By Sarah Hippolitus
A prospective college student walks into his doctor’s office for his mandatory wellness exam. He gets the required physical exam and his vital signs look good. He is given Hepatitis vaccinations for strains A, B, and C. Additionally he is given a tetanus shot, as required every ten years. He was immunized against measles, mumps, and rubella when he was young so he doesn’t need to re-vaccinate. The student’s immunization records and physical exam results, along with his signed certificate of “Health Examination and Immunity” are faxed over to the school’s wellness center, thereby completing his admission process. He has met the wellness standards for his university (and for most schools).
But aren’t these standards a little low? Have we not seen enough school shootings to raise them? I have.
A different scene: A prospective college students walks into his doctor’s office for his mandatory wellness exam. He is given the necessary vaccines required by the school and administered the standard physical exam testing his vital signs. He gets a PET scan, and it is determined that his monoamine oxidase A (MAO A) levels are quite low – a biological condition shown to be linked with aggressive behavior. In fact, he has been in and out of juvenile detention centers for vandalism and repeated assault. His parents made him go to therapy various times but to no avail. He never felt comfortable talking about his anger management issues and would just sit in the office with his arms crossed and stare at the clock. He is placed on an anti-depressant to increase his compromised serotonin levels, and an L-tryptophan supplement, an amino acid that increases serotonin levels thereby decreasing aggression (exercise also elevates tryptophan levels). Granted, there are many well-adjusted individuals with low levels of MAO A, but scientific studies* demonstrate a strong correlation between impulsive aggressive, criminal behavior and defects in this particular brain enzyme (lower platelet activity) involved in the metabolism of serotonin. He is ordered to have a psychiatric evaluation to determine his progress on the medication once a month for six months, and then once every three months. Follow-up paperwork is required to remain enrolled in school and will be kept in a confidential medical file at the university. The student’s immunization, physical exam results and drug prescription records, along with a signed certificate of “Health Examination and Immunity” are faxed over to the school’s wellness center, and his admission process is complete.
Of course, the first scenario is an everyday event, while the second one is just illegal. Yet where is the moral difference? It can’t be invasiveness – in the real-life scenario, we require someone to get a needle stuck in them depositing chemicals into the bloodstream. The second scenario is arguably less invasive – we are simply requiring someone to take a pill once a day, every day. Yet, society would not approve of requiring the second treatment for this student’s admission into school. Granted, one reason is that psychiatric drugs have more significant potential negative side effects than a vaccine, which usually causes minimal temporary side effects, if any. So, for the sake of argument, let us reasonably suppose medicine has advanced and there are no longer any harmful side effects to psychiatric drugs. My guess is that society would still have a problem with this proposal.
I suggest that society does not take mental illness seriously enough. Look at what we call it – “mental” illness, when it is clearly just as physical as any other illness. The label allows for the misconception that a person can think his way to good mental health. It’s high time we recognize the significant limitations of even the most advanced cognitive therapy. Of course, we want to utilize non-invasive treatments first – therapy, exercise, socialization, nutrition, and certain OTC supplements. I am not advocating medication as a first and only option. I am just pointing out the overlooked fact that sometimes a cognitive condition is serious enough where psychiatric drugs are necessary for behavioral improvement.
Do we assume that people have a special right to what goes on in their brains that they don’t have for any other body part? So, we can inject them with chemicals only if we aren’t treating a brain condition? Is it that we can’t legally do anything to someone’s brain that he doesn’t want done? – that can’t be it because we force kids to go to school until they are 18 (some states it is 16). So the moral difference can’t be forcing something upon another’s brain. It must be chemical force (via drugs), and specifically on someone’s brain.
This is troubling. We live in a society. If Dylan Klebold doesn’t want to take his medication, that refusal should be considered as a social and moral irresponsibility. I don’t think I should have to suffer the consequences of someone’s unhealthy, untreated brain. Again, we know that there is no definite behavioral expectation from something like low MAO levels, but let’s look at what’s going on in a brain like this in more detail. After all, aggression is a complex process mediated by several different areas of the brain.
Let’s say this young man also got a SPECT scan (Single Photo Emission Computerized Tomography, a sophisticated nuclear medicine study that looks directly at cerebral blood flow and indirectly at brain activity – or metabolism). In “Change Your Brain, Change Your Life”, Dr. Daniel Amen, MD, presents a common picture of a person’s brain with moderate to severe aggression issues. In our scenario, the following brain regions are defective as follows:
- “Decreased activity in the pre-frontal cortex (this area of the brain is involved in mediating concentration, impulse control, and critical thinking). Aggressive people often misinterpret situations and react in an impulsive manner.
