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>> sally satel discusses her book "brainwashed: the seductive appeal of mindless neuroscience" at the fourteenth annual book festival at the walter washington center in washington d.c.. ♪ >> welcome to the national book festival. i am wendi maloney of the copyright office of the library of congress. please note we are recording this presentation from a web casting. if you ask a question during the presentations then you are giving us permission to include you in the web cast. please turn off all electronic devices. it is my pleasure to introduce sally satel. sally satel is a psychiatrist and president scholar at the american enterprise institute. 1988-1993 she was an assistant

professor at yale university where she remains a lecturer. sally satel is the author of many scholarly articles and books including drug treatment:the case for coercion and pc md:how political correctness is corrupting medicine. in "brainwashed: the seductive appeal of mindless neuroscience," published by basic books in 2013, she and co-author psychologist scott o. williamfield revealed how applications of human neuroscience gloss over its limitations and complexities often obscuring the many factors in psychologies that shape our behavior and identity. they analyzed what brain scans and other narrow technologies can or cannot tell us about ourselves and stress the complex nature of free will and personal responsibility. "brainwashed: the seductive appeal of mindless neuroscience" was a finalist for the 2013 los angeles times book prize in

science. please welcome sally satel. [applause] >> great to see everyone. thank you. apologies about the slide projector. most of my slides are not very busy. in fact, my first slide is a copy of the cover of the book and to be honest right after we decided on that, i really thought of a better title. i wanted to be 50 shades of gray matter. not just a play on the popular novel but exclusively meant to evoke the concept of seduction. in this case the seduction into

certain beliefs about behavior, that technology is like brain scanning can lead us to and v e epitome of seduction i would say in neuroscience is -- okay -- is the brain scan which is now the signature technology of modern neuroscience. someone says the brain scan has replaced the adam as the symbol of science. that is a brain scan and it is quite a wondrous thing. the reason i consider it a perfect storm of seduction is so many forces converge on it. it is absolutely dazzling technology. not going to go into that, it is very complicated. it is amazing technology and like all technologies it promises subject to the and a more scientific gays.

it is about the breen. neuroscience is about the brain which is a masterwork of nature. 80 billion cells or neurons each communicating with thousands of others with more connections than the milky way, just some of them. it is the organ of self and people tend to think it can reveal all kinds of secrets about human nature. it is the visual and we are highly visible primates, not something you can say about genes. anyone can see a brain scan. harder to see nucleic acids. lastly there was an element, almost an element that accompanies brains scans, people tend to think, people not steeped in science or sophisticated in that realm, why should they be? the average person reading of the science times oh my gosh, it

is in the brain. it is in the brain. a key phrase. of course it is in the brain. all thoughts and emotions are in the brain. where else would the biological correlates of behavior, emotion and thinking be? they are in the brain. you see headlines, political bias and affects the brain activity accompanied by a brain scan. anxiety is in the brain. of course it is in the brain. psychiatrists, these headlines really annoyed me, proof that depression is real because we have a brain scan to show that or anorexia or p.t. std, now we know this suffering is real. we knew it before. we didn't need a brain scan to tell us that. we need a brain scan to tell us some things. right now is mainly in the realm of research. there are not that many clinical applications that a few in the realm of research and very good

research but like so much of research went it is filtered through the press into the popular media things get distorted. it is seductive in another way. it carries an exculpatory don't blame me, don't blame my brain and also the notion that if x lights up, you hear the phrase lights up, that means there is increased activity in a particular area of the brain. there's always activity in the brain. if there is not you are dead. if x lights up, then why behavior inevitably happens and that is not the case either and we will be talking a lot about that but you can see why that conceit, x lighting up and why inevitably following it would be so appealing to trial lawyers and indeed there is a whole new

