October 16, 2009

The Neurobiology of Wisdom

It's always in the last place you look.

Dr. Henry Nasrallah asks Does psychiatric practice make us wise?

We also integrate our complex observations and findings with the rich collage of each patient's unique cultural, religious, and educational background. We strive to find hidden or higher meaning in patients' symptoms... We assess their potential lethality toward themselves or others and examine the often tortuous course of their existence. And, unlike other physicians, we observe their transference toward us and simultaneously examine our own countertransference

etc.  What can be said?    The article is self-aggrandizing wishful thinking, the kind of thing you expect from a bass player when he tries to convince a girl that he's the soul of the band.

The article could be ignored, if it didn't take a tragic turn off a uranium mineshaft in the final third.

The wonder of psychiatric practice is that we somehow navigate each patient's unique jungle of thoughts, emotions, behaviors...  By doing so, we develop different regions or circuits in our brains than surgeons, radiologists, or internists do. Meeks and Jeste's wonderful article about the neurobiology of wisdom suggests that psychiatrists' brains probably develop "wisdom circuitry" via advanced neuroplastic connectivity in the:

  • prefrontal cortex (for emotional regulation, decision-making, and value relativism)

  • lateral prefrontal cortex (to facilitate calculated reason-based decision-making)

  • medial prefrontal cortex (for emotional valence and prosocial attitudes and behavior)


I hope that readers of this blog can now see through this inanity.  This is no longer just wishful thinking; it's an outright lie.  I don't need to read Meeks and Jeste's "wonderful" article to know that there is absolutely no way they could show that psychiatrists develop wisdom circuitry of any kind, let alone through the three made up pathways (aren't they all just the prefrontal cortex?) he lists in bullet points ("I've summarized the points you need to know for the test with bullets.")

Nevertheless, there's Nasrallah's article.  You don't realize how significant it is: it becomes another article listed in the superscript of references no one looks up, supporting statements like "there is considerable evidence that..."

II.

It's not all Nasrallah's fault: he saw porn and couldn't look away.  The Meeks and Jeste article he references has a catchy title-- The Neurobiology of Wisdom-- and it's in the Archives of General Psychiatry.  But Meeks and Jeste's article isn't just bad, it is horrendous.  It's the research equivalent of a sarin gas attack.  Everybody dies, nobody can tell why.

It would be impossible to list all of the specific problems with the paper.  As proxy, here's the quote at the beginning of the article:

Of all the pursuits open to men, the search for wisdom is most perfect, more sublime, more profitable, and more full of joy.--Thomas Aquinas

That the six letters w,i,s,d,o, and m appear in that order is the only similarity between the "wisdom" sought by Aquinas and the one pursued in this article.  While this might seem like an academic or minor quibble, it's not: the purpose of the paper is to conflate "wisdom" with a set of characteristics that have nothing to do with wisdom at all, and claim a biological link.  The article studies the color red and finds there "the essence of NASCAR." 

The pursuit of wisdom for Aquinas was the pursuit of ultimate truth or cause; the article uses the term as a relativistic judgment on behavior.  Here are the six components:

(1) prosocial attitudes/behaviors,
(2) social decision making/pragmatic knowledge of life
(3) emotional homeostasis
(4) reflection/self-understanding
(5) value relativism/tolerance
(6) acknowledgment of and dealing effectively with uncertainty/ambiguity.

Don't fall into the trap: though these may be positive attributes, only (4) has anything to do with wisdom as defined by Aquinas, or even as described by one of the references they use, e.g:

  • reasoning ability
  • sagacity
  • learning from ideas/environment
  • judgment
  • good use of information
  • insight

Spend a moment and think about the difference between the two "wisdoms."  But don't spend too long: the article takes the first group, finds a poor proxy for each, muddled by fashion and politics, and reviews the neurobiological data for those.

III.

Here's the first one:

One of the most consistent subcomponents of wisdom, from both ancient and modern literature, is the promotion of common good and rising above self-interests, ie, exhibiting prosocial attitudes and behaviors...
"Common good rising above self-interests" would make Ayn Rand stab a harp seal; but regardless of what you think of Rand, it's at least evident that this isn't at all "consistent" in the definition of wisdom.  Or are there no wise capitalists?  But accept it and follow the logic to your doom:

...such as empathy, social cooperation, and altruism.6 Thus, sociopaths, who may exhibit exquisite social cognition and emotional regulation that actually facilitate their selfish motives, would not be considered wise.
So selfish is not wise.  Ok, I get it.