- Increased activity in the cingulate, which causes people to become “stuck” on certain thoughts or behaviors. Aggressive people often become “stuck” on real or imagined injustices and think about them over and over.
- Increased activity in the basal ganglia, often found in patients who have anxiety or panic disorders. People who are aggressive often report a baseline level of tension or anxiety, and many clinicians have seen a pattern with these patients when they become increasingly more anxious before they act out.
- Increased activity in the limbic system. Studies consistently find that when the amygdala, a structure in the deep temporal lobes considered part of the limbic system, is stimulated, a person becomes more agitated and aggressive” (p. 218). (The limbic system heavily influences mood. Depression is caused in large part by low levels of serotonin, one of the three main neurotransmitters that influence the functioning of this brain region – the other two are dopamine and norepinephrine. Again, low MAO-A levels, aka the aggression neural correlate, result in low serotonin levels.)
We can see that several key brain regions in the left hemisphere are involved with an aggression disorder, and how they can be compromised. Again, should this hypothetical student be placed on prescription drugs to elevate his serotonin levels to offset the aggression as a prerequisite for college admission? Should he be required to undergo follow-up treatment to remain enrolled? Or, are we more comfortable with this student being admitted to a university with this kind of unregulated, defective, and volatile brain chemistry? This is the choice we confront. Let’s face it, if he goes untreated for too long and is provoked in just the right way, he could be set off and cause great harm to others on campus. If you think about it, crime is a consequence of letting someone’s brain chemistry remain his own private affair.
What if the Virginia Tech shooter had been required to undergo a brain scan and/or a psychiatric evaluation before being accepted? What if he had been required to take an anti-depressant? What if he had been required to follow-up regularly with a campus psychiatrist for continued enrollment? It cannot be argued that the tragedy could have been likely avoided this way. The alternative, not letting him go to school seems worse than just requiring him to take the necessary medication to regulate his aggression. The student in our hypothetical scenario earned the grades necessary to get into college, and it would be immoral to deprive him of an education because of his brain chemistry.
We all agree that we are morally obligated as a society to protect others as long as we don’t violate someone else’s rights. I argue we aren’t violating the student’s rights. The functioning capability of the brain is what drives our behavior. If he wants to go to school, he needs to be responsible for his behavior, which requires taking responsibility for his brain health. If this is a rights violation, I want to know why. If that is the case, there are serious ramifications to contend with – are these ramifications worth protecting this purported right? I really don’t think so – the stakes are too high.
There already is rapidly developing technology available for neurologists to devise brain implants to modify damaged areas of the brain. This might be an attractive alternative to psychiatric drugs. I suspect society won’t be keen on requiring brain implants either. Again, intuitions suggest that injecting chemicals into the bloodstream is okay, while insertion of silicon neuron chips onto regions of the brain isn’t. Why trust only intuition? Where is the relevant moral difference? I maintain that the moral qualm people have (I don’t, clearly) against controlling someone’s chemical interactions via psychiatric drugs in his brain is unjustified.
I expect the moral intuition is that requiring someone to heal their brains in this way is a violation of their freedom. We won’t mandate prescription anti-psychotic drugs, or brain implants – yet when a “mentally” defective person kills someone in an act of uncontrollable (yes uncontrollable) impulsive aggression, all we can think of to do is to throw him in jail. That surely is a restriction of freedom – where has our reverence for freedom gone then? You can’t say that jail isn’t invasive or freedom-restricting. And what about the freedom lost by the victim? We can’t ignore the tragic consequences of society’s unwillingness to exert some authority over the chemicals in someone’s brain. Ideally, the student would volunteer to be on medication, as that would be the ethical thing to do, but the assumption in this scenario is he doesn’t want to – maybe he thinks, thanks to society, being on an anti-depressant makes him a weak person. The conundrum is whether society may intervene to protect itself.
I want to close with a very moving passage from prominent psychiatrist, Dr. Daniel Amen (he is also a theist – don’t hold my atheism against me here, readers, this has nothing to do with it!):
I was raised in a strong Catholic family. I was taught to believe that if you lived a clean life and work hard, you will be successful. I believed that there was something the matter with character of people who were drug addicts, murderers, child abusers, and even those who took their own lives. After being involved with about five thousand brain SPECT studies my mind has changed completely. I now believe that it is essential to evaluate the brain when behavior is out of bounds. The brain is an organ that dramatically influences behavior, thoughts, and feelings [I’d say the brain causes behavior full-stop, not just dramatically influences it! – I think his theism is at play, but I could be wrong]. These cases and many like them are yet further examples to me to press on studying the brains of people with abnormal behavior. What we need is more understanding, more knowledge, and less judgment.
