Philosophical Problem with the Brain Disease Model of Addiction: Epiphenomenalism

You can no more explain mind in terms of the cell than you can explain dance in terms of the muscle.

– Alva Noe, Neurophilosopher

The brain disease model of addiction is rooted in a problematic philosophical stance on the mind and brain: epiphenomenalism. I know, it’s a big word, but bear with me. Here’s how the Stanford Encyclopedia of Philosophy sums up this view:

Epiphenomenalism is the view that mental events are caused by physical events in the brain, but have no effects upon any physical events. Behavior is caused by muscles that contract upon receiving neural impulses, and neural impulses are generated by input from other neurons or from sense organs. On the epiphenomenalist view, mental events play no causal role in this process. LINK

So, from this point of view, both our thoughts and our behavior are caused by brain activity – but what we think has no effect on our behavior or on the activity of the brain. Essentially, this philosophy completely rejects free-will at both the level of thought and action. From this view, brain activity simply happens as part of a fully physically determined chain of cause and effect – the brain develops in certain ways according to genetics and conditioning, and just reacts chemically, producing thoughts and behaviors over which we have only an illusion of control. Or, as researcher Edwin Locke put it:

A more common “soft” materialist view of thought is that, although thoughts exist, they are epiphenomena of physical events, that is, by-products of the physical having no causal efficacy. The doctrine of epiphenomenalism, of course, is a version of determinism, or more precisely, psychological determinism. This doctrine holds that with respect to his beliefs, thoughts, decisions and actions man has no choice. Given the conditions of his environment and his genes at any given time, only one alternative is possible. In sum, man has no control over his destiny; he is totally controlled by conditioning and physiology. (Locke, 1995)

This is the view of behaviorists and of the current crop of psychologists touting brain scans as evidence of the “causes” of various behaviors and psychological states. They have tried to reduce human functioning to the physical actions of the brain – completely ignoring the role of volitional thought, reasoning, beliefs, etc. This is essentially the view of the world’s most popular “addiction expert”, Nora Volkow of the NIDA. She revealed this view in a seemingly innocuous foundational statement for her brief essay on addiction in the companion book to HBO’s popular special documentary titled Addiction: Why Can’t They Just Stop?:

The human brain is a complex and fine-tuned communications network containing billions of specialized cells (neurons) that give origin to our thoughts, emotions, perceptions, and drives. [emphasis added] (Hoffman & Froemke, 2007)

Usually, we’d breeze right past such statements, but let’s stop for a second to really think about the implications of what she said there. She says that the brain and its activity “give origin to our thoughts, emotions, perceptions, and drives.” Does it really? If so, then any act where we feel like we are contemplating, judging, thinking something over, trying to reason through something, etc – and choosing, is a meaningless illusion. Any feeling of effort at thinking would just be an illusion from this point of view. It would all simply be the product of physical brain activity in which our conscious thinking self has no control – and in which our thinking self doesn’t even really exist as we know it. Are the physical actions of the brain the most relevant place to look in order to explain mental phenomena?

I think there’s more to our thoughts than just brain activity, and I think most people would agree *if they thought about it*! Personally, for example, I can introspect and see that I have reasons for my emotions. When I am sad, it’s often because I think that I’m missing out on something, or suffering a loss. Recently, my cat has been having some medical issues, and there’s little that can be done about it. I know that he’s very old, and can imagine that I will be without him soon. This results in a feeling of sadness, because I know I will suffer a loss, and I even wonder how quick or drawn out it may end up being. The mere sight or knowledge of any cat’s suffering would be somewhat upsetting to me, but not nearly as upsetting as when I consider what will happen to my cat and how it will affect me. There are evaluations I go through in my mind, and they have to do with the meaning I’ve attached to this particular cat’s life, and what I predict may happen to him, as well as how it will affect me.

There’s a lot of mental stuff involved in that process of creating an emotion – like judgment – I judge that I will lose something and feel pain in the future, and anticipating this makes me sad. Or how about love? I love this cat, and want him to be comfortable – the thought that he may feel pain and suffering himself actually hurts me too. Do neurons “judge”, “love”, or even “think”? Do neurons “hurt”?