Altruism: Altruism overlaps with cooperation, although altruism is notable for the potential harm or "decreased fitness" the altruistic person risks to help others.55 Harbaugh and colleagues56 demonstrated that the idea of voluntarily giving money compared with that of paying taxes... caused increased activation in reward circuitry... Similarly, Moll et al57 reported that both receiving monetary rewards and deciding to donate money activated ventral and dorsal striatum. This somewhat paradoxically suggests that the neural substrate of altruism may be akin to that of more instinctual self-pleasures.
I defy anyone to tell me how that paragraph describes altruism as putting the common good above self interest.  If altruism makes you feel good, then it doesn't rise above self-interest.  I'm not saying altruism isn't valuable, only that if it is valuable because it rises above "selfish motives" selfless, then the research suggests it isn't valuable (modus tollens).

IV.

In order to illustrate what this paper did, I'll explain it backwards: regions in the brain typically thought of as "reward centers" were seen activated in studies of donating money; the giving of money is thus labeled altruism, which, being a selfless activity, is "prosocial," which, of course, is a component of wisdom. 

Hence, one can write the following sentence:   "There is evidence showing a neurobiological basis of wisdom."

V.

The entire article is like this.  One more example:

Value Relativism/Tolerance:  Tolerance of other persons' or cultures' value systems is often considered an important subcomponent of wisdom.
Oh my God I need a nap.  Is this really true?  I'm not asking if  desirable, I'm saying is Julius Ceasar not wise?   Odysseus?  Any of the Indian killing Founding Fathers?  Or are they wise except for their wanting to take things over?

Brain Localization via Neuroimaging. Neuroimaging studies of tolerance have frequently focused on prominent societal prejudices, especially those related to race/ethnicity. Some investigations have demonstrated that the regulation of "automatic" prejudicial responses follows a neurobiological pattern similar to that described for impulse control: dorsal ACC detects an undesirable attitude surfacing, prompting lateral PFC inhibition of undesirable attitudes, and leading to downstream amygdala deactivation.122-123

First of all, the paragraph tells you these studies are about automatic race bias, e.g. does the picture of a black face make you think of the gun or the hammer?  But what does that have to do with "tolerance of value systems?"  Nothing, as they admit in the next paragraph:

While sharing rudimentary neurobiology with impulse control, value relativism is conceptually more complex and its study would benefit from the development of novel measures/tasks.

Here's the point: since you admit that paragraph doesn't support your argument, why do you even write it down?  Because then you can say:

Summary. Dorsal ACC and lateral PFC play important roles in tolerance of varied value systems by detecting and inhibiting, respectively, expressions of prejudicial responses.

VI.

One might now ask, "why was this paper even written, let alone accepted for publication?"  Go back to the quote:

Of all the pursuits open to men, the search for wisdom is most perfect, more sublime, more profitable, and more full of joy.--Thomas Aquinas

Note that they dropped the "Saint."  Meanwhile, there's no problem referring, a few sentences later, to Gandhi as "Mahatma."  That's okay, because no educated person actually thinks Gandhi is a saint, but there are still plenty of numbskulls who need to be reminded that  Aquinas isn't.

Cultural narcissism; the prevalence in science of "end of history" guys who think this time is different from all others, everyone who came before was stupid, naive, myopic, or less ethical.  The authors may even be good Catholics, who knows, but they know philosophy was just marking time until the invention of the MRI.  Summa Contra Gentiles becomes, well, a footnote.

They don't realize that their belief in the "neurobiology of wisdom" is nothing more than faith, structurally no different from Catholicism: a hierarchy of beliefs with no foundation in physical reality, and an endless stream of words.

But Catholicism doesn't call itself a science; and Aquinas at least had logic on his side.