Sometimes I want to cry when I think of all the children and teenagers who are in group homes, residential treatment facilities, and juvenile halls, or who have run away from home because their families could not deal with them any longer. I know that many, many of them, have brain problems that have never been properly evaluated. Perhaps they have seen a local counselor or physician who looked at the abnormal behavior and told the parents that the child could behave if only he or she really wanted to. In today’s “enlightened” society, that attitude is a prevalent as ever. No amount of trying would have changed Peter’s behavior” [in this section, he is talking about a young male patient who he successfully treated with psychiatric drugs for serious aggressive tendencies, when all other therapeutic methods failed] (218).
The attitudinal barrier here seems to be a belief in the false concept of free will – if you just try hard enough, you can resist your impulses and behave desirably. Dr. Amen is right – you can’t simply “will” your way to mental health. Our brains need help, and in serious cases, chemical manipulation via psychiatric drugs is often the very best option.
I leave the reader with this final thought: If we can require vaccinations to protect people from being harmed by another’s physical defects, why can’t we require medication for the same purpose? Why can’t we “vaccinate” against crime?
*Sources:
“Crime Times, Vol. 3, No. 2, 1997 Page 7” http://www.autismwebsite.com/crimetimes/97b/w97bp8.htm
“Research Links Brain Chemistry with Aggressive Personality” http://www.physorg.com/news100187677.html
Matthieu Guibert
Sarah Hippolitus
Jeff Randall
Luis Reinoso
Brian Gregory
Very well written argument! I fully support a mental/emotional exam being performed whenever a physical exam is required. You use college as an example in this post but what about the workplace? Given all the workplace violence that goes on, I think we should consider requiring a mental evaluation before an offer of employment is accepted. What are your thoughts on that?
Thanks Caryn
Yes, I used school admission as an example, but I think the same logic may lead us to also requiring a pyschiatric evaluation as part of the job application process.
We really need to work on a cure for stupidity first, but duct tape over the mouth has been successful for so long that the pharmaceutical industry probably has no motivation to make the investment.
The first thing that kept coming to mind while reading is that there are religion, moral, conscience, health, and other exemptions allowed for vaccinations. And schools can not discriminate against those who have chosen these exemptions.
Would you put into place the same type of exemptions for a mental health exam? For instance scientologists are very much against psychiatry, and drugs for mental disorders. Would you approve of little Tom Cruise Jr not having to undergo the same exam as other students? If you would force them to undergo it, would that not be a violation of the 1rst Amendment?
The second thought (and in my mind the biggest sticking point with this topic) would be that I personally consider anything that changes my brain to be more invasive than something that affects my immune system. We “are” our mind in a very real sense. By altering my brain chemistry, I am no longer the same person. Now if this is forced upon me by the government or a school or whoever, that seems to cross a line. Once I take any drug that alters my brain, I am no longer the same person. You can’t violate a person’s rights much more than to replace who they are with another person.
Today we have a definition of what a “non normal” brain would be. But for the sake of argument, let’s say that an oppressive regime in some country decided that “non-normal” included those people who oppose the current kind, prime minister, president, dictator, etc were “non-normal”. Now if they were able to find a pill or injection that could alter the brain in such a way that people would be more docile and accepting of their situation, there would not be much in the way of stopping them from pushing this throughout their country. In the US there are many people today who consider being gay a “disorder”. It was actually listed as a diagnosis for many years. If during that time where it was seen as a disorder, if there had been a pill that was capable of “correcting” this, would you condone people being forced to take this pill?
I agree, in principal, to the concept you’re talking about here. I just think it’s not nearly as easy as it comes across in this post.
That said, I think you’ve done a great job starting a discussion on what is a difficult topic.
Very timely article. Here at the University of California, Berkeley — we were about to genetically test all incoming freshmen in this fall’s entering class (see: http://ls.berkeley.edu/?q=stories/archive/ls-program-asks-students-bring-their-genes-cal), to help students better manage their college career by knowing about their genetic health markers. This seemingly positive effort caused such an uproar all across the nation that the effort was canceled. Looks like it will take some time for society to catch-up to good science. In the meantime we will suffer the consequences of this “lag”, as this article suggest. This is an important article helps us all move more quickly into our healthier and safer futures. Bravo!
Dad, thanks so much for your comment! I’m very interested to see this link but it doesn’t work – can you try again? Thanks
Dad, ah you put a “)” at the end of the link by accident. I got it, it’s
http://ls.berkeley.edu/?q=stories/archive/ls-program-asks-students-bring-their-genes-cal
Jeff –
I’m not aware of any allowed exemptions granted by a school for vaccinations. Can you provide me with an example of a school that will admit a kid with measels, mumps, and rubella if he/she doesn’t want to be vaccinated for religious reasons or otherwise?
