‘The Biology of Desire: Why addiction is not a disease’ by Marc Lewis (Public Affairs Books 2015)
Review by Robert M Ellis
Desire has had quite an image problem. This basic function of our bodies, that drives and motivates us to do anything and everything, is responsible for both our highest achievements and our worst sins, but is too often associated with the latter rather than the former. With Buddhism ultimately wanting to get rid of desire altogether, and a range of ascetic traditions appealing to God or rationality to help us keep it in its place, the major obsession of civilisation until quite recently seems to have been the suppression of what they saw as the evils of desire. But with the rise of industrial societies and their accompanying problem of alienation, the reverse problem has become increasingly common: a complete surrender to narrow, self-fuelling, self-destructive desires. Fleeing from our insecurities, we take refuge in alcohol, drugs, gambling, pornography, romantic love or computer games, etching ever deeper loops of dependence into our brains. Civilisation’s response is often more of the same: desire should be repressed, either by the addicts taking responsibility for themselves or by the intervention of medicine. But none of this takes adequate account of the way desire is central to our good works as well as our bad, and how even a wish to extinguish desire is also a desire.
Marc Lewis’s highly readable and informative new book is an excellent critical response to the dualism of this contradictory and ineffectual attitude to desire. A neuroscientist but also an ex-addict himself, Lewis makes the case that addiction is primarily a diverted learning process. We learn by seeking rewards, and then responding to the dopamine signals we get back to seek more of the same. A child responding to a teacher’s praise or a business person developing their successful exploitation of a market work in the same way as the addict who is rewarded by a drug high that removes an underlying anxiety. The only difference, of course, is that the feedback loop in drug addiction can more easily become both compulsive and ruinous. Nevertheless, Lewis maintains a big, humane perspective on the whole process, and reminds us that most addicts (if they don’t die) will recover within fifteen years. Not only that, but when they have recovered they will have benefitted in the long term from a profound learning experience.
Lewis offers a balanced critical argument against the dominant ‘disease model’ of addiction. Although willing to acknowledge the relative strengths and achievements of medicine in trying to help addicts, he argues that addiction is not helpfully understood as a disease. The chief reason for this is that addicts, in order to recover, need to shift to a bigger motivation for living their lives without addiction. The medical model tends to be deterministic in relation to the individual, assuming that they can’t help themselves but need the intervention of experts; and although there can be empowering types of therapy used within the medical model, the overall model itself is disempowering. Of course, if seeing something as a ‘disease’ has this effect, it raises the issue of whether other conditions beyond addiction are similarly disempowered by the model, and whether we should abandon or modify this understanding of disease as a whole. These are bigger questions that Lewis obviously does not see as within his scope.
On the other side, Lewis also sees the limitations of alternative models of addiction: the ‘choice model’ that puts all the responsibility on the addict, and the ‘self-medication model’ that sees the addict as ineffectually trying to cure themselves of past trauma. Lewis sees the need for the addict to take responsibility, but also recognises the full difficulties of doing so. He also recognises the role of past traumas in producing anxiety that addiction often seeks to allay, but that does not make self-medication a total explanation.
Lewis successfully interleaves accounts of the activity of an addict’s brain with biographies of five real cases, in the process making it clearer both why they reached the terrible states they reached and how they recovered. His basic account of the brain activity of addiction is that a feedback loop develops between the striatum – the motivating organ in mid-brain that is fired by dopamine – and the dorso-lateral prefrontal cortex, which shapes goals and methods of reaching them. When our goal becomes the relief from underlying anxiety that can be temporarily gained through the object of addiction, and we keep getting the dopamine hit of a goal fulfilled, the neural pathway between the two becomes ever more strengthened and alternative goals gradually become less powerful. Lewis also explains how the neural pathway also gradually shifts its location as addiction proceeds, so as to become gradually less conscious and more compulsive. The grey matter that provides reflective awareness in the prefrontal cortex decreases, as we descend to increasingly automatic actions dictated by our lower brains.