field called neuro law which is a looking at the implications of brain science, understanding the criminal mind. it is a really nice story, that defense attorneys can tell. my client had this in his brain, he could not control himself, he could not form the intent needed to commit a crime. this was a misreading of narrow imaging. sometimes without question people do have problems with their brains that renders them legally insane so they are not culpable. all kinds of damages can happen to one's cognitive apparatus rendering people either not culpable at all, or less culpable, let's say so they are

not excused but their sentence is mitigated. that happens clearly, but the point is at this point in time, things might change as the technology evolves, we cannot distinguish who those people are, the brain scans. we can't distinguish an impulse that is irresistible from one that was not resisted. this is the key point i want to get to. another misconception of popular readings of brain scans is the notion that you can actually pinpoint the motions or complex feelings. that is simply not true. in fact, that kind of activity has led to the phrase to accuse oversimplification, the reading of brain images as being akin to

narrow phrenology. as if the brain is highly modular and specific areas of it are involved solely with certain kinds of reactions. clearly certain parts of the brain are more involved, more heavily in mediating certain kinds of reactions. we know about the amygdala, a famously invoked when we talk about fear reactions but that particular part of the brain figures prominently in processing in novelty or surprise. there is not 1:1 correspondence. circuitry is where it is and all narrow scientists know this and again, a lot of the problem here is how narrow scientists came to the media.

there are wonderful science journalists who know the background and they're very comfortable and others a little less so and then there is a whole crop of people called neural entrepreneurs who are trying to make a buck from selling things that have to do with education and the lot of fads that one has to be very careful about. so really circuitry is where it is and that is where narrow scientists are focusing most of their energy. how various regions interact with each other. it is the enormously complicated but the m r i is basically a research tool. we are probably one foot into a 10 mile journey in understanding of the brain but nonetheless these brain images have migrated into the public's fear, the promise of decoding of the brain, one can see why politicians are so interested.

there are some -- some public relations groups that offer narrow imaging in an attempt to advise their clients about how to make their candidates more appealing. this was from an op-ed with the new york times in 2007 where candidates were shown to swing voters and the reactions of those voters's brains were indicative of what the candidate would have to do to appeal to them more. neuroscience at its most popular and dumbed down. marketers are very interested. this is a book with a very clever title, buyoff famous mineral marketer trying to tap into the brains of brain scans and other kinds of technologies that will reveal brain based

data to tap into the brain to learn what consumers want, like cutting out the middleman and going straight to your brain. certainly we would love to find a good lie detector. we have a whole chapter on this. this is one of the few with proof of concept, there are no signatures that can distinguish between truth telling and why in but almost impossible at this time to apply in the real world. in a laboratory setting with lots of controls it has some fairly good validity. then there is the question of how we engage the pool of temptation from oreos to cocaine and defense attorneys as mentioned before trying to prove their clients whack maligned in tent or even free will. i offer a book to anyone who knows who these two guys are?

i think i heard -- leopold and love. someone said that. i owe you a book. we devote a chapter to narrow marketing and lie detection, and we try to tease apart what seems promising, technical obstacles and achieving the ultimate goal of being able to infer something about the brain and what are conceptual barriers to doing that and pseudo neuroscience. with that as background, i want to focus on the part of the book that to me, i don't know if i speak for my co-author scott williamsfilled, one of the most interesting things is the culturally significant

implications of our growing ability to explain behavior in neurological terms. in other words the better we get at describing human behavior through biology and we are only going to get better at it, how is that going to affect the way we think about human freedom? the freedom to choose our actions? i am going to floor this through addiction. i am an addiction psychiatrist. that is my area of specialty. so i can say with complete honesty that for at least 20 years, 20 years, i have been very, very interested in the way addiction is conceptualize and portrayed to the public. frankly this is the way it is

talked about now. in the media, education will campaign. pardon me. the water, is over revers. this is your brain literally on cocaine, the new frying pan at. thanks. sorry about that. this represents a very legitimate and very interesting sermon. not interesting in terms of its results, you expect the vote results. basically this study has two general para don imus. one, you take someone who has a cocaine problem and expose them in the brain scanner, and the m r i, brain scan loses blood flow