I think you’ve hit the concern exactly – we aren’t comfortable manipulating someone’s brain but we are comfortable manipulating someone’s immune system. I challenge the rational basis for this. Psychiatric drugs don’t change who you are as a person in any spooky way – they merely modify behavioral tendencies, and let’s remember they do this for the better, so a person can function better. As for not being the same person once you take a drug – true. Then again you are never the same person at any point in time. Every experience you have alters your brain chemistry, and that altered brain chemistry in turn guides your behavior. This idea of static personhood is a byproduct of the false concept of free will – this idea that you are some kind of static person with a set of chemical interactions and only drugs disrupt it. Not true – any feeling you have disrupts your brain chemistry. Every thought you have alters your brain chemistry. So if your objection is drugs change who you are as a person, my response is so does every thought and feeling you have.
If a scientologist wants to go to school, today’s laws so far as I know mandate that he has to get vaccinated like everyone else. In my hypothetical proposal, he can get a psychiatric evaluation like everyone else. See, I’m not advocating this test to be a U.S. citizen. A school is a special institution that has the right to set standards for its students. A school has a right to demand a student modifies his behavior (if it’s volatile, as in the case I present) if he wishes to be enrolled and enjoy the benefits the insitution affords him.
Your final objection is the most compelling one, and one I knew was coming! The Orwellian, oppressive regime objection. Well, I’m not advocating here for anything other than keeping aggression levels in check – my interests go no further. So if schools start requiring heterosexuality or docile temperaments, this would not be on account of my proposal. All I want to do is to have the legal authority to prevent abnormally aggressive, violent behavior. I’m not saying let’s cultivate docile sheep – that would be terrible. From the begining to the end of history, experience tells us that violent impulsive aggression is an undesirable quality for a person and for society. So let’s do something about it. Is my proposal invasive? Yes. But so is being shot on a college campus. One case of invasiveness is infinitely worse than the other, and I don’t see a good justification to let a lunatic have sovereignty over his brain – not when said lunatic is enrolled in a university. It is morally wrong to make innocent kids pay for his defective volatile brain.
Sarah,
Re Orwell:
Glad I could help out here. I understand that your suggestion is only dealing with potential for violence, and I understand that my point is really just a “slippery slope” argument (which I would normally try to avoid), but it seems like too big a possibility for abuse to NOT mention it.
It is not my primary objection, but it is certainly something I think should be kept in mind in any discussion on this topic.
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Re altering somebody’s brain:
Yes I agree that who we are constantly changes due to our experiences. If we are, as I would contend, nothing more than a product of our neurons/brain chemistry and our experiences, then every time our brain chemistry is altered or we experience anything, we change who we are.
The difference here is this would be a government mandated change of who we are, as opposed to something we choose ourselves.
In the other thread we’re going back and forth on, I am pushing in favor of people being allowed to do recreational drugs, so it’s not the fact that it is a drug that changes us which I object to. It is the mandate of that drug, and the loss of personal freedom.
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http://www.ncsl.org/IssuesResearch/Health/SchoolImmunizationExemptionLaws/tabid/14376/Default.aspx
Looks like everybody except Mississippi and West Virginia has at least the religious exemption.
Except in those 48 states, plus DC…
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Yes, but as a public institution it also has to be available to all citizens as much as it possibly can be.
Yes, but in this case we are not talking about behavior. We are talking about potential for behavior. I have no problem with somebody who commits a crime having to undergo psychiatric treatment. And if it is found that a drug will “make them better”, I think it’s reasonable for a court to say they must be on that drug as a condition of their sentence.
But in your proposal, we are not doing this due to behavior, we are doing this due to a potential for some behavior. And THAT is where I think my biggest objection is.
Jeff –
First of all, I’m shocked and appalled that someone can get a religious exemption from getting immunized. That is despicable. Thank you for sending me this link.
I understand it’s the loss of freedom to choose to take a drug that you object to, not taking the drug itself. I’m not entirely comfortable with it myself, but I still am not convinced of a justification that a person has a right to regulate his own brain chemistry however he wants. This person lives in a society, and as I say, I don’t think I should have to suffer the consequences of someone else’s negligence to tend to his brain health.
I have to disagree that we aren’t talking about behavior – that is exactly what we are talking about. In the case I provided the young man had been convicted of crimes, including various acts of assault. So, his aggression has harmed others already. Also, we have to look at neuroscientific findings. If you check out the two links I offer at the bottom of the post, we can see how high the correlation is between low MAO A levels and violent behavior. This is not a speculative correlation, but one that has evidence to back it.
I’m surprised that you are okay with the court mandating someone be on a drug, but not the government? What about the personal freedom you are concerned with?
