Understanding how the brain works is challenging, but it’s progressing. The more we know about “neural networks,” the more we realize how, and how badly, things can go wrong. Science will be key to managing the errors.
The brain is a complex structure, reflecting “modern” types of interconnected cells layered onto the brains of our animal ancestors. But it’s extremely problem-prone. Sometimes evolution is sloppy.
Hosting 86 billion cells of various types (“neurons”), the brain generates and orchestrates perception, interpretation, comprehension, learning, memory and sleep, while coordinating many of our hormonal feedback systems.
Scientists used to think that once the brain matures, it gels into a permanent configuration, impervious to change or manipulation. An adult brain is as good as it gets.
Science itself overturned that misconception. The brain is, to some extent, “plastic.” It can be remodeled, sometimes in response to external inputs like injury and disease, but subject to experience and learning.
New tools study the brain’s structure and function with unprecedented detail. Enormous computing capacity enables mapping intricate brain structures, and then relating them to their functions. Functional magnetic resonance reveals which areas “light up” when their activity demands more fuel, linking them to specific tasks or thoughts. Optogenetics allows us to isolate neurons, spur them into action, and observe their function in real time.
Brain studies require “basic” science — determining how things are built and how they work, without demanding immediate practical uses. Applying basic science to enhancing brain health comes later.
Take Alzheimer’s disease, just one of many types of dementia. Dementia can manifest as memory impairment, inability to assess and reason, personality changes, and eventually, fatal deterioration of the body’s functions. The terminal trajectory of dementia can be horribly frustrating, prolonged and humiliating. It’s an unjust reward for a lifetime of responsible living and generosity. But life isn’t fair.
In 2017, care and treatment for dementia in the U.S. will cost approximately $236 billion, two-thirds paid by government coverage. The human costs are immeasurable. Thanks to scientific advances, more of us survive long enough to develop age-related dementias. This year, funding for dementia research grew by approximately $350 million, and Congress must confront further expansion next year.
At the other end of the age spectrum is Autism Spectrum Disorder, which impairs kids’ interpersonal interactions, social communications and language. Between 2002 and 2012, diagnosed cases rose by 123 percent, affecting one in 68 U.S. kids. Cost per affected family: $60,000. It’s not the vaccines, folks.
Mental illness that compromises decision-making and self-care is rampant among our population. After exorcisms fell from fashion, the insane, unable to form judgments in their own best interests, and sometimes unpredictably violent, were simply warehoused in “insane asylums.”
When new drug classes to treat psychosis and depression appeared, apparent remissions made it feasible to free patients from confinement. The notion “meet ’em, treat ’em and street ’em” became a prevalent strategy.
Unfortunately, medication can only work if we take it. Believing themselves “cured,” or still too sick to understand, many patients stop taking their meds. The symptoms recur. Back to step one.
To safeguard the mentally ill against abuses, even by well-meaning caregivers, the law intervened. With the right lawyer, a severely dysfunctional person might avoid commitment (which is legally justified when a patient poses “a risk to self or others”).
After improving as inpatients, many who relapse upon release are subsequently managed like first-timers all over again. They’re given the “benefit” of the doubt when there is no doubt, even as the cycle repeats.
It’s a revolving door.
Long-term inpatient facilities, now considered “too restrictive,” are increasingly defunded and closed. No medical warehouses. And fewer, less accessible outpatient centers for those who need them. Homelessness skyrockets.
These people are still sick, behaviors potentially risky. The prison serves as the new warehouse. Sentence served, the “perp” is set free, relapses, commits “criminal” acts and winds up back behind bars. Another revolving door, but often without effective treatment as a component.
The list of brain malfunctions is long. Learning disabilities in the classroom. Addictions, with their social and physical tolls. Traumatic brain injuries — concussions on the gridiron, roadside bombs in combat, a fall while roller-skating — can emerge subtly, with devastating long-term effects.
Another concern for politicians whose ideology derides science is that the more we learn about normal and abnormal brain function, the more obvious it becomes that to a very large extent, brains control both thought capacity and behavior.
Some people are so visibly insane, only a malfunctioning brain could explain their condition. But how about an otherwise normal teen with incurable Oppositional/Defiant Disorder? Is there any meaningful sense in which his “antisocial” acts are the result of “free will?” If the law won’t execute a psychotic murderer, should it jail the victim of ODD? Which “sinners” really deserve hell, and which just deserve understanding? Society is entitled to protect itself, after all.
Mental health spending can only increase dramatically — or the consequences will be even more expensive. The Great Wall of Trump must compete with other spending priorities. If Trump’s Congress denies the science of brain dysfunction, as they have other politically unpalatable scientific revelations, priorities are likely to be misplaced.
Some philosophers worry it’s impossible for the brain to understand itself. Perhaps, but the more we learn before we reach that impasse, the better off we’ll be.
Jon Hauxwell, MD, is a retired family physician who grew up in Stockton
and lives outside Hays.