But Lewis also tracks the process of recovery. Some addicts may die, but those who recover first hit a rock-bottom moment of exhaustion in which the full consequences of the state they’ve got into, and the possibility of getting out of it, are somehow recognised. The brain is still flexible enough to rebuild itself, and more positive goals provide a perspective that enables recovering addicts to re-frame the addiction as a diversion from those goals rather than an all-encompassing need. As Lewis makes clear, recovering addicts do not suddenly start to ‘control themselves’, nor are they cured by drugs or medical interventions. Rather, they reframe their goals. The practices of meditation and mindfulness can be very helpful in doing this.
The relationship of this reframing to the Middle Way should be obvious. As Lewis said in his recent podcast interview with Barry, he sees the Middle Way as lying between asceticism and hedonism, those two polar opposites in our attitude to desire that are even recognised in the classic Buddhist version of the Middle Way. So far, then, we have a highly informative and inspiring book whose overall intention is obviously very much in harmony with the Middle Way. However, I also find a number of limitations in the book, which I see as limitations in Lewis’s understanding of the Middle Way as it relates to neuroscience and psychology. These limitations involve a lack of intellectual integration between this approach to addiction and related issues of cognitive psychology, a puzzling interpretation of the role of the brain hemispheres, and an apparent residual allegiance to the model of self-control even when he elsewhere emphasises reframing as a better alternative.
To some extent Lewis does seem to recognise the close but counter-dependent relationship between addicted indulgence and what he refers to as ‘simple suppression’ (which I would call repression, as it tries to destroy the unwanted impulses rather than consciously leaving them to be dealt with later). ‘Acts of will’ of this kind do not work because they produce ‘ego fatigue’, the gathering exhaustion that eventually results in us giving in and flipping back into indulgence. Lewis charts this process in the case of Alice, an anorexic/ bulimic who flips between neurotic self-control and binge eating. However, the concept of ego fatigue is just another way of talking about conflict. You can repress a desire, but if it is still strongly present in the entrenched neural pathways Lewis describes so vividly, it will be back. The flips of the anorexic-bulimic resemble those of the addict making initial weak and unsuccessful attempts to quit, as also those of the religious convert, the hypocritical moralist, or the rebellious individualist. On one level they may be due to a lack of the glucose required to keep open a new synaptic track when an easier and older one exists as an alternative. But that by itself would not account for the counter-dependence of opposites in our cognitive construction of the situation. Easier tracks are not necessarily opposite tracks. To account for that we need to pay much more attention to the role of the brain hemispheres than Lewis does, as I will explain below.
Lewis acknowledges the different roles of the left pre-frontal cortex in specialising in goals and representations, whilst the right provides new information from the body and senses. However, he does very little with this, and some of what he does say is puzzling and (on his own admission) speculative. He notes that the recovery of addicts who generate a wider perspective in their lives seems to produce stronger links between the striatum and the left pre-frontal cortex. That would indicate that recovering addicts do need strong goals and representations, but that could hardly be enough by itself given the tendency of the over-dominant left pre-frontal cortex to absolutise – forming beliefs that it takes to be certainties. Given the established roles of the two hemispheres, it would seem impossible for an addict to recover without a good input from the right hemisphere integrated with the left. More false certainty would just provide a basis of further repression and conflict, as the rigid certainties of the over-dominant left hemisphere repress alternatives. Instead, the recovering addict must surely have access to new perspectives that challenge that rigidity and help him or her to re-frame rather than repress the patterns of addiction. These could only possibly come from the right hemisphere, even if this happens indirectly through more adequate integration with the left as well as stronger communication between the left and the striatum.
What puzzled me in Lewis’s account of the hemispheres was also that he gives an account of the relationship of each to time that is completely inconsistent with that of Iain McGilchrist. Lewis talks of the left hemisphere’s grasp of time being linear and the right’s being cyclic, and he tries to use this to explain the stronger links with the left pre-frontal cortex in recovering addicts (though he does admit that this is speculative and based on limited evidence). ‘Linear’ here seems to mean having goals in view and ‘cyclic’ not having them. By contrast, McGilchrist’s explanation of the two hemispheres’ relationships to time is entirely consistent with, and helps make sense of, all the other well-established specialisations of each hemisphere. In McGilchrist’s account, the left hemisphere thinks sequentially, but does not actually experience the passing of time between points, unlike the continuous experience the right hemisphere has of time. Far from being able to get a wider perspective of their longer-term interests through sole dependence on the left hemisphere, then, recovering addicts will need an active sense of how their experiences at different times are linked. Such linking can only come from the right hemisphere integrating the otherwise isolated sequential goals and representations of the left.