Again, we are mandating the drug because the person has already demonstrated aggressive behavior, severe enough that it has gotten him into legal trouble. We aren’t putting a kid on drugs because he is angry and moody. We are taking this recourse because he has already exemplified violent behavior, and hurt others. What I think you are referring to is my claim that medicating him may prevent something quite serious like a school shooting. Sure, that is speculative enough because he might not be provoked to do something that serious, but look at the brain scan of these school shooters and you’ll see something very similar to the neural picture Dr. Amen provides (accompanied by the low MAO A levels). We vaccinate to prevent diseases, why can’t we medicate to prevent violent crimes which are often performed by people with similar brain chemistry? Again, I am completely aware that there is no guarantee someone with a severe aggression disorder is going to go apeshit and do something as insane as shoot up a school. It would be awfully hard to assess the likelihood. However, the brain profile is just right for such a thing…don’t we have an obligation to keep our students safe? And, let’s remember the health of the kid – he is better off having his aggression in check! Let’s not forget he is benefitting from receiving proper medication!! He didn’t choose it, but people who aren’t in rational states of mind rarely will choose what is best for them. I’d wager, he’d be grateful it was imposed on him when he sees how much more peaceful his life is with the proper medication.
What do you think you’re doing every time you have a glass of Shiraz? You’re regulating your brain chemistry.
We currently don’t regulate health in most cases. People are allowed to smoke, allowed to eat massive amounts of trans fats, allowed to do no physical exorcise, allowed to spend hours in the sun, etc. We, as a society, suffer the consequences of those choices with increased medical expenses for all people, decreased productivity, etc.
If you’re referring to a more direct impact on the rest of society, then we can look at something like religious extremism. We allow people to participate in churches where hatred and intolerance is taught as coming from god. This leads to cases like the shooting of George Tiller or men being allowed by law to beat and rape their wives or parents being allowed to let their children die or curable medical ailments.
You’re looking at one case after the fact to justify profiling people BEFORE they do anything. Yes I agree that the VT shooting could have possibly been avoided if your idea was put in place as a system at schools. But is it worth the cost? I’m not sure…
I understand that there is a strong correlation, but correlation is not always equal to causation. Until a full causal link has been established I would be very wary of forced modification of a persons mind.
In the case of the court, it is a condition of their sentence for some crime they have committed. They have given up some aspect of their freedom, which could reasonably be said to include the freedom to choose their brain chemistry.
I’m torn on this argument. On one hand if makes perfect sense. And yet at the same time I see it as a violation of a person’s rights and freedom.
Here is where I think the comparison with vaccinations breaks down. With measles, if you’re exposed, and were not previously vaccinated, you’re going to get sick, and you can pass that on to others you come in contact with. With mental disorders, you may be “primed” neurologically and never show any symptoms. With many of the violent mental disorders the latest research shows there to be both a neurological and an environmental factor that combine to cause the actions. Either one, without the other, will not lead to violent behavior. but both together are a VERY good indication of the potential for violence.
I think I’d be 100% supportive of testing, and counseling. I just believe that forcibly changing somebody’s brain with drugs crosses a line that I don’t think I am ready/willing to cross.
Jeff – Re: Shiraz – Really? Come on now, you know what I meant. I’m not saying we can’t regulate our brain chemistry. I already demonstrated my understanding that we do this with every thought and feeling we have. The moral difference here is a glass of shiraz isn’t hurting anyone. My claim is we shouldn’t have 100% say over our brain chemistry, particularly when this dominion negatively impacts someone else.
You said, “We currently don’t regulate health in most cases. People are allowed to smoke, allowed to eat massive amounts of trans fats, allowed to do no physical exorcise, allowed to spend hours in the sun, etc. We, as a society, suffer the consequences of those choices with increased medical expenses for all people, decreased productivity, etc.”
Right, and I’m not too keen on paying the medical bills for irresponsible adults eating fried foods, smoking, and frying their skin. At least in these cases, someone’s obesity, lung or skin cancer does not interfere with my ability to live my life, aside from taking more of my tax dollars than I think I ought to be required to give for their bad decisions. Aggressive people are DANGEROUS. A fat, cancer-ridden person is not dangerous.
You said, “In the case of the court, it is a condition of their sentence for some crime they have committed. They have given up some aspect of their freedom, which could reasonably be said to include the freedom to choose their brain chemistry.”
And why has this freedom not been given up in my scenario? A kid commits vandalism and various counts of aggravated assault. My point is exactly the same – because of these transgressions, they have now given up some of their freedom, in this case to have full-regulative authority over their brain chemistry. I don’t care if it’s the court or the government mandating it so long as the aggression-reducing chemicals are pumped into their bloodstream.
