We Are Our Brains

by D. F. Swaab

  Young children have no religion; religious beliefs are imprinted in them by their parents at an early stage of development in which they accept without question anything they are told. In this way, beliefs are passed down from generation to generation and become fixed in our brains. Children should be taught not what to think but how to think critically and how to make their own ideological choices in adult life. Segregating young children in belief-based schools is pernicious—it not only prevents them from learning how to think critically but it also fosters an intolerant attitude toward other beliefs.

  THE UNPRODUCTIVE: THEIR OWN FAULT?

  The variation that drives our evolution is still proving fatal to some.

  Politicians have never lost faith in the misconception that social engineering can reprogram the brain. On the contrary, as of the 1980s, alarmed by recession and the top-heavy welfare state, they began to stress individual responsibility for prosperity and welfare. People were told that their fates lay in their own hands—a claim at odds with the many studies showing that people’s capacities are largely determined by genetic factors and environmental influences in early development. An educational disadvantage is hard to eliminate. An innate lack of capacity can’t be entirely compensated for. And more and more people are unable to meet the increasingly high demands placed on them by today’s rat race society. Those whose capacities are lacking or who have mental health problems are now being unjustly blamed for their own failure. Young people with mild learning disabilities (IQ 50 to 85) are an especially vulnerable group. They make up 16 percent of the Dutch population but are strongly over-represented among those tried for criminal offenses (accounting for 50 percent of them). They are held responsible for their own choices despite their inability to compete in the employment market. In the current repressive climate, misdemeanors that would previously have incurred a strong warning have now been criminalized. This group is easily influenced, a characteristic that often gets them into trouble. It’s also the characteristic that should make it easy to help them to stay out of trouble. Unfortunately, the structures and facilities that would make this possible have fallen victim to budget cuts.

  Children of poorly educated, poorly paid parents are more likely to drop out of school and end up in low-paying jobs; they also run a higher risk of poor health, criminality, addiction, gambling, and unemployment. There is a life expectancy gap of six years between the lowest- and the highest-educated. This discrepancy is largely due to lifestyle. Making tobacco and alcohol more expensive to encourage the former group to change their habits has proved ineffectual. Negative lifestyle factors are most pronounced when people live in deprived areas.

  Deprivation often appears to be inherited, contagious even, since these problems accumulate in certain neighborhoods. According to the Netherlands Institute for Social Research, almost one hundred thousand Dutch children, 4 percent of the total, are socially excluded. They aren’t members of a sports club, are almost never taken on outings, don’t go on vacation, and hardly ever visit the homes of friends. If this definition is applied slightly less strictly, 11 percent of Dutch children can be considered to be socially excluded. This is largely because of their parents’ financial situation. But their parents, too, are marginalized, and such families live in neighborhoods devoid of proper playgrounds and plagued by vandalism and antisocial behavior. These aren’t circumstances in which a child’s brain can develop optimally.

  There’s no quick fix for this problem. We can do our utmost to foster optimal development and to prevent damaging influences. But we must also accept that in a complex process like brain development things occasionally go wrong. As a result there will always be a small proportion of people who aren’t properly equipped for life, who suffer from mental disability or have neurological or psychiatric problems. This can happen to any child in any family, and society must shoulder its responsibility by providing sheltered jobs, social benefits, and good, practical supervision. As things stand, there is a lot of room for improvement. Better education and public information are also needed to prevent society from laying the blame for failure at the door of those who, through no fault of their own, incurred a developmental brain disorder.

  There’s a similar tendency to assign blame to people struck by brain diseases in adulthood. They are often told that a positive attitude toward, say, MS, will promote healing. It’s an appealing notion. However, not only is there absolutely no evidence for it, the result is that if the disease worsens, the poor patient will be blamed for not doing his best to overcome it! It’s high time we abandoned the “own fault” myth.

  THE BRAIN AND CRIME

  Aggression levels are determined by gender (little boys are more aggressive than little girls), genetic background (tiny variations in DNA), fetal nourishment, and pre-birth exposure to smoking, drinking, or medication. The likelihood of boys displaying uninhibited, antisocial, aggressive, or delinquent behavior increases in puberty, as their testosterone levels rise. The level of violence shown by adult male criminals is also testosterone-related. So there are many factors beyond one’s control that determine whether someone gets into trouble with the police or ends up in court. That doesn’t mean that criminals shouldn’t be punished, but criminal law should take these neurological factors into account. The development of the prefrontal cortex is a slow process, continuing at least until the age of twenty-five. It’s only at that age that an individual is fully equipped to control their impulses and make moral judgments. On the basis of neurobiology, therefore, the age at which offenders are tried under adult criminal law shouldn’t be reduced to, say, sixteen, as some politicians are urging in an effort to woo voters, but should rather be raised to an age at which the brain structures are mature, at around twenty-three to twenty-five. People who commit a minor offense as teenagers shouldn’t have that held against them later on in life.