If we recognise the segmented and sequential nature of the over-dominant left hemisphere, that makes it easy to account for inconsistencies in belief in both addicts and dogmatists. If we understand the repressive nature of absolutising, we can also make sense of the way that beliefs as well as associated desires flip between opposite extremes. When we are absolutising, everything that is not the absolute we identify with is a negation of it. That is a point that applies to addicts as much as to (for example) fundamentalists. For example, a heroin user desperate for their next fix separates the world into the ‘good’ that will provide the fix and the ‘bad’ that will impede it. All other distinctions disperse together with the grey matter that would be needed to make them.
Lewis also lays much stress on ‘now appeal’ meaning discounting of the future, which may indeed be a particular problem for addicts who want their fix immediately. However, there is no reason to think that our temporal absolutisations more generally need to necessarily take the form of discounting the future in favour of the present. If you look at the whole range of cognitive biases involving time, they can also include fixation on the past against the present (sunk cost fallacy) or fixation of the future against the present (forecast illusion and neomania). Given the left hemisphere’s disassociation from the actual experience of time passing, this is hardly surprising – all that is needed is an idea of a time to become fixated on, at a remove from actual time. ‘Now appeal’ needs to take its place amongst a range of temporal biases rather than be given the special status that Lewis sometimes seems to claim for it.
Lewis’s limited view of the hemispheres also seems to come with an associated problem of assumptions about the self. Although he perceives the limitations of the Platonic ‘rider and horse’ view of mind and body that he mentions as a common model for ‘self-control’, Lewis’s model for how the addict recovers still seems to involve a single locus of control in the left hemisphere. But the left hemisphere, as any reader of McGilchrist must realise, is not the single locus of a single self. When we form a string of discontinuous certainties that may be inconsistent with each other, this seems to produce varied selves, or at least the lack of any grounds for assuming a single self. Those varied selves are differentiated from each other through conflict, as the beliefs of one moment contradict those of another. You cannot resolve such conflict simply by ‘winning’ – i.e. through a (somehow magically consistent) left pre-frontal cortex imposing its will on the rest of the brain through better linkage with it. Instead it requires a dialectical process.
Here we get to the heart of the ‘reframing’ that Lewis does not seem to give us an adequate explanation of. To reframe, I need to recognise and accept a different perspective, and allow it to modify the assumptions of the one I currently identify with, in a way that maintains continuity but also allows a more adequate view to emerge. In a dialectical process, the best parts of two opposed views are mutually adopted, but the unhelpful assumptions that were producing conflict are discarded. The ‘two mules’ picture gives a strong symbolic representation of this process, which is also fundamentally one of reframing so as to resolve conflict. But you can’t integrate two views dialectically unless we first accept that there are two views.
In my view, then, it is only possible to make sense of the recovery of an addict by using a model of the brain that recognises it as at least potentially containing multiple selves, which can also then potentially go through a process of integration. The clearest route to this lies through seeing our separate selves as represented by the left hemisphere at different times, but the right hemisphere also having the potential to integrate those conflicting selves, by confronting them with falsificatory conditions and providing a framework of continuity in which they can engage with each other. ‘Self-control’ is unsuccessful because it assumes a unified self doing the controlling, and we have no grounds to make such an assumption. We may only have one brain, and from a neuroscientist’s point of view what may be happening is different sets of entrenched synaptic links, but from the standpoint of experience we need to recognise that we have several selves, and that the belief in the single self should not be unconsciously imported into the assumptions of neuroscience.
