Neurophilosophy and the Healthy Mind

7/23/2019 Neurophilosophy and the Healthy Mind

1/6The Neuropsychotherapist issue 21 December201510

Neurophilosophy and the Healthy Mind

Learning from the Unwell BrainGeorg Northof

University of OttawaInstitute of Mental Health Research


2/6www.neuropsychotherapist.com 11The Neuropsychotherapist

This is the situation Paul Broca (18241880), a fa-mous French neurologist and anthropologist, faced inthe middle of the 19th century. He encountered severalpatients who, all of a sudden, were unable to articulateand express themselves through speech or languageand stopped talking altogether for the rest of their lives.However, these patients still appeared to comprehendwhat was said to them. His rst and most famous pa-tient got the nickname Tan because he could only pro-

nounce one word, tan. Most interestingly, upon inves-tigating this mans brain after his death, Broca observedthat he had suered from a lesion in a specic part of thebrain, the left frontal lobe, which lies in the anterior partbeneath the forehead. Because Broca conrmed thiscorrelation between the symptom and the brain loca-tion by observing the same lesion in the brains of otherdeceased patients who had suered from similar speechdecits (called now expressive or motor aphasia), thisregion in the brain has since been named Brocas area.

Following Broca, Carl Wernicke (18481905), a Ger-

man doctor, observed some patients who exhibited aslightly dierent pattern of decits. These patients wereunable to understand speech, but they could producewords and speech. They could still speak and articulatewords, so their repertoire was not limited to one par-ticular word like kin or tan. However, their talk andthe way in which they combined words made no senseanymore; it was meaningless word salad, as this kindof speech came to be described.

Your friend would not have stopped talking alto-gether, but rather would suddenly have started to mixwords up so that you would not have understood any-

thing. Despite the fact that she would have been ableto pronounce words correctly, the combination of thesewords would have amounted to gibberish. The primarydecit here is not in the expression or motor articulationof speech but in its reception or sensory processing. Thistype of aphasia is therefore called receptive or sensoryaphasia (instead of expressive or motor aphasia). Ratherthan being associated with the frontal cortex, as is Bro-cas region, Wernicke found the main lesion in these pa-

tients to be more posterior in the brain, in the superiortemporal cortex, now called Wernickes area.

What do these examples from the historical originsof neuroscience in the 19th century tell us? Decits inspeech and their underlying lesions in the brain revealedthat higher-order cognitive functions such as language,which characterize humans, are related to the brain.Specically, these cases show that language is not ahomogeneous entity but can be broken down into dif-ferent domains, such as articulatingmotor and recep-tivesensory, which are related to dierent regions in

the brain (Brocas and Wernickes areas, respectively).Since then, research has shown that language is a highlycomplex function involving several processes and a widevariety of dierent regions in the brain.

Most importantly, these cases demonstrate that wecan learn something about the brain and how it func-tions from our patients and their symptoms. Such a per-spective worked well in the case of language. Why nottry the same approach for understanding the mind andinvestigate abnormalities in mental features such as self,consciousness, emotional feelings, and personal identi-ty? Such an approach leads us to neurological patients

Mind and Brain

How does the mind relate to the brain? This is the big question of our time. Much has been re-solved in terms of the role of evolution, the unconscious, and most recently, the genetic contri-bution. The nature of the mind and its origin in the brain, though, has remained elusive so far. How

can we gain a better understanding of what the mind is? In fact, what is it that we think of when we

talk about the mind?

Lets consider the following imaginary case scenario:

You are having tea with your friend, who is about 34 years old and an established jour-

nalist. You are talking about the bad weather, how cold it is, and discuss the latest fash-

ion in winter coats that promises full protection against the daunting wind. Your friend

vividly describes the beautiful coat she recently bought, then suddenly stops talking. Af-

ter a few moments she starts stuttering only one term, kon, which she repeats slowly

several times. You ask her, Whats wrong? She does not answer. You ask again. No re-

sponse. The only answer you get is kon. Now you realize that something must be seri-

ously wrong. You call 9-1-1 and the ambulance comes.



in vegetative states and to psychiatric patients suer-ing from depression or schizophrenia. My overarchingaim in this book is to demonstrate what we can learnfrom these patients and their unwell brains in order toincrease our understanding of how the healthy mindworks. As with other situations in life, sometimes it isthe malfunctions that help us understand how thingswork.

