered a sophisticated analysis of our instincts for fairness and social sympathy in his first book, The Theory of Moral Sentiments (1759). Despite being the Zeus of market rationality, Smith’s arguments for these forces to balance self-interest were lost in the laissez-faire hubris of the recent decades leading up to the financial crisis.

John Maynard Keynes reintroduced this concept in the 1930s when he referred to ‘animal spirits’, coining the phrase to describe a range of emotions, impulses, enthusiasms and misperceptions that drive economies - and ultimately unwind them. In Animal Spirits: How Human Psychology Drives the Economy, and Why It Matters for Global Capitalism (Princeton University Press, 2009) the economics professors Robert J Shiller and George A Akerlof, the latter a Nobel Prize winner, argue that those who subsequently interpreted Keynes’s thought ‘rooted out almost all of the animal spirits - the noneconomic motives and irrational behaviours - that lay at the heart of his explanation for the Great Depression’.

Passions, or animal spirits, relate to the hybrid make-up of our brains. The human brain is not really a single organ, but three brains in one: a triune, in the famous Yale neuroscientist Paul MacLean’s theory of brain evolution. A primitive ‘lizard’ brain, designed millennia ago for survival, lies at the core and straddles the roots of ancient dopamine-reward pathways, the channels of pleasure, curiosity and desire.

Around this reptilian base evolved the limbic cortex of the early mammalian brain. This is where kinship behaviour and the nurture of the young - characteristic of all mammalian species, and particularly evident in our own social behaviour - is rooted.

The third part of our brains is the overlying cortex, the size of which differentiates us from other mammals. Subsequent evolution within the mammalian species is marked by a continuous expansion of this cortex, and by extraordinary growth of the frontal region, the part that was damaged in the uninhibited patient I examined as a medical student. This distinguishes us within the primate lineage behaviourally and physically: it is the place where information from our three brains is brought together, analysed and distilled. This hybrid apparatus blends emotion and reasoning, just as Hume and Keynes surmised long before magnetic resonance imaging made it visible.

There are two areas that brain research is illuminating which challenge how we organise society. One is our essentially social nature: we are herd-like animals who show a strong tendency to conform with group norms. The human brain is much larger than other primates’ because of the development of our remarkable capacity for social skills: empathy, co-operation and fairness. There is growing evidence that we are more like nodes in a relationship network than discrete entities. It is through our capacity for empathy that awareness of how our behaviour is judged by others emerges. From the to-and-fro with other individuals we learn to navigate as citizens in a social order.

The second area of astonishing discoveries is in the plasticity of the brain. Dr Normal Doidge, a psychiatrist and psychoanalyst, has become a literary superstar around the world with his book The Brain that Changes Itself (Scribe, 2008). We are not, in computer-speak, hardwired: our brains can change well into old age. Parts of the brain can learn new tricks. We can shape our brains to create new habits that we might have thought we were incapable of; we can learn to see things from new perspectives and react in a different way.

The implications of this for policy development are considerable. For example, it is now well known that early childhood deprivation can scar the brain, leaving a mark that is visible to imaging technologies. This informs much of the focus on early childhood education and intervention. The scars - disadvantage etched on the brain - mean that those who trumpet the individual’s capacity to triumph over their environment must confront significant limitations. On the other hand, Doidge’s notion of neuroplasticity tempers extreme beliefs of environmental determinism and suggests that we can remake ourselves.

Much of this modern brain research is affirming for social democrats. By highlighting psychological frailties, such as our preference for immediate reward when it is available before our eyes, and the way this contributes to market epidemics, a powerful case can be made for regulation, paternalism and social measures to promote feelings of security. Hence the popularity of the concepts promoted in Richard H Thaler and Cass R Sunstein’s book Nudge: Improving Decisions about Health, Wealth and Happiness (Penguin, 2009) and its associated invention of a new political philosophy called libertarian paternalism. As Associate-Professor Olivier Oullier observes, this is a way of encouraging a certain behaviour, such as not smoking, but making people feel like they were empowered to make the choice themselves. A combination of advertising aimed to shock with bite-sized portions of relevant information has been shown to be most effective method.

The persistent mantra of choice is undermined by social psychology findings that show how bad people are at predicting what will make them happy, or even remembering what has made them happy in the past.

There is ample evidence from brain studies that humans have a fundamental instinct for fairness, just as Adam Smith believed two and a half centuries ago - undermining those who believe inequality is minor collateral damage in the generation of wealth. But Smith’s notion of the invisible hand of the market ensuring an equitable order without regulatory interference is on weaker ground away from the tight-knit agrarian communities of yesteryear and in the hyper-global world of multinational corporations and instant communications.

There is, though, much from our insights into the brain that also offer support to those on the right of politics. It is true that we are programmed for self-preservation amid scarcity, so self-interest is our primary motive. The modern world of abundance, with its relentless flow of novel and cheaper opportunity, is a great challenge. The economics historian Avner Offer writes in The Challenge of Affluence: Self-control and Well-being in the United States and Britain Since 1950 (Oxford University Press, 2006) that wealth breeds impatience and impatience undermines wellbeing. We struggle to make decisions for the long term; conservative philosophies that stress the importance of social institutions which have evolved over time and reflect a natural order, like the family, church and other civic institutions, protect us from ourselves. Offer refers to these as ‘commitment devices’ and points out that, as we become richer, we mistakenly think we do not need them. Social institutions and cultural taboos are ways in which generations hand down tacit knowledge about human nature. They should be protected from social engineers.

There are limits to how much we can apply neuroscience to policy. Even the most sophisticated neural imaging cannot differentiate between physical pain and the pain of social rejection. Even in the simplest of tasks the brain functions as an integrated unit, with many parts seemingly working together. The findings of a particular part of a brain lighting up in the isolated, controlled environment of a lab should be taken with a grain of salt.

But it would be disingenuous to discount the growing knowledge about the brain and human nature, and whether it might contribute to a more substantive meeting between the various sides of politics and policy. Conservatives cannot discount the importance of social context, inequality and the limits of market rationality. Likewise, so-called progressives need to be wary of the capacity of the state to empower communities, and more interested in the role of social norms and civic institutions. Our brains evolved in small, homogenous communities but are now faced with extraordinary diversity in a fast-changing, globalised knowledge economy. It is a period of great creativity, change and more than a little bit of danger. We can be better equipped by a more nuanced knowledge and acceptance of the flaws that science, the highest application of reason within our animal brains, is shedding light upon.

This subtler perspective on human behaviour is something my patients remind me of every day. They are a jumble of primitive instinctual beings, striving for love, approval and meaning, for whom economic self-interest plays only a tiny part in explaining why and how they behave.