-------

update

Previous post on the overreach of neuroradiology



----------------------------
Summa contra gentiles, from where the quote was taken, was Aquinas's discussing "wisdom" using arguments of reason, not religion:

Some of the Gentiles, such as the Mohammedans and the pagans, do not agree with us on the authority of any Scripture by means of which they could be won over--in the way that we can argue with Jews by appealing to the Old Testament and with heretics by appealing to the New Testament. But they accept neither the Old nor the New Testament. Therefore, it is necessary to revert to natural reason, to which all are compelled to assent

--------------

http://twitter.com/thelastpsych





Comments

Neuroscience reveals all so... (Below threshold)

October 16, 2009 12:56 PM | Posted by Cole Bitting: | Reply

Neuroscience reveals all sorts of tremendous insights into the brain. That is where its wisdom is. When those thought are extrapolated in grand fashion, they become less wise and more metaphorical.

When neuroscience affirms good psychology, there is a sense of firmer ground. Still, when soaring with an idea in this area, the air gets thin quickly. (I hope I know when I'm not getting enough oxygen).

Thanks for the article. No punches pulled here :)

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"why was this paper eve... (Below threshold)

October 16, 2009 2:24 PM | Posted by Jack Coupal: | Reply

"why was this paper even written, let alone accepted for publication?"

Duh!

Dr. Nasrallah is editor-in-chief of Current Psychiatry Online. Dr. Nasrallah wrote his opinion, Does Psychiatric Practice Make Us Wise?. Dr. Nasrallah pondered long whether or not to publish his opinion in Current Psychiatry Online.

After long evaluation, he decided it was so valuable to the psychiatric community, he said, "What the heck!"

Next question!

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Is there nothing neuroscien... (Below threshold)

October 16, 2009 3:33 PM | Posted by Anonymous: | Reply

Is there nothing neuroscience cannot answer? For those who believe the answer to that question is a negative (and many do) that is what tells us that neuroscience has become a cult.

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I particularly liked the co... (Below threshold)

October 16, 2009 3:45 PM | Posted by Anonymous: | Reply

I particularly liked the comment

But Catholicism doesn't call itself a science

which is accurate as far as it goes. Catholicism doesn't need to call itself a science. It goes far beyond science, asserting it is the one, true church. It has god and truth- why on earth would it need wisdom? Except, of course, the Sophia element which we'll ignore because it's just another non-scientific assertion of absolute wisdom.

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Nasrallah's article makes m... (Below threshold)

October 16, 2009 6:03 PM | Posted by theskepticalshrink: | Reply

Nasrallah's article makes me ashamed to be a psychiatrist.

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Well I always thought psych... (Below threshold)

October 16, 2009 7:37 PM | Posted by James Gaulte: | Reply

Well I always thought psychiatrists were really smart.Now they can show you their MRI and prove it and they would but they are too altruistic to do that.

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How unfortunate that the sa... (Below threshold)

October 16, 2009 8:15 PM | Posted by Z. Constantine: | Reply

How unfortunate that the same fallacies which drive superstition have learned to cloak themselves in the rigor and veracity of the scientific method (though it is hardly applied in self-congratulatory panegyrics like Dr. Nasrallah's).

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Philosophy was just mark... (Below threshold)

October 16, 2009 10:54 PM | Posted by Jane: | Reply

Philosophy was just marking time until the invention of the MRI.

Brrr. You may have had your nap, but I doubt I'll get any sleep tonight after that.

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"Natural reason." I like th... (Below threshold)

October 17, 2009 1:13 PM | Posted by K.: | Reply

"Natural reason." I like the sound of that.

I'm not at all wise but at least I know it. Not sure if the writer of said article can claim the same thing, though.

Your articles, even the ones (like this one) that are hard for me to follow due to educational constraints, have helped me see life from a different point of view and I'm grateful about that.

Thanks.

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Yeah, but "social justice" ... (Below threshold)

October 17, 2009 2:09 PM | Posted by MH: | Reply

Yeah, but "social justice" is cool now, and we all know that the coolest people are also the wisest. Like the Fonz.