You said, “With mental disorders, you may be “primed” neurologically and never show any symptoms. With many of the violent mental disorders the latest research shows there to be both a neurological and an environmental factor that combine to cause the actions. Either one, without the other, will not lead to violent behavior. but both together are a VERY good indication of the potential for violence.”
Again, I am not saying put anyone on a drug before they have demonstrated violent, aggressive behavior. It is only after this demonstration that I entertain the idea of taking medical action. As I point out in my essay, many have low MAO A levels and are well-adjusted. For this reason, I’m not advocating required drugs to prevent aggression, but to prevent FURTHER aggression (than what has already been demonstrated prior to school enrollment.) The bad behavior has to come first. We shouldn’t drug anyone if that person hasn’t demonstrated the bad behavior. I say this precisely because we can’t predict behavior based on neural correlates. Environment is key.
You said, “I understand that there is a strong correlation, but correlation is not always equal to causation. Until a full causal link has been established I would be very wary of forced modification of a persons mind.”
Again, I am not saying correlation is causation, which is precisely why I’m waiting for the causation before I medicate someone. MAO A levels are a correlation, but not enough to justify medicating someone. So if a person beats the shit out of an old lady, are you comfortable with a forced “medical modification”? I am. That is all I’m saying. I’m not saying let’s medicate you because you seem angry. I’m saying let’s look at the history of your behavior. Do you have any repetitive red-flag aggressive episodes in your recent past? If so, let’s start to take care of it before you move in to a college campus, where stress levels and social pressures are high.
You said, “I think I’d be 100% supportive of testing, and counseling. I just believe that forcibly changing somebody’s brain with drugs crosses a line that I don’t think I am ready/willing to cross.”
Counseling isn’t enough for your serious aggression disorders. That is just a fact. Unfortunately, plenty of people think this way…and by not crossing this line, we’ll just stand by and watch these people hurt and possibly kill innocent bystanders. That is the choice we confront. People just don’t get the severity of these disorders. You can’t talk your way into feeling better, no more than you could do so if you had diabetes. Chemical assistance via psychiatric drugs is the necessary course of action in the cases I’ve been discussing.
Ok, from this response I think I had misunderstood your original proposal.
I thought you wanted all students tested before being allowed in schools (like vaccinations today).
And all students who showed low levels of MAO A (or some other test result which showed a correlation with violence) to be medicated to “fix” their imbalance.
I seemed to have missed that you were only talking about people who have already shown some type of violent behavior.
With that in mind, as long as people with no history of violence are being forced to medicate, I think I could agree with your proposal with a few conditions. If somebody is forcibly medicated, they should also be given free regular exams to keep an eye out for any negative side effects. Counseling should also be provided, if they choose it. And those who are in the position to make the decision of who should and should not be medicated must undergo regular and updated training to keep up with the latest scientific understanding of these disorders.
Sarah, you saw this recent NPR story about the neuroscientist who looks for “aggression patterns” in brains, right? And how he has the patterns in question, but he has no history of aggression?
http://www.npr.org/templates/story/story.php?storyId=127888976
What would you do in a case like this? Require him to medicate or not do so because he has no history of violence (pretend he’s 18)?
Sarah,
Also, related to Tana’s question, but reversed. How would you deal with a student (or potential student) who has a history of aggression, but the brain scan shows nothing abnormal?
Tana – YES, I did see that and I thought it was really fascinating. Nope, wouldn’t medicate without prior history of severe aggression.
Jeff- history of severe aggression, I’d want to medicate this individual. It would be highly, highly unlikely a brain scan wouldnt reveal any abnormalities, but for the sake of argument, even so, yes, I’d want to medicate this individual to prevent further acts of aggression on college campus.
If there is no brain abnormality to “fix” with medication, what would they be put on? Typically anti-psychotic meds work by alter brain chemistry, but if somebody chemistry is already “correct”, it’s not going to do any good.
An example of how this could happen would be somebody who is raised in a household where they see a lot of aggressive behavior and are themselves abused. Even without the trigger mechanism of having a non-normal brain chemistry themselves it’s not only possible, but could be expected that such a person would have aggressive tendencies. But in such a case it seems that therapy/counseling would be of much more use than medication.
Right, if there is no chemical defeciency/ dysfunction, medicine isn’t going to do anything. So, I really can’t grant for the sake of argument the behavior without the accompanying brain state because this violates science. I can’t suppose we have a depressed person who doesnt have low serotonin levels – that violates science. Similarly, I can’t suppose for the sake of argument we have a very aggressive individual with no abnormalities in the brain regions I list in my essay and/ or deficient MAO A levels. You won’t see the behavior without the neural correlates to accompany it. So, what you present then (the behavior without the dysfunctional brain state) is a non-issue.