It is said that the “addicted brain” “wants” only the “rewards” provided by substances – that the brain “craves” drugs and alcohol, etc. Brains don’t really “want” “crave” or experience “reward.” People – not brains – with their consciousness, lives, ideas, evaluations, etc. – are the type of entity that crave, want, desire, and experience rewards. Brains do no such thing. This is a serious conceptual problem in the field of neuroscience, as some respected thinkers have pointed out:

…do we know what it is for a brain to see or hear, for a brain to have experiences, to know or believe something?  Do we have any conception of what it would be for a brain to make a decision?  Do we grasp what it is for a brain (let alone a neuron) to reason (no matter whether inductively or deductively), to estimate probabilities, to present arguments, to interpret data, and to form hypotheses on the basis of its interpretations?  We can observe whether a person sees something or other – we look at his behaviour and ask him questions.  But what would it be to observe whether a brain sees something – as opposed to observing the brain of a person who sees something.  We recognize when a person asks a question and when another answers it.  But do we have any conception of what it would be for a brain to ask a question or answer one?  These are all attributes of human beings.  Is it a new discovery that brains also engage in such human activities?  Or is it a linguistic innovation, introduced by neuroscientists, psychologists and cognitive scientists, extending the ordinary use of these psychological expressions for good theoretical reasons?  Or, more ominously, is it a conceptual confusion?  Might it be the case that there is no such thing as the brain’s thinking or knowing, seeing or hearing, believing or guessing, possessing and using information, constructing hypotheses, etc., i.e. that these forms of words make no sense?  But if there is no such thing, why have so many distinguished scientists thought that these phrases, thus employed, do make sense? [emphasis added] (Bennett, 2007)

Another respected neurophilosopher, Alva Noe (who also wrote a popular column for NPR debunking the claim that addiction is a brain disease) takes aim at neuro-reductionism and the conceptual confusion surrounding consciousness, mental events, and the brain:

We—adult humans and other animals—think; we see, we feel, we judge, we infer. It’s working in a big, plain circle to say that what makes it possible for us to do all that—what explains these prodigious powers of mind—is the fact that our brains, like wily scientists, are able to figure out the distal causes of the retinal image. For that just takes for granted the nature of mental powers without explaining them. Is cognitive science guilty in this way of reasoning as if there were mind-possessing agencies (homunculi) at work inside us?

Keep in mind that when Noe says “adult humans” he means the whole person – not just the brain. In fact, a mantra of his work is “you are not your brain.” Noe also takes aim at the philosophical perspective of Volkow and other brain disease pushers:

Consciousness is not something that happens inside us. It is something we do or make. Better: it is something we achieve. Consciousness is more like dancing than it is like digestion.

…The idea that the only genuinely scientific study of consciousness would be one that identifies consciousness with events in the nervous system is a bit of outdated reductionism. It is comparable to the idea that depression is a brain disease. In one sense, that is obviously true. There are neural signatures of depression. Direct action on the brain—in the form of drug therapy—can influence depression. But in another sense, it is obviously not true. It is simply impossible to understand why people get depressed—or why this individual here and now is depressed—in neural terms alone. Depression happens to living people with real life histories facing real life events, and it happens not only against the background of these individual histories but also against the background of the phylogenetic history of the species. The dogma that depression is a brain disease serves the interests of drug companies, no doubt; it also serves to destigmatize the struggle with depression, which is a good thing. But it is false. [emphasis added] (Noe, 2010)

There is clearly something very wrong about describing neural events in the language of mental events, and vice versa – it’s just not accurate to describe mental events by reference to physical processes of the brain. 

Furthermore, while it’s clear that these events correlate with one another, and it’s possible that they happen simultaneously and/or they may even be the same thing viewed from different angles, it’s not clear that mental events are a useless impotent byproduct of neural events. But that is exactly what epiphenomenalism assumes. The epiphenomenalist looks at a brain-scan, and interprets it as the cause of human thought and behavior – without ever considering the possibility that such brain activity may be the reflection of freely chosen thought and behavior. This is exactly what Nora Volkow and others who hold up images of the “addicted brain” are doing. They see the neural correlates, and they are either conflating them with thoughts and behavior, or presenting them as the cause of thoughts and behavior. Either way, they are ignoring real mental experience – they’re ignoring introspective data (what you get when you stop to look at your own thoughts and inner mind states). Imagine the absurdity of this – they think that thoughts are useless, and that people have no control over their own lives.