The efficacy of the practical approaches that Lewis recommends becomes much clearer with this model. He talks a lot about connection as the basis on which to overcome addiction, including the ‘Birmingham Model’ that aims to help addicts by giving them connections in the community: but connection is something we experience through the right hemisphere, which not only mediates all input from outside our minds but helps us identify and relate to persons. He also mentions the benefits of meditation for some of his examples, but meditation begins with body consciousness (overwhelmingly right hemisphere) and the soothing of the left hemisphere’s obsessive trains of representational thought. Lewis also puts a lot of emphasis on narrative, and of the need to overcome addiction by having a strong story of where one’s life is going. But narrative does not just consist in conceptualised goals: rather it involves a dialectical process in which barriers to those goals are negotiated. By the end of the story, the hero may achieve her goals, but she will also have learnt something in the process that disrupts her previous limitations. This, again, involves an integration of the hemispheres: or more precisely, the use of the right hemisphere to integrate temporally separated representations of the left.
In adopting such an approach, too, it becomes possible to unify our account of addiction with our accounts of dogma and of cognitive error. Lewis frequently notes the ‘stuck’ nature of the addict, rigidly thinking and doing the same things over and over again regardless of the circumstances. Our cognitive biases also take this form, of tendencies that may have made sense in some circumstances but no longer do so, and our dogmatic beliefs are such precisely because of this tendency. The feedback loops of confirmation bias are not ultimately different from those of addiction, with each being motivated by the rewards of finding what we expected to find. Lewis helps us to understand the addict’s loops thoroughly, even if he does not make all the further connections. Despite its limitations, then, Lewis’s book can provide a stimulating and helpful account that in the larger view contributes to this gathering picture of the nature of absolutisation – and of its avoidance, the Middle Way.
I’m grateful and honoured that Robert Ellis took the time and attention to read my book, The Biology of Desire, and to grapple with it in such a thoughtful and insightful fashion. I have nothing to say about the first half of the review. Yes, you got it, and that’s the greatest gift any author can hope for. But in the second half of the review, criticisms are offered. And though I value these at least as much, I have to respond to what I think you got wrong or misunderstood.
In reading these paragraphs, I got the sense that the left hemisphere was being villainized, much like that nasty cauldron of hedonism, desire — but in the opposite direction. Must the left hemisphere be characterized by “absolutising,” or would it be better seen (at least in its dorsolateral quarter — the most sophisticated and reflective region of the prefrontal cortex) as the place where we form strategies? Surely strategies are good things, as epitomized by the clear, logical thinking we require to steer between extremes and find the middle way.
In a typical passage, Ellis decries “the segmented and sequential nature of the over-dominant left hemisphere, that makes it easy to account for inconsistencies in belief in both addicts and dogmatists.” I’m familiar with McGilchrist’s work, but this sounds a bit like neuro-graffiti: it caricatures the left in too broad brush strokes. (By the way, McGilchrist uses caricatures brilliantly in his TED talk…but those are teaching tools, not the last word.) Segmentation and sequentiality are not evil. They are tremendously valuable commodities when it comes to, well, language is the prime example. But analysis itself — a particular kind of thinking — is necessary for rising above the fray of experience and figuring out how to improve it. For me, the best example of that improvement, when it comes to overcoming addiction, is being able to think of one’s life as a progression through time, that is, as a narrative with a past, present, and future. Without sequentiality, achieving that perspective is impossible, and without a sense of the future, there is little hope for the addict in overcoming his or her addiction.
I fully agree with Ellis that the intimate glide through experience provided by the right hemisphere is essential as well. He’s right that integration between the hemispheres is necessary. In fact, I can’t imagine what the left would do without the right, since that’s where it gets its “feed.” But we shouldn’t imagine that the regrowth of some capacity of either hemisphere must overshadow the participation of the other. That participation is deeply built into the brain, and only the most extreme form of pathology could ever interrupt it. [https://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight?language=en] In fact, the power of the left prefrontal cortex to shift perspective is of utmost value for getting us to tune into forms of experience that have become submerged (or repressed, in Ellis’s terminology) by the mindless habits driven by subcortical systems. Shifting perspective necessitates categorizing and classifying alternatives: that is often the only way forward.