You’re saying that people can’t “learn” a behavior without an altered brain chemistry?
I’d beg to differ:
Granted in many cases there will be a tangible physical aspect to the behavior, but in some cases it is a learned behavior of an otherwise healthy mind.
Sarah,
I am confused concerning the extent of your argument here. One one hand you seem to have such a high degree of optimism in the medical community’s ability to detect and treat aberrant behavior through medication that a patient’s history need not be known. You give a reductionist-style account of human behavior to this end. On the other hand, you imply that a history of aberrant behavior needs to be present for a proper diagnosis. It is the former claim that raises red flags. I find it difficult to believe there would be anything close to a consensus within the scientific community that, absent known and consistent aberrant patterns of behavior, treatment should be forced on an individual. [I can think of several strictly physical abnormalities that manifest no history of symptoms in some patients and are thus properly left untreated - herniated discs discovered in unrelated CT scans come to mind.] The factors leading to dangerous antisocial behavior are simply too complex and not sufficiently settled (unlike vaccination for the diseases that you mention). Indeed the two are not comparable. On the other hand, anyone with a known history of dangerous aberrant behavior could be forcibly medicated and monitored (and/or institutionalized). I am well outside my area of expertise here, but my understanding is that our medical procedures already have such safeguards in place. This has been part of the findings associated with the killings here at VA Tech. The safeguards (isolation of the patient) were simply not followed. I also suspect that the laws regarding the involuntary committal and medication of a patient vary greatly from state to state, nevertheless the procedures that you seem to advocate are largely in place already. So what exactly are you suggesting that we change?
Thank you for the well-thought and provoking blog!
Jeff,
First, acts of aggression are not necessarily symptomatic of a disorder. Aggression is natural and healthy to a point. The case I speak of concerns someone reaching a point where the aggression is severe and unhealthy. Where do we draw the line? I grant, there is some subjectivity here. However, as I’ve said before, we judge where we ought to draw lines in murky areas all the time (e.g., When is someone overweight? When is dusk? When does a fetus become a human being?), and just because we can’t pinpoint the exact pound that makes someone overweight, or the exact minute dusk occurs, or the exact developmental stage in which a fetus is now a “human being”, similarly, just because we can’t pinpoint the exact brain state that characterizes abnormal aggression, it does not follow the line we draw is arbitrary – on the contrary, this line is meaningful albeit not precise.
Second, (regarding your first statement) brain science tells us that for every behavior, there is a chemical modification of the brain. Everytime I behave in any way, my brain chemistry has altered in some way. It doesn’t matter how the behavior is acquired or what it is.
It’s a tough line to draw. And there exists a lot of potential for abuse of such a system if it were to be implemented. I would hope that major safeguards would be put in place to prevent problems with it.
As for the brain chemistry:
It’s possible that all people with aggressive behavior would have low MAO A levels (or some other diagnosable brain chemistry abnormality), but as far as I am aware that only shows one subset of aggressive people. I’d be interested (and surprised) if there was something so clear to search for in ALL aggressive people.
Eric – good to see you here on my blog
Yes, let me clarify. I do not wish to medicate anyone absent a history of aberrant behavior for the reason you point out – there often are chemical deficiencies or aberrations in someone’s brain but due to a postive enivironmental stimulus, no dysfunctional behavior meriting concern results – the genetic predisposition is latent. Of course, this behavior could manifest down the line, but it would be inappropriate to medicate before we see any signs of it.
What I’m advocating is forced medication if there is a history of serious aggressive behavior as a requirement for school enrollment. As I say, counseling is not enough to treat a serious aggressive disorder, though it should also be part of the required treatment (as should exercise and a healthy diet, but these would be hard to enforce!).
What I’m advocating is illegal. A patient always has a choice not to take psychiatric drugs if he/she doesn’t want to. I’m challenging this on the grounds that my safety shouldn’t hinge on someone else’s moral irresponsibility not to properly safeguard against his/her aggressive tendencies (via psychiatric drugs).
There are absolutely clear ways of finding the neural correlates of aggression in a person. A neuroscientist looks at an image of a brain, and sees more or less the same patterns in every severely aggressive person. As I say, aggression is a byproduct of activity in various key brain regions. The scientist looks at the relevant brain areas, i.e., those empirically shown to be involved with aggression, and assesses their functioning.
I provided the relevant brain areas in my essay:
* “Decreased activity in the pre-frontal cortex (this area of the brain is involved in mediating concentration, impulse control, and critical thinking). Aggressive people often misinterpret situations and react in an impulsive manner.
* Increased activity in the cingulate, which causes people to become “stuck” on certain thoughts or behaviors. Aggressive people often become “stuck” on real or imagined injustices and think about them over and over.