but they both reflect increased enhanced activity in the brain. pardon me. you put them in a scanning apparatus and shows them films, those little mirrors in these machines and a person looks at the end they can see a film of people using cocaine. cocaine paraphernalia, and they experience a subjective desire to use cocaine and their brain will reflect what we call the reward area. special activation, the desire to use cocaine. when we show the same person up picture of the beach or a meadow or something neutral you don't elicit the same kind of metabolic activity, in this case mainly doberman a chick activity. the other version is what is the

cocaine user and what is not? you show them the films of people using and get this reaction, the person who has the cocaine history but not in the person who has never used cocaine as you might expect. it has been replicated a lot. it is great. but the way to describe is this is the brain being hijacked by cocaine. specifically referring to hijacking the limbic system which is a complex and fairly old brain circuitry. it contains regions, you may have heard the amygdala, the cap could -- the hippocampus and others. it mediates reward and memory and emotion but the language is that it hijacks the brain, it

hijacks this limbic system and the implication, sometimes less an implication and stated out right, is that when someone's brain looks like this effectively they are out of control. they can no longer -- in control over their actions and their drug use is involuntary. the existence is like many experts call addiction a brain disease, a brain disease because they are operating in the context of addiction. there are brain changes in the context of addiction, but still the label brain disease deserves a lot of scrutiny. first, changes in the brain are not a signifier of past policy. learning italian changes the brain. there is much plasticity

involved with learning. alzheimer s the brain. but addiction is not like learning an italian. language lessons don't take the quality of a compulsion like the crack habit nor is it like alzheimer is with its own inexorable progression to dimension which is beyond control of the sufferer. the changes in alzheimer's disease render the patient resistant to any rewards or sanction. if you said to your grandmother i am going to give the $1 million if your memory doesn't deteriorate or i am going to shoot you if your memory deteriorates, it won't matter. the brain changes of addiction, thank goodness, do not impair the capacity to be featured. i realize that might sound a little strange or it might sound not strange at all, not people

who use drugs can see the suspicions they have every day, no more or less vulnerable. in any case going into the lab, we know that rewards and sanctions can and do modify the course of behavior. which is the essence of behavior can be modified to behave from its consequences but that sounds too theoretical so let me give you an example. these are vietnam vets. in june of 1971 president nixon became panicked that there would be a flood of veterans from southeast asia coming back to the inner city and further inflame the heroin epidemic in big cities that were already underway. he was afraid of this because at least half of all g is had tried

opium and heroin in vietnam war where it was very abundance. 15 to 20% may have actually been addicted so he was very concerned. they instituted a program called operation golden flow where everyone happy in a cup and if it wasn't -- if it was positive, you weren't leaving vietnam. to make a long story short almost everyone passed the test, everyone who was using this passed the test. the few who didn't were given an extra week to clean up, then they came back to the united states. then a researcher at the university of washington named the robins followed these people for three years and was expecting to see higher rates of

addiction and once they were back home, if they would resume their habit, but only 12% had used in the three years that they had come back and that was very very surprising but also very encouraging and frankly it is what lies at the heart of recovery and reasonable public policy for addiction which is the intelligent use of sanctions and rewards which we can make good use of in the criminal justice system. i won't get into legalization, taking the system as we find it to the extent that we can divert people from incarceration because of nonviolent drug crimes and put them in drug courts. we have been doing that for years and these courts are based on the principles of behavior which is swift, certain but not

severe sanctions can shape behavior and drug courts have been going on for quite a while and quite successful. the point is if you just focus at the level of the brain, just talk about the nucleus and the hippocampus, i apologize. [coughing] >> you would not think about shaping behavior. when you are told something is a brain disease you think it is involuntary. how do drug addicts work with patients so they don't crave? we come up with strategies to allow them to what is called self binding, wasted basically put barriers between themselves and their drugs. you probably heard the common one, stay away from people, places and things. thanks so much. deposit your paycheck.