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The way forward in our evol... (Below threshold)

October 18, 2009 5:54 AM | Posted by Anonymous: | Reply

The way forward in our evolutionary process will tip the world on its head, currently there are many forms of therapies, healing practises, wether its mind or body, and then there are the healing of our spirit, either from spiritual, faith, or metaphysical healing, there are completentary, holistic, alternative, and the damb right bizarre, but they all have a place in our concious society....well now i have something to share with you, you see currently we are living in the age of pisces, since the birth of christ, and come end 2012 we will enter the age of aquarius, what does this mean....it means that we will all eventually start to evolve and learn to live 4th dimentionally , rather then 3th dimentionally,it will be a gradual process, and will mean we will start to live on a highter vibrational frequencies, just like you have radio waves, we will learn to connect to our higher senses, and develop our intuitions, learn to see our electromagnetic energy field or aura to some, we will be more intune with nature animals other people and our own lifes in general, in the many different kinds of psychic spiritual and healing circles all over the world this has been common news for a long time, so how does this affect the world of the mind, psychiatry and psychology, well so far we have all these different paths in medicine, healing, religion, as well as science, mathamatics, physics, quantum pysics, chemistry, metaphysics, astronomy ect ect, well now it seem like all these different kinds of understanding, processing information and constant discovery and rediscovery, along side all the medical, healing, spiritual, and religious studies, they will all emerge and become one, as all of these have a valid place to add, and as it would of been impossible to have discovered and studied all of this as part of our evolutional information, all at once,so by us choosing to discover things in smaller groups, giving them different names and putting them into catagories and individual rules and/or laws of creation,it became part of our history, then its now time to evolve all of these, and carry them into the 4th dimention, which will mean only one thing, they will all emerge and connect together and works in unison to become one, as we become more adapt at using our extra sensory perceptions to make sense of our world and communicate with it, then so everyone will become interconnected and all the worlds information will join that aswell, just like the world wide web, but without the use for a computer, there is talk of computers becoming powered by crystals in the distant future, as these carry energy and that energy can power and store information, all energy has a frequency and vibrational field, everything is made from energy, just like our bodies, made up of atoms as well as physical cells, so this energy will heal, inform, communicate, teach, and evolve into a complete new understanding of the way the our world and our how our universe was created and how it will continue to evolve, now i know thats its totally chaos for some people to get their heads around, and im seriously putting the whole world and how we know it out there for ridicule and disbelief and some will not be able to visualise this kind of existance within our world, but if you had told the 1st man to walk the earth that he would talk, discover the wheel, make tools,learn to love rather then just procreate by instinct and having a relationship rather then just a "mating" process and develop our technological revolution, our medicial evolution, and live with a concious mentality and continual growth and self discovery, write computer language and have made history in space and time, the ability to grow a new ear on your arm form the cells of your body, replace your organs with new ones, and so forth and so forth...........
well i can imagine he would of looked at you blankly and bashed you over the head with a stone....if you fail to heal the dis-ease of the body, it can manifest into the mind, if we fail to heal the dis-ease of the mind, it can manifest into our spirit, or some call it soul, if we fail to heal the dis-ease of our spirit, we loose ourselves completely and become darkended and without a light, we collect every bit of nasty, angry, violent, manipulative darkness left over from other people,time and places, we become absorbed in this dark entity, and can probaly call them evil, murderous warlords, dictators with power crazy visions of world domination, the violence of people inside our own society, with such horror in their lives, they create hidding places in the dark spaces, where even the daylight of our sun fails to shine, living in the shadows, where crime is the power, the places that the light cant find, and the religious mythologies that created the fears of demons and satanic devil worship, so the things i want to share with the world is to become open to the idea of something that is already here, but on a large scale, that will eventually, with a few hundred years practice, become our new way of life, our DNA will grow and change, and we will discover the human blueprint of our creation from a much further point behond space and time, mind body and spirit will become one rather then mind and body, with our spirit being seperate, depending of wether you currenly believe in the human soul ofcourse, and if you dont, then i suggest you start reseaching and learning about the world of energy and spirit, as its as real as you and i, and our minds are becoming open to many different possibilities that could create such a thing, having the knowledge about its place in our lives, takes the mystery away and it becomes very easy to understand and learn how to connect to our higher selves, and all healing forms and medicinal therapies aswell as the psychiatric and psychology, will heal the entire person, mind body and spirit, as we learn that you cannot heal 1 without the other when we learn to live 4th dimentionally....