* Increased activity in the basal ganglia, often found in patients who have anxiety or panic disorders. People who are aggressive often report a baseline level of tension or anxiety, and many clinicians have seen a pattern with these patients when they become increasingly more anxious before they act out.
* Increased activity in the limbic system. Studies consistently find that when the amygdala, a structure in the deep temporal lobes considered part of the limbic system, is stimulated, a person becomes more agitated and aggressive” (p. 218). (The limbic system heavily influences mood. Depression is caused in large part by low levels of serotonin, one of the three main neurotransmitters that influence the functioning of this brain region – the other two are dopamine and norepinephrine. Again, low MAO-A levels, aka the aggression neural correlate, result in low serotonin levels.)
Scientists know the relevant brain regions involved in aggression. They have looked at the brains of normal functioning adults and pinpointed the neural areas where moral decision making happens. Mainly they look at the the frontol lobe (specifically the Pre-Frontal Cortex) and the limbic system (specifically the amygdala.) For further evidence that aggression is a byproduct of biology in various areas of the brain, and which areas, check out http://www.sciencedaily.com/releases/2007/11/071106122309.htm. You’ll see what I have pointed out. Commonly, a very aggressive person will have low MAO A levels, low levels of serotonin (which is a consequence of the low MAO A levels), decreased activity in the pre-frontal cortex (PFC is the “executive control” center of the brain that allows us to override impulses, when it is functioning well; when it isn’t it can’t carry out its executive function to regulate impulses), overactive amygdala (causes impulse control problems), etc.
Here’s just one excerpt from the link I provided.
“New studies from the University of California, San Diego, are helping scientists better understand what goes on in the brains of some teenage boys who respond with inappropriate anger and aggression to perceived threats. Preliminary findings from these studies suggest that such behavior is associated with a hyperactive response in the amygdala, an area of the brain that processes information regarding threats and fear, and with a lessening of activity in the frontal lobe, a brain region linked to decision-making and impulse control.”
Not all brain scans of a severely aggressive individual will look identical (and why should they?) but there will be commonalities time and time again simply because there are only so many brain regions that are in play in an aggressive individual. The same brain regions will be impacted and in the same way (meaning overactive or underactive). That’s clear enough for me.
Remember ultimately this doesn’t even matter, as I have already said only history of aggressive behavior will justify forced medication. And I’m not suggesting we medicate a kid because he punched his friend in a fight. For example, medication would be justified in the following scenario: A boy (sorry to use males all the time but thanks to testosterone, we all know aggressive disorders are more common in men – that’s just a scientific fact.) beats the shit out of some kid, vandalizes cars, and maybe kills a cat, etc. before we medicate him. I defer to the medical professionals (psychologists and psychiatrists) to judge the presence of an aggression disorder. We won’t need to ponder whether or not these were in fact aggressive behaviors – clearly they are. We actually don’t even NEED to know what is going on in the brain for my purposes, which works out well since brain scans are very expensive.
While It’s possible that all aggressive behavior will correspond to some altered brain chemistry, I’m not convinced it will be the case in all people who act aggressively. If I am wrong, this would make it much easier actually, as then there would be clearly defined “goals” of medication in all cases.
Perhaps more common, but far from exclusive:
(Any excuse to link to a video of a chick fight)
Well we would need to know what is going on in the brain, so we know the specific medication which will work best and the correct dosage to give.
Of course we need to know what is going on in the brain to *medicate*. My point was we don’t need to know what is going on the brain to identify aggressive behavior. We can diagnose an aggression disorder (not me but a medical professional) without peering into the brain. We can do it based off of behavioral observation. Of course when it comes to medication, what is going on in the brain and where is of the utmost importance – there would be no way to medicate if we didn’t have such knowledge. But you knew what I meant, and I suspect are just being difficult.
Never said chicks don’t fight each other.
Of course the aggressive behavior is diagnosed from the behavior.
My point is that once the behavior is diagnosed I’m not convinced there will always be a corresponding chemical imbalance to explain it. Perhaps I am wrong, but I think that at least in some cases this will be like searching for the “gay gene”, in that there is no one factor, but a combination of many small things, all combining to one behavior.
And I know you did not say chicks NEVER fight, but it was a chance to post a video of women in little clothing fighting. There was no way I was passing on that opportunity.
Jeff, It IS a combination of factors, which I took much time to lay out for you. I can’t understand how you’ve interpreted all of what I’ve said to mean that there is one factor to look for. I don’t see how I can be any clearer that it is a combination of factors. Yes, aggressive behavior to the extent I’ve been talking about is always symptomatic of a chemical imbalance, like any ohter mental illness.