don't have money available. i had a patient who used to shoot up. every time he looked at his arms where he had tracks it would stimulate a sense of craving. he would wear long sleeve shirts all the time or find himself too arrau's. avoid boredom. this is the kind of thing people have to do. the point is this involves motivation. this involves conscious engagement. if we focus too much at the level of the brain when won't pay attention to these things. it is a kind of ulysses phenomenon where patients where patients bind themselves not to the mast in this case but create barriers to their use, to recognize situations of vulnerability like hearing the

siren song of cocaine but restraining yourself in some ways. okay. so addiction is a good example in this discussion of what scott and i call narrow centrism and that is one of the problems with the way neuroscience has been popularized. narrow centrism is the idea that human behavior can be best explained by looking primarily at the brain. that somehow that level of analysis gives you the most authentic, true, reliable, understanding of the behavior. probably true if you have alzheimer's disease. post-traumatic stress disorder know, depression no. problems with the narrow centric view is you emphasize medication too much. i am not against medication.

to think this is the answer in and of itself is clearly not true. you downplay the importance of psychology, behavior, we can't afford to lose the mind in the age of brain science. when i refer to mind i am talking about feelings, thoughts, desires, tensions, memories, subject to the. i don't want you to think we are falling into any kind of do a dozen track. the mind is wholly dependent upon the brain, no questions there, it is all subjective experience, mediated through the brain, no brain, no consciousness that it is important to realize the physical rules from one level of

analysis. i apologize. you can see that very well. basically breaking all levels of analysis down starting from the environment and ending up with genes. it could end up in quantum physics. that is we can't yet use physical rules on the cellular level to predict activity at the psychological level. if you want to understand if you are reading a book and went to understand what the text means you don't subject the ink to chemical analysis. that is not the levels that is going to inform you about the meaning of the book. the important thing is questions are answered better as one or more of these levels. others are answered at others. they are not right or wrong. does addiction affect the brain? of course it does. if we stay at that level we are

going to miss a lot. >> it is not just addiction but biological explanations of complex behavior can mislead in the courtroom as well and trial lawyers love that and are counting on jurors to get to this as well. there are certainly cases where people's brain-dead defective and cannot be held legally accountable, not just brain images are helpful in distinguishing who they are and i have to say maybe that will change at some point but it can be highly misleading and biological explanations influence the way we think about responsibility over action. there are many interesting studies, explaining behavior in

biological terms and compared to psychological terms. that is the big flap, describing some sort of correlate of behavior, people are much more likely to attribute less blame to the person if they committed a crime and explanation given for their behavior the impulse to punishes a lot less severe when people understand it as being a behavior that is caused by of rain problem and as opposed to a childhood problem but this could backfire. mental illness and substance abuse, the desire for social distance and stigma enhancers, and treatment therapy will work and individuals are more dangerous.

this is important to know. the implications of how we describe behavior, not telling you how you should describe the behavior. they won't manipulate explanation so as to elicit specific kinds of reactions. if the problem is in the brain of an apple you have to be truthful and talk about that. it is interesting how these explanations affect fundamental -- intuition of human agencies. my point is simply they can be manipulated. let's go a little bit deeper. leave a little time for discussion. i want to go a little deeper.

when lawyers use brain scans in capital cases, they are making the point that their client couldn't form and in 10 or their clients couldn't reason properly, their client had some sort of poor control but the implication is the default circumstances is most people can control themselves, most people know what they're doing, most people can be deterred, but not my client. some narrow scientists and philosophers are going a step further and arguing no one has capacity for choice, none of us could act other than we did and all of us, not just criminals, are not in control of our actions at any point.