  Some children are markedly more aggressive than others. A strikingly high incidence of psychiatric disorders is found among delinquent youths imprisoned for violent crimes—as high as 90 percent of the total group in the case of adolescent males. Genetic factors are also influential, as studies of twins have shown. The application of criminal law should be confined to individuals with healthy brains. But our criminal law system continually sins against this “M’Naghten rules” principle. Can a pedophile be held morally responsible for his sexual orientation, which he owes to his genetic background and atypical brain development? Can a child be deemed culpable for the combination of his genes and his mother’s smoking during pregnancy, causing him to develop ADHD and to get into trouble with the police? We know, too, that malnourishment in the womb increases the likelihood of delinquency. And can an adolescent whose brain has just been completely reconfigured by sex hormones be considered fully responsible for committing a crime?

  Moral responsibility is a tricky concept in these situations, free will an illusion. This doesn’t mean that criminals shouldn’t be punished, simply that punishments should be effective. In the field of medicine we have learned that to reach truly scientific conclusions, the effects of a drug or other therapy need to be ascertained in a properly controlled study. However, criminal law clings to the notion that punishment must be determined on an individual basis, rather than thinking in terms of well-defined groups. In point of fact, the criminal justice authorities are using the same arguments that psychoanalysts did in the days before it was systematically established whether a particular form of psychiatric therapy worked or not. As a result, it’s impossible to determine the effectiveness of a punishment. Moreover, the criminal justice system is increasingly being pressured by politicians to devise ever more penalties, from community sentences to boot camps for young offenders, without establishing how they measure up against traditional forms of punishment. In the absence of a proper study involving a control group, the efficacy of measures will always be contentious. However, politicians have little interest in scientific methods. They only think in the short-term—particularl
y of the coming elections.

  THE END OF LIFE

  Do you, like us, believe more in life before death?

  Dutch Humanist Association

  Although all efforts in the medical field are focused on delaying the end of life, death always wins in the end. If at all possible, we want our brains to be healthy as death approaches, so that we can continue to make our own decisions in this final stage of our lives, right up to the last moment. People in the Netherlands who have cancer or some other serious illness are fortunate to have the option of euthanasia, which Dutch law considers acceptable as a means of preventing pointless suffering. If someone suffers from a brain disorder, however, assisted dying is a problem. Patients who are in a coma or similar state can no longer communicate their wishes, and patients with dementia or psychiatric disorders present doctors with the difficult task of assessing their mental competence. Views on euthanasia or assisted dying in these two latter categories are progressing, although the decision to perform euthanasia, which remains extremely difficult for doctors treating patients with chronic psychiatric disorders, is rarely made. Yet it can prevent horrible suicides. In general, Alzheimer’s progresses so slowly that you have time to seek out and consult with a physician who can help you choose the right moment to end your life. But there are other forms of dementia, like vascular dementia, which can overwhelm you before you have had time to organize matters. So it’s important that those close to you know your feelings on the subject, and that you make sure that your doctor will give you the assistance you want in the final stage of your life and that over time you can both prepare for this moment.

  There is, however, a large and rapidly growing category of people for whom assisted dying still falls outside the scope of the legislation on euthanasia: elderly people who simply feel that their time has come. We’re trying to address this problem by means of a civil society initiative whose aim is “to legalize assisted dying for elderly people who believe their time has come, under the proviso that this takes place at their express request, with all due care and in a manner that’s open to scrutiny.” The initiative, which was set up by Yvonne van Baarle, is called Uit Vrije Wil (By Free Will). Not wishing to complicate things unnecessarily, I refrained from mentioning to the group my view that free will is illusory until we had secured the forty thousand signatures that were needed to ensure discussion of this question by the Dutch parliament. In fact that only took four days. It would seem that people in the Netherlands are very concerned about this issue. We will see how politicians respond and how long it takes for the law to be amended.

  NEW DEVELOPMENTS

  When I started work as a student doctor in 1966, brain research was the domain of a few mavericks who were regarded with considerable suspicion by society at large. These days, the great social significance and huge potential of this field appear to be universally recognized, and neuroscience has become a top priority at universities and research institutes all over the world, where hundreds of thousands of scientists explore a wide range of technologies. The highly complex research techniques call for specialized scientists, who must work in multidisciplinary teams to achieve new insights. Networks are becoming ever larger and more international, as can be seen from the growing number of authors and affiliations cited at the top of publications.