As for temporal biases, sure, they abound in other forms than now appeal. But how do we overcome biases except by recognizing them as biases? And that requires differentiation and comparison. My professor in grad school, Robbie Case, a developmental thinker down to his toenails, taught us to see differentiation and coordination as inseparable partners in the child’s progression to more sophisticated forms of thought. In this he followed Piaget. Although I’m a newcomer to the Middle Way Society, I’d imagine that this dynamic duo of cognitive development is the hero, not the villain, when it comes to your credo of reconciling opposites in the formation of higher-order perspectives.
I agree that there are multiple selves that need to be integrated or at least coexist peacefully. And we seem to agree that one way to achieve this is by representing these different selves along a temporal continuum or life story organized by the left hemisphere (yes, with loads of input and experiential integration through the right). I fully agree that this story includes awareness of barriers to one’s goals and the negotiation of those barriers. I do not see the left dorsolateral prefrontal cortex as the top dog, or as the ultimate controller. Rather, I see it as a guide. Along the lines of McGilchrist’s analysis, I see it as the emissary we rely on to live our lives in a coherent and productive fashion.
As someone who has both researched and then grappled with issues of “addiction, I’m somewhat baffled by this review. While it is important to (continue to) understand, research and explain the neural pathways and synaptic changes that often happen in addicts, I really don’t know how any of these pathways can be so clearly pinned down to the point of challenge. Theories on resiliency have continued to show that certain “X” factors exist, but among broader patterns. And, perhaps more importantly, perhaps Lewis’ work is not to contend with discursive intelligentsia, but with “addicts” who can connect with his narrative in ways that can be authentic.
Hi Jasmine,
I don’t think I understand your point here, perhaps because I’m not familiar with the theories of resiliency you refer to. Please could you explain these better, and more specifically how they are incompatible with my comments on Marc’s book?
I also find your final sentence bordering on insulting. I’m presuming here that I’m supposed to be part of the ‘discursive intelligentsia’, which seems to be being used as a put-down of some kind. Are you assuming that neuroscientists have all the answers with such certainty that they can gain nothing of value from inter-disciplinary discussion? If so, you appear to be thinking in a very small box that I would urge you to get out of.
I’d certainly agree that addicts themselves have an important voice that should be listened to in the study of addiction, but your implication that therefore anyone else who takes an interest in the subject is ‘inauthentic’ appears stacked with prejudice. Besides which, one of the key insights I find in Marc’s work is that addiction is continuous with many more ordinary states, and there are many degrees of addiction in relation to many objects. Though I have never myself been a substance-addict, I have struggled at times with an addiction to computer games. I think you would be hard-put to it to find many people in the population who had not had some degree of ‘authentic’ experience of some degree and type of addiction. Just because somebody like myself also tries to take a wider, synthetic view and relate addiction to other issues, does not make them ‘inauthentic’, and the assumption that this must be the case is what I find the most insulting aspect of your post.
Hi Jasmine. This is my third attempt to reply to you, but my words keep disappearing when I click Post Comment. Anyway, please see the last paragraph of my reply to Robert, below. In that I summarize what I was trying to say.
Yes, and addicts who make it out the other side to “recovery” (not just abstinence or sobriety), are incredibly resilient. Not a recommended method for enhancing resilience, but it happens nonetheless. Those “X” factors are always at play, as in the Birmingham Model mentioned above, or Emmy Werner’s classic Kauai study, and other effective treatment methods— and are all socially mediated.
Hi Marc,
Thanks for these responses. It doesn’t seem that we actually disagree about much of substance, and I can entirely agree with your last 3 paragraphs. But I think you are misreading my account of brain lateralisation. I am not ‘villainising’ the left hemisphere at all, and I fully recognise the interdependence of the two hemispheres and vital importance of the left’s functions. Perhaps you have transferred this impression from my advocacy of McGilchrist’s book, but I do disagree with McGilchrist when I think he rather falls into ‘villainising’ the left hemisphere at the very end of his book – and if you read my review of ‘The Master and his Emissary’ on this site you will see that I’m critical of that part of the book.
