THE MODERN REALITY OF HUMAN SALIENCE & REWARD by Robert Taylor I recently had the pleasure of enjoying a talk by Dr Derek Tracey, a research psychiatrist, medical practitioner and member of the Advisory Committee on the Misuse of Drugs. His topic - the evolution of human consciousness - illuminating for both laypeople and experts alike, managed to reduce a very complex philosophical and practical question into a discrete series of categories. This reductionist view on the human psyche stunned me. How have I, a third year neuroscience student, managed to go through my university career without having a senior lecturer talk down at me for an hour regarding how each system of the human brain falls into place. What is the bigger picture of the electrical homeostatic environment that we all identify as our conscious world? The brainstem controls breathing and the heartbeat, the mesolimbic area controls our reward and salience, and the cortex then came along and explained away these incredible physical properties as an act of god; our first modest organ. “What’s deep is ancient, whats ancient is important,” said Dr Tracey, alluding to the fact that it is irrelevant what the cortex thinks of itself or of its neighbouring brain regions. However, the fact remains that an organ attempting to rationalise its existence might no longer have its biological best interests at heart, as the path of least resistance might not be the most rational and vice versa. The philosophy of mind-body dualism has hindered psychiatry a great deal, and its effects, unlike other scientific fallacies that have been perpetuated throughout our history, remain today. How would one study the movement of the planets of our solar system if the central tenant of astronomy was that the earth was flat, situated on the shell of a tortoise balancing
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on two elephants? Yet, despite our very clear understanding that who we are is contained within the neurones of our brain, psychiatric conditions are still often explained through the metaphysical domains of unpleasant feelings and bad thoughts. Break your leg and no one is going to tell you to just go and walk on it, pretend it’s not there. Psychiatry in its modern form was probably revolutionised by William Battie in 1758, who, for the first time, acknowledged that mental illness did not have to be locked up in a jail cell and could be cured. The first steps towards acceptance that mental illness was not some bereavement caused by an act of the Almighty who was displeased about some inconsequential action, were indeed important. Prior to this, people who were suffering would find themselves locked up, tortured like animals to flush their bodies of the devil, branded as witches or subjected to all kinds of inhumane tortures to ‘cure.’ This is a historical reality for all scientific inquiry. Throughout our history, its easy to look back on the less knowledgeable and laugh, as it is a common theme for philosophy to precede science in an attempt to explain phenomena that we have no way of quantifying with current technology. This was the case with astrology, alchemy, medicine and, indeed, psychiatry. Today, philosophy struggles with questions of AI alignment, ethics and human behaviour as these are all things we cannot quantify yet. However, the trouble with modern psychiatry is that it is still influenced by the historical dualism that kickstarted the scientific disciplines of neuroscience and psychiatry. Social mental health support is expensive, cumbersome and, at times, aimless. The NHS target