The Hard Problem of the Mind and the

Soft Solutions of the Brain

The human mind has various unique features: con-sciousness, a sense of self, something that accounts forour personal identity over time, emotions, cognition,and free will, among other things. The most centraland basic of all these mental features is consciousness.Without consciousness, nothing else mattersor so itseems. But what is consciousness? For most of our lives,

we are conscious if we are awake (i.e., not asleep). Thereare, of course, exceptions, such as when we undergosurgery and are being anesthetized, or when we have amotorcycle accident resulting in the loss of conscious-ness.

Consciousness is one of the biggest puzzles still con-fronting researchers and thinkers in many elds. Whyand how can something as subjective and colorful as per-sonal experiences, that is, consciousness, arise from ourbrainsbrains that are objective and a rather dull grayin color? This is what the contemporary Australian phi-losopher David Chalmers (1996) called the hard prob-lem, and it is indeed a tough nut to crack. All the fancytools of neuroscience that are used these days to inves-tigate the brain show us dierent neuronal features ofbrain functioning. These neuronal mechanismsthe in-ner workings and elaborations of the brainare increas-ingly better understood. However, none of these toolsshows us why and how the neuronal features of thebrain are transformed into the mental features of con-sciousness, self, or emotional feelings. Despite all the

progress, something very crucial is yet lacking in currentneuroscience and its account of the brain: the answer tothe hard problem is still missing.

What precisely is lacking in current neuroscience andits view of the brain? Our brain processes the variouscontent or inputs it receives from its own body and theenvironment. That is the easy part of the puzzle and re-mains beyond dispute. However, the brain seems alsoto add an extra factor that transforms the purely objec-tive processing of contents into subjective experience.We do not just process the color red in an objective way;

we also experience the redness of, say, a ripe, red to-mato in a very subjective way. This is what the philoso-

pher Thomas Nagel (1974) described as the what it islike part of our experiences that characterizes our con-sciousness as intrinsically subjective rather than merelyobjective.

Where does this what it is like feature of con-sciousness come from? Past philosophers such as RenDescartes assumed that some kind of immaterial soulexists within the body and brain. This soul was supposed

to account for the subjective nature of human experi-ence and hence for mental features like consciousnessand self. Nowadays, such an assumption of an immate-rial soul separate from brain and body is largely obso-lete. How, though, can we then explain the what it islike, the subjective nature of mental features, if thereis nothing but a seemingly objective brain to accountfor it? This question leads us straight back to the hardproblem: Why and how is there consciousness ratherthan nonconsciousness and mere brain material?

Does the brain itself add this subjective compo-nent, the what it is like aspect? All kinds of objectiveneuronal mechanisms have been suggested in currentneuroscience and philosophy elds to account for thesubjectivity of human experience. We discuss some ofthese mechanisms in the course of the book. But, aswe will see, none of them can explain why and how theobjective neuronal states of the brain are transformedinto the subjective mental features of consciousness.Why and how are the neuronal features of the braintransformed into mental features? This is the questionguiding our investigations into the brain. In our search



for answers to this question, we will go deeply into bothphilosophy and neuroscience, or neurophilosophy, as itis called these days.

Neurophilosophy

Sandwich Between Mind and Brain?

What is neurophilosophy? Neuroscientists increas-

ingly venture into the originally philosophical territoryof the mind and its mental features. There they areconfronted with mental concepts of consciousness,self, emotions, identity, free will, and many others.These concepts were originally dened in the contextof philosophy, with its spiritually oriented baggage, andtherefore the baggage resurfaces with the concepts inneuroscience. How shall we deal with the philosophicalbaggage in the concepts we use to describe mental fea-tures?