I do think there is a false dichotomy when you write “Must the left hemisphere be characterized by “absolutising,” or would it be better seen (at least in its dorsolateral quarter — the most sophisticated and reflective region of the prefrontal cortex) as the place where we form strategies?” Of course, it’s both, not either/or. The left hemisphere absolutises when it becomes over-dominant and excludes other perspectives, which then cease to be available to us, as in your examples of addicts no longer considering other longer-term life goals in face of the immediate dominance of the represented object of addiction.
Strategies are indeed ‘good things’, but how good they are depends on the breadth of awareness and the extent of the conditions addressed by the goals that we are trying to reach. So that enables the left prefrontal cortex to play an essential role in both our best and our worst states of mind. My thesis (and I think McGilchrist’s), however, is that the worst can be best explained by the overdominance of the left. I very carefully included the ‘over’ at all points, and full account needs to be taken of it. I certainly don’t think segmentation and sequentiality are evil (did I write that? I don’t think so), they’re just not enough by themselves. Analysis is also essential, but will proceed in narrow circles of confirmation bias unless also accompanied by synthesis (I wonder if you are perhaps ascribing some qualities to analysis that should be more accurately attributed to synthesis?).
At the centre of my thesis on these matters is the link between absolutisation and repression. Absolutisation is the certainty that one has a wholly true and complete representation, which thus involves the exclusion from awareness of alternative kinds of framing and also the rejection of the opposite belief. This seems to fit closely with your account of the state of mind of an addict, so what precisely is your objection to understanding the addict’s states of implicit belief in those terms? To say the left prefrontal cortex seems to have prime responsibility for such absolutisation in no way excludes it from playing a helpful role in other respects or other circumstances.
I can imagine that when you have an intimate knowledge of the neuroscience involved, any generalisations made by those without such detailed knowledge of the specifics may seem like over-simplifications. However, my approach is synthetic and provisional. I think there’s an enormous value in making theories more adequate by developing them to encompass a range of studies and aspects, and this is what I see mainstream academics as largely not doing. The absolutisation thesis seems incredibly useful because it can potentially explain so many things at once: not only addiction and dogmatism, but also cognitive error and the basis of ethics, and it can also be extremely helpful in developing a practical framework to respond to these things. The wider the scope of a theory, the thinner it will appear to those used to only justifying their claims on the basis of a certain density of evidence, but this is very much the effect of an education and research system that prioritises analysis over synthesis and advances by creating more and more over-specialisation (again, please note the ‘over’).
My challenge to scientists is this: not to run away at the appearance of a term like ‘absolutisation’, or the very existence of a synthetic theory, on the assumption that it must be speculative nonsense. Instead, consider it positively, improve on it and test it out. Synthetic theories are not necessarily less testable than narrower ones, but they will obviously require a wider range of testing to support a wider thesis, and the rewards will be greater if the testing turns out to support the thesis. From those psychologists I’ve encountered so far who are unhappy in some sense about the theory of absolutisation, I have also yet to meet any alternatives with the same scope. How else, for example, would you explain the links and the degrees of similarity between addiction and the holding of dogmatic beliefs such as those of Islamic Fundamentalism (to take a very obvious example)? McGilchrist is one of the few scientists I’ve encountered so far who really has the courage to stop saying “that’s not my field” and to start taking the risks that are required to get a bigger view of these matters.
Hi Robert,
You’re right that we don’t disagree on very much at all. And of course I too am attracted to synthetic theorizing, as you can tell from my book. By the way, clearly analysis and synthesis can be another dynamic duo in development, but, true, we often get pulled too far in one or the other direction.
