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.

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update

Previous post on the overreach of neuroradiology



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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

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