Opinions dier widely. Some traditionally mindedphilosophers such as Thomas Nagel, Peter Hacker, andColin McGinn argue that mental concepts cannot beresearched empirically at all; the question of the mind,whether seen as materially caused or not, escapes scien-tic methods and thus remains a philosophical one thatcannot be addressed in neuroscience. The proponentsof this idea state that the mind belongs exclusively tophilosophy, and hence has no place in neuroscience. Ina nutshell, neuroscience is, and can only be, about thebrain, whereas philosophy addresses the mind.

However, the opposite extreme is much more pop-ular and can be found in what is described these daysas neurophilosophy. With the eld having developedpredominantly in the Anglo-American world, neuro-philosophers such as Patricia and Paul Churchland andJohn Bickle argue that there is no need any more for anykind of mental concepts. Put in rather broad and gen-eral terms, one may summarize their convictions in thefollowing way: Throw overboard the mental conceptssuch as self, free will, and consciousness and replacethem with the neural concepts of the brain. There is

no mind; there is only the brain is their claim. However,despite all the progress in neuroscience, even these em-phatic neurophilosophers have not provided convincinganswers to the question of how the brain transformsneuronal activity into mental features.

Most neurophilosophers currently argue that themind is the brain and that its various mental featuresare nothing but manifestations of the neural featuresof the brain. They provide various arguments and theo-ries that, despite being elegant in their logical analysis,ultimately fail to provide an answer to the question of

neuronalmental transformations. Why do they fail?

Because they leave open the exact mechanisms bymeans of which the brain and its not yet fully clear neu-ral features are transformed into mental features andthus generate consciousness.

How can we investigate the turning point, the mo-ment, in which the brains neural activity is transformedinto mental features? When, for instance, is a particularneural state of the brain associated with a mental state

such as consciousness, and when is it not? We currentlydo not know. Neuroscience increasingly understandshow the brain works, operates, and functions. However,neuroscience has not yet fully elucidated why the verysame neuronal features lead to mental features as theyare described in philosophy.

Approaching Neurophilosophy by Inferring

the Healthy Mind from Unwell Brains

How can we change our philosophical preconceptionsuch that we can get a grip on how the brain transformsits neuronal activity into mental features? Neurosci-ence usually investigates the healthy brain. Philosophyfocuses on the healthy mind. Both seek to explain howmental features such as self and consciousness comeinto being. What philosophers have discussed in previ-ous centuries regarding the mind is now put into thecontext of the brain. For instance, Descartess assump-tion of the soul as a special faculty underlying mentalfeatures now resurfaces as a specic region, network, ormechanism within the brain. The term mental is oftensimply replaced by the term neuronal. Mental featuresare declared to be neuronal features. That shift, though,



still leaves unexplained how the seemingly objectiveneuronal features of the brain can generate somethingas subjective as mental features. In short, the questionof neuronalmental transformation remains open.

Though desirable in a broad sense, the collaborationbetween philosophy and neuroscience seems to havetransferred the old problem of the mindbrain rela-tionship into the new context of the brain. The tradi-

tional dualism imposed between mind and brain resur-faces within the dualism between two kinds of neuronalfeatures: those that are purely neuronal and those thatare relevant to mental features. The brainbrain prob-lem replaces the mindbrain problem. There is thus avicious cycle or deadlock between philosophy and neu-roscience in that the originally metaphysical conceptsand ideas of the former are reinforced and implementedwithin the empirical context of the brain.

How can we escape this deadlock between philoso-phy and neuroscience? We need another source outsideboth elds and their mental and neuronal concepts. Onesuch possible source is neurological and psychiatric dis-orders. The loss of consciousness due to brain injury thatproduces a vegetative state may tell us something im-portant about how the healthy brain transforms its neu-ronal features into states of consciousness. Similarly,the alterations in self, emotional feeling, and personalidentity that characterize psychiatric disorders such as

depression or schizophrenia may help to reveal somepreviously unclear secrets about the healthy mind andhow it is related to the brain.