I hadn’t given much thought to absolutisation before reading some of the stuff from the Middle Way Society. But I’m not so sure it’s the child of the left hemisphere, as much as the offspring of the marriage between the two. You and McGilchrist (I think) both gloss over a critical factor in your discussion of these issues, and that’s emotion. Anxiety, fear, and perhaps other negative emotions are considered the province of the right hemisphere (based on a good deal of research). Fear is what causes us to retreat to simple, over-practiced solutions (which we might loosely say are indexed by the left). It’s true that the left is guilty when it comes to confirmation bias: the narrow circles you describe are indeed leftish, and we can all see how destructive this can be in, say, religious fundamentalism. In fact left-sided temporal-lobe epilepsy (a storm of overactivation) often shifts ideation toward religious dogmatism: sin and punishment and all that.
But addiction is weird when it comes to confirmation bias. Addicts get disconfirmation thrust in their face time and time again: this doesn’t make me feel better; this makes me feel like shit. Yet the fear of going without, returning to emptiness, drives us back. Then desire takes over. Desire, by the way, also works through the left: the left PFC is thought to be responsible for approach (as opposed to avoidance). So what I speculate about linear time is really just one capacity among many: some are valuable and some get us in a lot of trouble.
Although you find Jasmine’s comment bordering on insulting, I think I see her point. We are floating through some very speculative terrain, and the actual down-to-earth needs of addicts can easily get side-tracked. Of course I like theory, as do you. But I sometimes feel frustrated with my own theorizing when I realize how difficult it is to apply to the relief of suffering.
Hi Marc,
An interesting point about fear and anxiety, but couldn’t fear and anxiety be separated into right-brain and left-brain types? Roughly, right-brain anxiety is a response to a threat that has been picked up through the senses, whilst left-brain anxiety is a response to the disturbance of an expected representation. Of course, they’re interdependent as well and there are likely to be cases that it would be difficult to differentiate. If there is such a distinction to any extent, one could then see primarily right-brain anxiety as potentially much more integrated, concerned with addressing external conditions, only drawing on the left brain to help us recognise genuine threats. When we see a tiger it’s actually helpful to flee. However, over-dominant left hemisphere anxiety could be primarily a response to a threat to a habitual view, and is thus liable to lead to repression and confirmation bias loops in a way that an immediate response to danger is not. Could such an account be consistent with the neuroscientific evidence?
Surely, if addicts tend to ignore disconfirmatory experience time and time again, this is evidence that they are in absolutizing states?
I don’t agree that the terrain we’re on is speculative at all, at least from my point of view. There may be uncertainties about the details of the way absolutisation and the Middle Way relate to the brain, but those conceptions are ones that I was already working on from lots of different directions long before I realised they could be understood in terms of the brain. I only read McGilchrist’s book and was alerted to this in 2011, when I’d already been writing about Middle Way Philosophy for 10 years. Absolutisation and ways of working with it are primarily matters of experience, and my reasons for being interested in it are primarily practical.
Hi again Robert,
I don’t think the feeling of fear (which is also at the core of anxiety, despite its temporal distinctiveness) can ever be “left brained”. But the things we fear, the things that are called “appraisals” by emotion theorists, I suppose we could sort according to all kinds of factors, including the immediacy vs abstractness of the threat.
And yes, I guess addiction is a form of absolutising…. I’m not familiar enough yet with the concept to know if we’re talking about the same thing. But probably we are.
What I meant to say was speculative was all this sorting of enigmatic cognitive mechanisms into particular neural compartments like left and right PFC. Yes, we can do it for language, math, and so forth, to a degree (we know both are involved in both, but in different ways), but when we’re talking about a person’s sense of his/her life, continuity in time, and so forth, we really are speculating…which is always a good first step in science. I never meant to imply that middle-way concepts were speculative. Haven’t they been around for thousands of years?
Hi Marc
Iain McGilchrist once said that just as Woody Allen sees the brain as his second favourite organ, he himself sees the the left hemisphere as his second favourite hemisphere. From what I know of Robert, I don’t think he has a preference for either, at least as far as the latter two are concerned.
Thanks for the laugh, Barry. Luckily we can set up shop in the corpus callosum, that bundle of 200+ million fibers that connects the two (latter) organs.
Another review – by Laura Miller: http://www.salon.com/2015/06/27/addiction_is_not_a_disease_a_neuroscientist_argues_that_its_time_to_change_our_minds_on_the_roots_of_substance_abuse