you will recognize this as the fiendish ancient debate about free will. which we are not going to resolve here. so you know. many narrow scientists claim we don't have free will and this is not new. this debate has been going on for centuries. but they do argue that neuroscience will make this clear. that neuroscience will resolve the free will debate. that debate, neuroscience will finally clear up the free will debate. that brings us to an interesting aspect. the implications of morality, more generally, not just whether an individual could or could not control themselves or should be responsible but whether the concept of responsibility at all

is a coherent one and that gets us back to our boys. 1924 i think everyone knows this story in chicago these two brilliant kids wanted to commit the perfect crime so they found a 14-year-old boy and killed hi.

and were very pleased and at the end but there was a 12 hour summation by clarence darrow. he was arguing for life in prison as opposed to hanging. he did succeed although the judge said it had to do with his youth, not his arguments and the argument was right out of the determinist playbook. in other words i will tell you what he said. why did they kill little bobby franks? not for money, not for spite, not for hate. they killed him because they were made that way. they were nature's victims. and he said, this is from the essence -- i am sure you remember this from philosophy 101 but the notion of determinism which is that each act we perform criminal or otherwise followed from a cause and given the same conditions,

the same result will flow everytime. again we are talking for example of all the causes but go into a person, the gene, your experience with history, your environment, your genetic history, and all these in the context of the moment, the ideas that the salt impinge on the individual so the moment of having to make a decision there is basically it kind of faded to make one shoelace. there is no real choice. with a huge his suit over salad or murder over mercy there's no choice to be made, we couldn't have chosen otherwise based on this whole history of this whole causal parade. i am assuming this sounds

familiar. there is no praise, there is no blame. you couldn't have done otherwise. couldn't have acted on the force is impinging on you. this is not an intuitive view of how you react. on the other hand it is true much of our behavior and cause even in unconscious ways, that is true. how is neuroscience compared to -- two quotations but the bottom one, we are victims of our own circumstances does the top one is clarence darrow. the bottom is a narrow scientists. they were all versions of their own circumstances. if true what happens? there is no blame. it means we have to change our criminal justice system radically. turn it into one that is

utilitarian, where we like to put people in jail but it is to deter them from acting again and to deter others from observing how we punish them, to contain dangerous people and rehabilitate them but no punishment. this is going on for a long time. and the addition of neuroscience, they lead of to this question. moral responsibility in a world in which all events leading up to the moment of choice determining what the choice will be. we see that process. this is what happens to me. it was not resolving it. the point is neuroscience is not

resolving this either. and think about the kinds of freedom that are necessary to make the choice. and the kind that is completely not caused, people essentially operate in a vacuum. and unless we live in a causal vacuum. and ultimate free will. those are hard determinants and they do go towards the utilitarian view of the criminal justice system and then we have people, i am more sympathetic to this view that basically says as long as people can reason, deliberate, planned, change their minds, that is enough

freedom for people to be considered to have free will. if there is something wrong with your brain so that you can't reason or deliberate or respond to reason, then maybe you as an individual do have your freedom compromise and maybe you should be excused. as species, we do have free will. i don't know how you come down on that but neuroscience won't help you resolve it. i should end fair. only five more minutes. i have more to say. the book is basically a culture book. i consider it much more of a culture books than a science book. it is inevitable that biological manifestation and mechanisms are understood and enormous therapeutic benefit. we even talk about the benefits.