  In the years to come, insights into the molecular biology of brain disorders will produce new objectives for therapeutic strategies. Stimulation electrodes implanted at precise sites in the brain are being used to treat not just Parkinson’s disease but also obsessive-compulsive disorders. Their effect is also being studied in such areas as minimally conscious states, obesity, addiction, and depression. As with all effective therapies, there are side effects. And these can be considerable in the case of Parkinson’s patients undergoing stimulation of the subthalamic nucleus, ranging from obesity to changes in character, impulsive behavior, and even suicide. Psychosis, lack of sexual inhibition, and compulsive gambling have also been reported. Researchers are looking at the effect of transcranial magnetic stimulation on depression and tinnitus. This technique is also used to prevent hallucinations among schizophrenic patients. It’s still too new for its side effects to be known. Neuroprosthetics—devices that can replace sensory systems—are becoming ever more sophisticated. One paraplegic had a plate with electrodes implanted into his cerebral cortex that allowed him to control a computer mouse and a prosthetic arm with his mind. Visual prostheses are being developed for the blind. Attempts are being made to carry out repairs in the brain and spinal cord by implanting fragments of fetal brain tissue or stem cells and by initiating gene therapy.

  New discoveries are constantly being made, thanks to the huge growth in neuroscience and the technical advances made in the field. And they are vitally important, because 27 percent of Europeans suffer from one or more brain disorders. In the Netherlands, over 30 percent of the health care budget is spent on patients with brain diseases. You would expect that at least a proportionate amount of research funding would be earmarked for brain research, but in Europe only 8 percent of this budget is allocated to neuroscience. When will governments finally develop that much-needed long-term vision to ensure healthier brains for generations to come?

  To all the scientists who stimulated my brain so intensely, and to Patty, Myrthe, Roderick, and Dorien, who formed my enriched environment at home

  Acknowledgments

  This book came about after the Dutch newspaper NRC Handelsblad asked me, in 2008, to write a column in which I answered readers’ questions. I’m grateful for the help I received from Jannetje and Rinskje Koelewijn during this process. Portions of these chapters appeared in the NRC. I could never have written this book without being immersed in the international network of brain researchers and benefiting, in my own research group, from an amazing amount of new data and feedback supplied by a great many excellent, critical, and talented students, analysts, PhD students, postdocs, and staff members. Patty Swaab corrected all the chapters before I dared show them to anyone else and had her work cut out in doing so. I’m also indebted to the following people for suggestions and corrections: Bao Ai-Min, Els Boelens, Martijn Boelens, Kees Boer, Ruud Buijs, Wouter Buikhuisen, Hans van Dam, Marcel van Dam, Gert van Dijk, Cisca Dresselhuys, Frank van Eerdenburg, Tini Eikelboom, Michel Ferrari, Eric Fliers, Rolf Fronczek, Anton Grootegoed, Michel Hofman, Jan van Hooff, Witte Hoogendijk, Inge Huitinga, René Kahn, Bert Keizer, Felix Kreier, Jenneke Kruisbrink, Paul Lucassen, Martijn Meeter, Joris van der Post, Liesbeth Reneman, Carla Rus, Erik Scherder, Reinier Schlingemann, Eus van Someren, Roderick Swaab, Martijn Tannemaat, Unga Unmehopa, Joost Verhaagen, Wilma Verweij, Ronald Verwer, Geert de Vries, Linda de Vries, Frans de Waal, Katja Wolffenbuttel, Zhou Jiang-Ning, and many others. I enjoyed working with the staff of Uitgeverij Contact on this book, particularly Mizzi van der Pluijm, Bertram Mourits, Cindy Eijspaart, Kirsten van Ierland, Bieke van Aggelen, and Jennifer Boomkamp. I would moreover like to thank Maartje Kunen for her excellent drawings. Finally, I am extremely grateful to Jane Hedley-Prôle for her excellent English translation, the improvements to the text, and the most pleasant collaboration.

  ABOUT THE AUTHOR

  D. F. SWAAB has been professor of neurobiology at the University of Amsterdam since 1979. From 1978 to 2005 he was director of the Netherlands Institute for Brain Research, now the Netherlands Institute for Neuroscience. In addition to heading the institute’s research group on neuropsychiatric disorders, he holds three guest professorships in China and the United States. In 1985 he founded the Netherlands Brain Bank, whose tissue samples are used by researchers all over the world to increase understanding of the brain and to develop therapies for neurological and psychiatric diseases. In 2008 he was awarded the Medal of the Royal Netherlands Academy of Arts and Sciences for his contribution to neuroscience.

  ABOUT THE TRANSLATOR

  JANE HEDLEY-PRÔLE works at the Dutch foreign ministry and as a freelance literary translator. Her book translations inclu
de Diaghilev: A Life by Sjeng Scheijen (with S. J. Leinbach) and The Fetish Room by Rudi Rotthier. She is currently translating a book on the nature of identity.