Do you think I’m going overboard when I attribute these beliefs to Volkow? Let’s look at that quote from her again:

The human brain is a complex and fine-tuned communications network containing billions of specialized cells (neurons) that give origin to our thoughts, emotions, perceptions, and drives. [emphasis added] (Hoffman & Froemke, 2007)

She followed this up with a statement about “addiction”:

repeated drug use disrupts well balanced systems in the brain in ways that persist, eventually replacing a person’s normal needs and desires with a one-track mission to seek and use drugs. At this point, normal desires and motives will have a hard time competing with the desire for the drug.

She contends that addiction can be entirely explained by the physical state of the brain. In doing so, she counts out all of the reasons people quit: to save a relationship, to have a better life, to become a parent, to stay out of jail, to improve their health, because they want newer and better recreational activities, etc etc etc. All of that is meaningless in the epiphenomenal view in which it all comes back to brain activity.

Still think I’m wrong in claiming that Volkow’s views don’t allow for the mind, choice, and free-will? Check what she told a New York Times reporter a few years ago:

We think we have free will, she continued, but we are foiled at every turn. First our biology conspires against us with brains that are hard-wired to increase pleasure and decrease pain. Meanwhile, we are so gregarious that social systems — whether you call them peer pressure or politics — reliably dwarf us as individuals. “There is no way you can escape.” (Zuger, 2011)

She scoffs at the thought that we have free will. She is a materialist and epiphenomenalist through and through. As such, her views of human functioning are logically impossible to assert. Now, this is the most important point of this article, so pay attention: it is impossible to prove that our thoughts are physically determined by our brains. Impossible. Locke described this point well. Let’s look at his description of epiphenomenalism again:

A … “soft” materialist view of thought is that, although thoughts exist, they are epiphenomena of physical events, that is, by-products of the physical having no causal efficacy.*

Now if that doesn’t match Volkow’s message that “We think we have free will, she continued, but we are foiled at every turn. First our biology conspires against us with brains that are hard-wired to increase pleasure and decrease pain” then I don’t know what does. Locke continues:

The doctrine of epiphenomenalism, of course, is a version of determinism, or more precisely, psychological determinism. This doctrine holds that with respect to his beliefs, thoughts, decisions and actions man has no choice. Given the conditions of his environment and his genes at any given time, only one alternative is possible. In sum, man has no control over his destiny; he is totally controlled by conditioning and physiology.

He shows how this doctrine is impossible to assert:

Behaviorists believe that materialist determinism is the correct, objective scientific approach to psychology. Actually this doctrine is self-refuting. Numerous philosophers and psychologists have identified the insuperable contradiction of epiphenomenalism and therefore of psychological determinism (e.g., Bandura, this issue; Binswanger, 1991; Boyle, Grisez & Tollefsen, 1972; Locke, 1966). The advocate of epiphenomenalism is asserting that his doctrine is true and at the same time asserting that he is just a robot, conditioned or programmed to emit certain word sounds by heredity and/or environment. Further, the epiphenomenalist is claiming to offer logical arguments in order rationally to persuade his audience of his view, even as he claims that his audience consists of robots who have no choice about their beliefs. (Locke, 1995)

This should give the careful reader pause about the veracity of most assertions that evidence of some brain activity amounts to a causal explanation of a mental state or behavior. Neural correlates do not equal neural causation. This is the basis of the brain disease model of addiction, in which we are presented with a snapshot of the state of a brain of someone who uses drugs or alcohol often, and then are told that the state of their brain is the cause of their mental experience of craving and substance use related behavior. It is a fatally flawed claim.

Hard Evidence Against Epiphenomenalism

The philosophical case presented above is enough to refute epiphenomenalism, but is there “hard evidence” against this view? Well, I don’t know if that’s the right term or the right question, but basically – Yes. There are two threads of knowledge which I think help to refute epiphenomenalism, but they must incorporate the proper philosophy. The first is introspective evidence. That is, you can look within, and see that you have reasons for your behavior. You can witness your own mental processes. This has validity, or at least as much validity as other evidence obtained by the senses.