and i assume we will talk about that as well. and it will have -- the final scientific frontier. that is all very true. but we shouldn't get seduced into thinking too mechanically about ourselves or to too reductive about human nature simply because we a learning more and more about how we function. thank you so much. [applause] >> there might be time for two more questions. is there -- >> is it normal? >> the question was does a a work? the short answer is it works for

whom it works. don't mean to be flip but some people it saves their lives. most treatments don't have the great rates. a a doesn't either. at the individual level it can be life-saving. the average person won't stop drinking right away. they are the kinds of treatments that work best are the ones we don't use. we don't use these rewards of sanctions very much which is a shame unless you are a doctor or a pilot and if you lose your license we have all kinds of built-in contingencies, you have something to lose a you will lose unless you shape up and the rates of recovery and for professionals are 95% because there is so much to lose and obviously these are people with skills as well. you are dealing with a different

kind of population but they don't -- they do much better, professionals do much better in terms of recovery when there are contingencies attached to them as well. >> can you talk a little bit about food addiction? you said you are from yale. and the food addiction scalers a marriage, a survey of behavior with neuroscience and brain scans but that was not poised to impact legislation and prepared food industry. >> that is from an article i wrote about last year. there was of research studies that got an inordinate amount of attention and that quality work but it compared rats with rats. rats are fine but there's only so much you can extrapolate to

humans. anyway, cocaine oreos were as addictive as cocaine. don't know if you recall that. the idea was they made this, they concluded this because the same narrow signatures, this is true in humans as well, the reward halfway i mentioned is solicited by food and anything pleasurable and cocaine. it is fair seal to say food addiction is like cocaine. shows us people have a desire for it. there is anticipation and desire. it may register anticipation more than it does actual desire and the same principles apply as they do to addiction in the sense or to any behavior to the extent that we can learn the

cues that make us more or less vulnerable and with motivation and other kinds of techniques we can overcome them. the same natural mechanisms are engaged but i would argue against the person is rendered helpless. i do think that you are exactly right. there have been a lot of product liability efforts to sue big food and that this potentially is a trial lawyer's dream to make it as analogous to addiction as possible. that would be a real abuse of neuroscience. do i have one more? >> a little confused. i am addicted to ice-cream. if it is not in my brain where is that addiction located?

>> that is -- of course it would be in the brain. that is exactly where it is. that is where everything is. it is trivially true to say something is in the brain. there are things in the brain we haven't found. if you recall the awful crime in 2001 of andrea yates, this poor woman with postpartum psychosis and drowned her kids there was no brain scan in her trial. but even if they attempted to bring one in now it wouldn't review much. we can't make the most significant psychiatric diagnoses like postpartum psychosis, bipolar schizophrenia, we can't make those diagnoses with great certainty based on brain scans. i am sure we will one day or with other information be it genetics or genetic information is now so difficult. there are hundred genes involved

with schizophrenia perhaps of very complicated. we will get there but we are not there yet. it is limited technology and responsible narrow scientists know that and cringe when they see it being applied in the public realm but they cringe but we wrote the book. >> one more. >> do you believe that there is a pre genetic disposition, that people are born with -- if you were an alcoholic and the recovery and you are automatically going to be addicted to something else? >> there is no question there are genetic predisposition is to these things, genetic predisposition can be anything from how pleasurable. how pleasurable we find a

certain let's say alcohol varies a lot. some people find it disgusting lose some people can't metabolize, difficult for asian populations to metabolize alcohol very well. there won't be a lot of alcoholism because -- these are probabilistic. your parents are alcoholics, some people say don't even try it. why even put yourself in that position. not like your mother has huntington's and you don't have that jean. it is not that kind of simple genetic transmission at all. we are talking probability and in this case in the most simple way, not even go near it at all, and pace yourself, there are all kinds of strategies of person can use so that if they do feel things are getting out of control they can pull back and i must tell you most people pullback, clinicians' tends to

see people who have trouble. there's something called the clinician's illusion which is a problem i have engaged in as well where we extrapolate too vigorously from the people we see in the clinic to people in the general universe. we saw this after 9/11. it was an assumption that new york city would be traumatized. the amount of money that went into mental health services was astounding and well-meaning and it turned out that if you were in the tower you could have had a severe psychiatric reaction. if you knew someone who died you were vulnerable but the vast majority of people were upset as hell but not pathological at all. people are resilient but that is not the people psychiatrists see. we see the people who have tle