Broca and Wernicke learned about language andhow it is related to the brain from their patients. Analo-gously, I take neurological and psychiatric disorders in-volving abnormalities in self, consciousness, emotionalfeelings, and personal identity as the starting point for

investigating the yet unclear relationship between neu-ronal functions and mental features. These disordersreveal how the workings of unwell brains dier fromthe healthy brain. Most importantly, the unwell brainstell us, in an indirect way, about the mechanisms thattransform neuronal functions into mental features in ahealthy mind.

Bottom line: my aim is to infer the healthy mind fromthe unwell brain. This will also tell us whether and, ifso, how we must change our philosophical concepts inorder to properly describe what philosophers call mindand brain. I invite you to join me in a journey that takesus from case examples of ctive patients with neurolog-ical or psychiatric disorders, inspired by my clinical ex-perience as a psychiatrist, to fascinating neuroimaginginvestigations that I am working on as a neuroscientist.Last but not least, we will consider new, wide-rangingtheories of mind and brain that I encounter in my workas a neurophilosopher.



Neuro-Philosophy and the Healthy MindLEARNING FROM THE UNWELL BRAIN

Applying insights from neuroscience to philosophical questions about the self,consciousness, and the healthy mind.

Can we see or nd consciousness in the brain? How can we create workingdenitions of consciousness and subjectivity, informed by what contemporary re-search and technology have taught us about how the brain works? How do neu-ronal processes in the brain relate to our experience of a personal identity? Wheredoes the brain end and the mind begin?

To explore these and other questions, esteemed philosopher and neuroscien-tist Georg Northo turns to examples of unhealthy minds. By investigating con-sciousness through its absencein people in vegetative states, for examplewecan develop a model for understanding its presence in an active, healthy person.

By examining instances of distorted self-recognition in people with psychiatricdisorders, like schizophrenia, we can begin to understand how the experience ofself is established in a stable brain.

Taking an integrative approach to understanding the self, consciousness, and what it means to be mentallyhealthy, this book brings insights from neuroscience to bear on philosophical questions. Readers will nd a science-grounded examination of the human condition with far-reaching implications for psychology, medicine, our dailylives, and beyond.

ENDORSEMENTS & REVIEWS

It is a rare thing to be a philosopher, clinician, and neuroscientist, but George Northo is all three. In this won-derful book, he brings his unique and deeply learned perspective to problems of self, identity, and consciousness,and shows how understanding certain clinical disorders can enlighten us on the nature of the human mind, thebrain, and even the age-old questions of being and time. Todd E. Feinberg, MD, Professor of Psychiatry and Neu-rology, Icahn School of Medicine at Mt Sinai; author of From Axons to Identity

A synopsis of consciousness as a bridge between the brain and the world, grounded and contextualized withpoignant examples from neuroscience and psychiatry. Northo projects us toward coherent understandings of theself, the mind, and experience, with far-reaching philosophical and clinical implications. A truly intriguing perspec-tive on the intractable mind-brain-body problem. Jaak Panksepp, PhD, College of Veterinary Medicine, Washing-ton State University, author of The Archaeology of Mind

BOOK DETAILS

Paperback

Forthcoming January 2016

ISBN 978-0-393-70938-4

4.5 7.3 in / 256 pages

Sales Territory: Worldwide

Georg Northo, MD, PhD, a neuroscientist, philoso-

pher, and psychiatrist, is professor of neuroscience, psy-chiatry, and philosophy at the University of Ottawa In-stitute of Mental Health Research. His trans-disciplinary

approach to understanding the neural mechanisms un-derlying mental features like the self and consciousnessand philosophical issues like the mindbrain problemhas made him a world-recognized leader in the eld of

neurophilosophy. He lives in Rockclie, Ontario.

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Neurophilosophy and the Healthy Mind