Vote up Vote down Report this comment Score: 0 (0 votes cast)
The way forward in our evol... (Below threshold)

October 18, 2009 5:55 AM | Posted by Anonymous: | Reply

The way forward in our evolutionary process will tip the world on its head, currently there are many forms of therapies, healing practises, wether its mind or body, and then there are the healing of our spirit, either from spiritual, faith, or metaphysical healing, there are completentary, holistic, alternative, and the damb right bizarre, but they all have a place in our concious society....well now i have something to share with you, you see currently we are living in the age of pisces, since the birth of christ, and come end 2012 we will enter the age of aquarius, what does this mean....it means that we will all eventually start to evolve and learn to live 4th dimentionally , rather then 3th dimentionally,it will be a gradual process, and will mean we will start to live on a highter vibrational frequencies, just like you have radio waves, we will learn to connect to our higher senses, and develop our intuitions, learn to see our electromagnetic energy field or aura to some, we will be more intune with nature animals other people and our own lifes in general, in the many different kinds of psychic spiritual and healing circles all over the world this has been common news for a long time, so how does this affect the world of the mind, psychiatry and psychology, well so far we have all these different paths in medicine, healing, religion, as well as science, mathamatics, physics, quantum pysics, chemistry, metaphysics, astronomy ect ect, well now it seem like all these different kinds of understanding, processing information and constant discovery and rediscovery, along side all the medical, healing, spiritual, and religious studies, they will all emerge and become one, as all of these have a valid place to add, and as it would of been impossible to have discovered and studied all of this as part of our evolutional information, all at once,so by us choosing to discover things in smaller groups, giving them different names and putting them into catagories and individual rules and/or laws of creation,it became part of our history, then its now time to evolve all of these, and carry them into the 4th dimention, which will mean only one thing, they will all emerge and connect together and works in unison to become one, as we become more adapt at using our extra sensory perceptions to make sense of our world and communicate with it, then so everyone will become interconnected and all the worlds information will join that aswell, just like the world wide web, but without the use for a computer, there is talk of computers becoming powered by crystals in the distant future, as these carry energy and that energy can power and store information, all energy has a frequency and vibrational field, everything is made from energy, just like our bodies, made up of atoms as well as physical cells, so this energy will heal, inform, communicate, teach, and evolve into a complete new understanding of the way the our world and our how our universe was created and how it will continue to evolve, now i know thats its totally chaos for some people to get their heads around, and im seriously putting the whole world and how we know it out there for ridicule and disbelief and some will not be able to visualise this kind of existance within our world, but if you had told the 1st man to walk the earth that he would talk, discover the wheel, make tools,learn to love rather then just procreate by instinct and having a relationship rather then just a "mating" process and develop our technological revolution, our medicial evolution, and live with a concious mentality and continual growth and self discovery, write computer language and have made history in space and time, the ability to grow a new ear on your arm form the cells of your body, replace your organs with new ones, and so forth and so forth...........
well i can imagine he would of looked at you blankly and bashed you over the head with a stone....if you fail to heal the dis-ease of the body, it can manifest into the mind, if we fail to heal the dis-ease of the mind, it can manifest into our spirit, or some call it soul, if we fail to heal the dis-ease of our spirit, we loose ourselves completely and become darkended and without a light, we collect every bit of nasty, angry, violent, manipulative darkness left over from other people,time and places, we become absorbed in this dark entity, and can probaly call them evil, murderous warlords, dictators with power crazy visions of world domination, the violence of people inside our own society, with such horror in their lives, they create hidding places in the dark spaces, where even the daylight of our sun fails to shine, living in the shadows, where crime is the power, the places that the light cant find, and the religious mythologies that created the fears of demons and satanic devil worship, so the things i want to share with the world is to become open to the idea of something that is already here, but on a large scale, that will eventually, with a few hundred years practice, become our new way of life, our DNA will grow and change, and we will discover the human blueprint of our creation from a much further point behond space and time, mind body and spirit will become one rather then mind and body, with our spirit being seperate, depending of wether you currenly believe in the human soul ofcourse, and if you dont, then i suggest you start reseaching and learning about the world of energy and spirit, as its as real as you and i, and our minds are becoming open to many different possibilities that could create such a thing, having the knowledge about its place in our lives, takes the mystery away and it becomes very easy to understand and learn how to connect to our higher selves, and all healing forms and medicinal therapies aswell as the psychiatric and psychology, will heal the entire person, mind body and spirit, as we learn that you cannot heal 1 without the other when we learn to live 4th dimentionally....