For example, when one performs a brain scan, they trust their senses in using an FMRI machine that outputs visual results. They trust that what their senses have delivered to them is an accurate representation of the physical reality of the brain. If that can be trusted, then why shouldn’t you trust your “sense” of introspection? (if it’s not a sense, then what is it?) Why is it that you should trust what you witness visually, but not what you witness introspectively when you direct your attention toward your inner mental processes? It’s direct observation – as direct as it gets. Locke covered this:

The fundamental epistemological premise of behaviorism is that only the study of behavior can be objective; its corollary is that the study of consciousness cannot be objective. This premise is based on the philosophy of logical positivism. Its central tenet is that knowledge can only be based on that which is verifiable in direct sense experience. This would seem to rule out conscious experience from science, but there is a double irony here. First, sense experience is an experience, a conscious event. Second, although consciousness cannot be observed by the senses (since it consists of sensory input and the processing one does of that input, it can be observed directly — through introspection. Introspection involves turning one’s focus of attention inward instead of outward.

He added:

The only difference in the concept-formation process between the cognitive psychologist and the physicist involves what facts they attend to. The physicist looks outward with his senses and observes objects fall, integrates his observations, makes the appropriate inferences and forms the concept of gravity. The cognitive psychologist does the same essential thing but in a form appropriate to his subject matter, man’s nature as a conscious being. He looks inward at mental concepts and processes instead of outward to form his concepts.

You can look inside, as I did above when pondering what values and implications create the feeling of sadness about my cat’s condition, and see what’s going on in your mind. You can get to the end of one of these passages I quoted, and be left with a feeling of not understanding – then you can choose to look inside your mind, and review what you took in. You can examine it logically to try to make sense of it. You can reread and check definitions, then juggle these thoughts in your mind to see if they make sense, then rack your mind for contradictory thoughts and beliefs – and then conclude that one of these passages is either true or false – and you can witness yourself freely choosing to put in the effort to do all of this. That act of searching for the source of your confusion is a type of introspection. It has validity.

The other thread of evidence that I think applies here is the work on expectancy effects. There are countless studies showing that expectancies and beliefs beget all kinds of human experiences. A good example would be research on the placebo effect whereby taking on a particular belief creates real emotional, behavioral, and physiological responses (Kirsch, 1999). There are also many neuroscientific studies which show that people can modify their emotions and the corollary neural activity when asked to do so (Beauregard, 2007). In fact, the data on these two points is overwhelming. Check those two references if you’re interested.

Summary

I’ve made a few points here, and I understand they can be overwhelming, so let’s go through a quick review.

1. There are people who conclude that the observed neural correlates of addiction (what we see in the famous brain scans of “addicted brains”) are evidence that the behavior of addiction and conscious experience of craving or obsession with substances is caused by abnormal physical actions of the brain.

2. The philosophical stance that leads them to believe this is called “epiphenomenalism.” It is the belief that consciousness is a meaningless byproduct of brain activity, and that all of human experience can be reduced to the laws of physics acting on the brain. It is a philosophy that denies free will.

3. Nora Volkow and other addiction-as-brain-disease pushers are epiphenomenalists.

4. Epiphenomenalism cannot be logically proven. Since it holds that our thoughts are simply the product of brain activity, then if it were true, the epiphenomenalist would have to assume that he was forced to believe in it by the physical activity of his brain. As such, she couldn’t validate her position by knowing that she had really thought it through and carefully reasoned it out – thought and reason are meaningless illusions from this point of view.

5. The neural correlates of any given human experience are part of that experience – but they are not the experience itself, nor are they necessarily the primary cause of that experience. Neurons don’t crave, nor does a brain think, nor do either “feel” anything. Neurons have chemical and electrical activity. To say that neurons “give rise” to conscious states and behaviors is silly. It would be like saying that the pistons in the engine of my car “give rise” to a trip to the store to buy milk and bread. No such thing happens. If I should choose to go to the store, then the component parts of the engine of my car will be involved in this process, but they are not the cause of it.

