W&M Neurodiversity - class on brain stimulation

Neurodiversity Class – Monday March 26

Brain Stimulation

In our class on brain stimulation I’d like to present some emerging therapies that offer the promise of changing brains in elemental ways.  Changing brains means changing personality, intelligence. Such an action has the potential for altering one’s very hopes and dreams, and that carries significant ethical implications for anyone who advocates for the therapy, whether as a parent, guardian, or professional.  It also has implications for any adult who considers partaking, or any child or person under guardianship who faces having it “done to them.”

Bertrand the Brain Dog, waiting outside the hospital.
Dogs like Bertrand made an unheralded but substantial
contribution to neurological research over the past 150 years.

The development of these therapies heralds a new era for humanity.  Cognitive attributes that were thought to be immutable turn out to be flexible.  Ideas like "That's evolution, nothing you can do," or, “God made him that way” will be supplanted by the possibility of human-driven change.

As new cognitive therapies and treatments emerge they will present great opportunity to help people.  Some of those people will have profound and long unmet needs.  Others will have wants.  Some may not want treatment at all, yet have it thrust upon them.  With tools as powerful as these ethical questions will surely arise.

Let’s discuss those issues with the help of several scenarios.

Scenario #1:

The brain is an electrical organ.  Billions of neurons are connected with almost uncountable numbers of microscopic threads – axons and dendrites – carrying signals from one neuron to another.  The network builds itself and then fine tunes itself throughout our lifespan. 

In addition to the natural process of development we can energize and change the network.  Chemicals can travel through the bloodstream into the brain where they change the properties of that network.  That’s how recreational drugs and psychiatric medication work.

Electrical stimulation can enter the brain through electrodes applied to the scalp or through wires implanted in the brain. This is called (transcranial) direct brain stimulation, or TDCS

Circuits in the forebrain may be energized and stimulation with infrared laser energy, where photos of laser light penetrate the skull and are absorbed by molecules in the neurons, stimulation them to action.  That is Transcranial Laser Stimulation.

The circuitry in the outer layers of the brain may also be energized or suppressed through the process of electromagnetic induction.  That is Transcranial Magnetic Stimulation, or TMS

The therapies above are all real.  Psychiatric meds and recreational drugs are widely used.  TMS and TDCS are being studied for some therapies and deployed for others.  Laser therapy is still in the research stage but shows promise.

Now consider this scenario:

A therapy is used to relieve anxiety and depression and it works well for 30% of patients.  10% report slight benefit.  5% feel worse.  0.02% commit suicide and can no longer be evaluated.  The causal connection between the therapy and suicide is disputed because some percentage of the population is destined to commit suicide anyway.  

13 of every 100,000 people in the general population kill themselves every year.

20 of every 100,000 people in the treatment kill themselves every year.

30,000 of every 100,000 report a benefit

• You are a regulator.  What do you do?  Is the risk real, and should a therapy with that risk be allowed?
• You are a therapist.  Do you take the chance and recommend therapy, or take the safe route and talk instead?
• You are a patient.  Do you do it?

Scenario #2:

A ten-year-old autistic child has a strong logical mind, but very little sense of the emotions in the children around him.  He has no friends and is very lonely.  At the same time, he seems to be quite the prodigy on the computer.

He says he’s going to be a computer scientist when he grows up.  He says the thing he wants most of all is to have friends who will play with him at his birthday party.

You have been told about a brain therapy that will rebalance his brain, allowing him to see emotion in other kids.  The therapy has worked for other kids, and he is likely to gain the ability to make friends, but he may lose interest in logic and computers.  Nothing like this existed when you were a child; the very idea was the subject of fantasy movies.  But it’s real now and some applications are even covered by health insurance.

• You are his parent.  Do you give him the therapy?  What do you tell him?
• You're ten years old.  What do you want most in life?  Are friends more important than intellectual superpower?  Is intellectual superpower important to you?  Think back a few years . . .

Scenario #3:

Thanks to the convergence of brain stimulation and brain imaging we know that your brain and mine react the same when we see a red ball.  We know that red, green, or blue trigger specific patterns in our brains, and when we use eye tracking to know where we are gazing and brain imaging to see the reaction, a computer can now tell what color we are looking at.

Shapes and objects form distinct and recognizable patterns too.  Supercomputers can accurately resolve thousands of common objects including cars, airplanes, dogs, cats, guns and pencils.    The computers can associate emotion too, separating any house from home, and any female from mom.

Science has delivered us the ultimate lie detector. The mind probe of science fiction is real.

You have a suspected terrorist in your custody.  He is placed in the scanner and shown images associated with a recent bombing.  You have identified the house where the bomb was made.  The suspect’s brain lights up as home.  You show a picture of the carnage of the bomb. The suspect’s brain reflects a pattern of pride.

• You are a government leader.  What do you do with the suspect?  Is a trial needed; would it serve a purpose?
• You are a scientist in the program.  Should your newfound power be kept secret?
• You call yourself a freedom fighter.  The enemy calls you a terrorist.  How do you combat this machine?

This technology is [very likely] in development now (it’s classified.)  The practical difficulty of getting uncooperative subjects into the scanner and getting them to view materials may delay deployment somewhat.

(c) 2018 John Elder Robison

John Elder Robison is an autistic adult and advocate for people with neurological differences.  He's the author of Look Me in the Eye, Be Different, Raising Cubby, and Switched On. He serves on the Interagency Autism Coordinating Committee of the US Dept of Health and Human Services. He's co-founder of the TCS Auto Program (A school for teens with developmental challenges) and he’s the Neurodiversity Scholar at the College of William and Mary in Williamsburg, Virginia. He's also a visiting professor of practice at Bay Path University in Longmeadow, Massachusetts and advisor to the Neurodiversity Institute at Landmark College in Putney, Vermont.  

The opinions expressed here are his own.  There is no warranty expressed or implied.  While reading this essay will give you food for thought, actually printing and eating it may make you sick.