Vote up Vote down Report this comment Score: -1 (1 votes cast)
Holy shit!I've onl... (Below threshold)

October 18, 2009 8:35 PM | Posted by titmouse: | Reply

Holy shit!

I've only just read the cringe-worthy, self-congratulatory "wisdom circuitry" paragraph near the top of the article. I'll get the rest in a sec, just couldn't contain that "holy shit!" impulse.

What an amazing piece of unintentional irony. One for the record books.

Having watched my colleagues give Dean Ornish a standing ovation at the last APA, I confess some skepticism 'bout this "wisdom circuit" notion. LOL.

You know how to pick 'em, Alone. That salmon study and now this. Well done.

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The ability to suppress jud... (Below threshold)

October 20, 2009 12:46 PM | Posted by Eddie Sylvano: | Reply

The ability to suppress judgement and honestly appreciate the values of another doesn't seem to me a marker of wisdom, but one of apathy (or limited emotional reactivity). Autistics would be good at this.

The wisdom here is "it is better to stay silent and be thought a fool than say something and remove all doubt." Still, staying silent does prove difficult for a lot of people, so at least they've mastered this trick.

I imagine judgements are still made anyway. How else would the therapist feel worthy/capable of directing their charges?

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Yes, it's all a bit narciss... (Below threshold)

October 25, 2009 12:01 PM | Posted by brainchild: | Reply

Yes, it's all a bit narcissistic and grandiose isn't it? And it tends to ignore the fact that some people go into psychiatry (and psychology) to deal (or not deal) with their own issues. I'd love to read your thoughts on narcissistic personality disorder amongst psychiatrists. As the child of two doctors - a GP/psychologist and a pain specialist - who grew up in a dysfunctional (or only quasi-functional) family with a father with NPD, I found your blog about psychiatrists as parents a very interesting and insightful read. I've got quite a few friends with very dysfunctional psychiatrist fathers as well so I'd be very interested in your insights into the matter.

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"The ability to suppress ju... (Below threshold)

October 27, 2009 9:27 AM | Posted by AK: | Reply

"The ability to suppress judgement and honestly appreciate the values of another doesn't seem to me a marker of wisdom, but one of apathy (or limited emotional reactivity). Autistics would be good at this."

Eddie S. has given us a description of one of the great wisdom figures of popular culture...Mr Spock.

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Correction: It's Gandhi not... (Below threshold)

November 26, 2009 10:05 AM | Posted by AnIndian: | Reply

Correction: It's Gandhi not Ghandi.

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Alone's response: I'm no... (Below threshold)

December 19, 2009 5:28 PM | Posted by Alone: | Reply

Alone's response: I'm not sure if this is irony or what: in a letter to the editor, a psychiatrist writes:

"Dr. Nasrallah should make us all proud. In his editorial, he presents how deep, complex, and relevant our work as psychiatrists can be and how it can enhance our personal development and wisdom. I think this article should be required reading for every medical student."

and then closes:

"Extending that idea to Dr. Nasrallah’s column, in our days of 15-minute med checks, we might ask, “Among all psychiatrists, how many are Nasrallah psychiatrists?” As the saying goes, it takes one to know one."

Wow.

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what does a psychiatrist u... (Below threshold)

August 22, 2010 5:38 PM | Posted by Anonymous: | Reply

what does a psychiatrist using their brain every day to think about other people mean? Is there actually a deeper meaning? Why would you even look for one? ?????????

The fact that thoughts about certain things create electrical impulses in certain areas is not very surprising, it is in fact extremely fucking obvious, and has nothing to do with WHY. and why is not even usually testable... so... what is ever the point, besides an agenda? If the point were to really understand the human mind on a deep level, why would that not be a quick start point (What areas of the brain are physically associated with X?) before you moved on to the actual issue at hand?

But you know that already, obviously....

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