6. Introspective evidence (looking directly within at your own thoughts and mental activity) is just as valid as looking outside of yourself at the results produced by an FMRI brain scan. Both require trusting your conscious experience. Thus, study of human functioning needn’t be reduced to the observation of physical phenomena alone. There is something happening inside this thing we call a mind, and to ignore it or deny it would be arbitrary and irrational.

7. There is evidence of conscious processes such as belief and expectancy, and even mindful attention affecting the brain. It has been shown that people can volitionally initiate thoughts that alter their brain activity. People report thoughts, and the effort of changing their thoughts, which then results in both different conscious experiences and different brain activity. Are we to categorically disbelieve these reports because we can’t physically dissect their thoughts and sense of volition? If we are to believe our senses when viewing physical phenomena, it would be rather arbitrary to disbelieve this other type of phenomena.

We must be clear that those who claim addiction is a brain disease are not claiming that the brain is literally degrading as in an Alzheimer’s patient – they are claiming that merely different brain activity is the cause of the pattern of thought and behavior of “addicts.” This must be founded on an epiphenomenalist view, which is logically impossible. If they are correct, then all behavior – “addictive” or “normal” – is disease behavior – all of it would have to be unchosen, i.e. determined. Of course, if it’s true, then we couldn’t logically prove it. So, you can invest in that unprovable grand theory that leaves us no hope – and just go wherever the wind takes you. Or you can trust your senses, and know that what you’ve directly observed within yourself about putting effort into thinking, and the effect this has upon your experience of life, is true and real – and you can use it to improve your existence.

I hate that there’s a need to address this issue. The last thing I want to do is get into discussing theories of mind. But unfortunately, epiphenomenalism is the trend with psychiatrists and psychologists, so to understand their claims, we must examine this issue. I hope that we can sum up the problem here by exposing the absurdity of it: these people believe that beliefs don’t matter – that beliefs have no effect on human behavior – yet at the same time, they think it’s very important for us to believe that our brains are causing our behavior. BUT IT DOESN”T MATTER WHAT WE BELIEVE!!! (according to their philosophy)

I won’t be changing your brain activity on this website, nor will I be telling you how to change your brain with a scalpel or medication – I’ll only be offering up ideas you can use to try to understand things and make your own choices. If you want to go the epiphenomenalist way, you should probably choose to stop reading this website, because you’ll agree with nothing here.  However, I guess that if you’re correct, then you can’t choose to stop reading this website. So, whatever.

Is addiction a disease of the brain? That’s a bit like saying that eating is a phenomenon of the stomach. The stomach is an important part of the story. But don’t forget the mouth, the intestines, the blood, and don’t forget the hunger, and also the whole socially-sustained practice of producing, shopping for and cooking food.

And so with addiction. The neural events in VTA clearly belong to the underlying mechanisms of addiction. They are necessary, but not sufficient; they are only part of the story. (Noë, 2011)

Citations:

Locke, E. A. (1995). Beyond determinism and materialism, or isn’t it time we took consciousness seriously? Journal of Behavior Therapy and Experimental Psychiatry, 26(3), 265–273.

Hoffman, J., & Froemke, S. (Eds.). (2007). Addiction: Why Can’t They Just Stop? (1st ed.). Rodale Books.

Bennett, M. R. (2007). Neuroscience and philosophy brain, mind, and language. New York: Columbia University Press.

Noe, A. (2010). Out of Our Heads: Why You Are Not Your Brain, and Other Lessons from the Biology of Consciousness (First Edition edition.). Hill and Wang.

Zuger, A. (2011, June 13). An Addiction Expert Faces a Formidable Foe: Prescription Drugs. The New York Times. Retrieved from http://www.nytimes.com/2011/06/14/science/14volkow.html

Kirsch, I. (Ed.). (1999). How Expectancies Shape Experience (1st ed.). American Psychological Association (APA).

Beauregard, M. (2007). Mind does really matter: evidence from neuroimaging studies of emotional self-regulation, psychotherapy, and placebo effect. Progress in Neurobiology, 81(4), 218–236. doi:10.1016/j.pneurobio.2007.01.005