INTRODUCTION

This chapter shifts attention to the public policy context of neuroscience and examines the possibilities and problems inherent in attempts to shape an international policy agenda in neuroethics. The line between neuroethics and neuropolicy is a porous one and ultimately all of the most important neuroethics issues will find themselves embroiled in the policy arena. Like genetics and stem cell research, neuroscience promises to be a highly controversial political issue in and across countries. It, too, raises political and cultural red flags that arise whenever we deal with human cells, selves, and societal values. However, although the political ramifications of human genetic research have been well documented and widely analyzed over the past decade, and the social, legal, and ethical dimensions funded as part of the human genome project, there has been no methodical scrutiny given to neuroscience. In light of the rapid advances in our knowledge of the structure and functions of the central nervous system (CNS), it is timely to examine the impact of this new understanding and the vast array of applications that accompany it on human behavior, social institutions, and our perceptions of the human condition.

The array of techniques and strategies for intervention in and imaging of the brain are expanding rapidly and are certain to be joined in the future by even more remarkable capabilities. In addition to treating neural diseases and disorders, these innovations promise increasingly precise and effective means of predicting, modifying, and controlling behavior.

NEUROTECHNOLOGY: A FOCUS FOR PUBLIC POLICY

The field of neuroscience draws together many disciplines in the study of the nervous system and the properties of mind. Although understanding the basic structure and physiology of the brain and its processes has led to high-impact findings, it is typically the manipulation or application of this knowledge that is most interesting to individuals outside the scientific community. The development and use of neurotechnologies, those tools and devices that interact with and modulate the nervous system, is a fast-emerging area of technical achievement that has vast potential to impact our understanding of, and interaction with the brain. The rapidly growing field of neurotechnology research and development employs knowledge and tools from diverse fields. It is through interdisciplinary, collaborative thinking that great advances have been made to develop, research, and transfer neurotechnology to the clinic and beyond. Such technologies include functional magnetic resonance imaging (fMRI), electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), deep brain stimulation (DBS), and neural prosthetics. Investigation into the mechanisms and functions of the brain is leading to a vastly improved understanding of brain disease, injuries, human cognition, and behavior, and will give us an unprecedented ability to heal, enhance, and manipulate the nervous system.

Many ethical, legal, and social implications (ELSI) of these technologies and their identified and potential uses have emerged, with others still to surface, as the scientific community and general public have increasing access to medical and commercial neurotechnologies (Eaton & Illes 2007).

INTRODUCTION

My introduction to this book on neuroethics, a volume with a large diversity of topics, is based upon a very personal selection of some of the numerous highlights that form the contributory history of the field of neuroscience. This volume shows how the way in which we look upon the brain has changed – in a relatively short period of time – from being just one of the organs that housed a soul to being the focus of a huge multidisciplinary endeavor to study the source of the mind. The focus of brain research has moved through that endeavor from the study of macroscopically visible pathologies of the brain to the subtle structural and functional differences that form the basis of psychiatric disorders and of our character. The sexual differentiation of our brain in utero – the programming of our gender identity and sexual orientation for the rest of our life – is discussed as an example of one of the many aspects of our character that become hardwired in our brain during early development. The concept of a critical window during which a developmental process can take place in order to structure brain systems and their function for the rest of our life is also why it is so difficult to repair lesions in the adult brain. In spite of this difficulty, it is now possible to sketch a series of new technical developments in neuroscience that bear the promise of leading to new, effective therapeutic strategies to tackle brain disorders in the near future.

THE NEUROSCIENCE AND NEUROPHENOMENOLOGY OF PAIN

The problem of pain

If the profession and practices of pain therapeutics are to be focally dedicated to right and good care of those in pain, then it is imperative to (1) pursue knowledge of the mechanisms and effects of the disorder that has rendered them to be patients, and (2) recognize and acknowledge that the uniqueness of pain as sensation and experience is inextricably bound to these neural event(s) (Giordano 2006). In this chapter I argue that these facts establish the progressive epistemological basis for a neurophilosophy of pain that both informs and sustains the direction for ongoing research, and gives rise to a neuroethics of pain care.

Some forty-seven years ago, British scientist and novelist C. P. Snow described what he believed was a deeply entrenched, widening rift between the “two cultures” of modern society: the sciences and the humanities (Snow 1959). Yet, one of the most significant accomplishments of contemporary neuroscience has been to make ardent strides toward what biologist E.O. Wilson calls consilience: “… a jumping together of knowledge by the linking of facts and fact-based theory across disciplines to create a common groundwork for explanation”.

In the ten years since this chapter was originally written – for an issue of the journal Topoi devoted to the topic of moral reasoning – the hopes expressed in its opening paragraph have been fulfilled beyond even my own fond expectations. Since then, brain imaging has revealed a number of neuroanatomical locations that seem disproportionately active during moral reasoning and various forms of social interaction. At a lower level, neuroethology and neurophysiology have jointly identified several distinct neurotransmitter chemicals that play a major role in long-term pair-bonding, in the establishment of mutual trust and cooperation between individuals, and in the commitment of personal resources to the joint parenting of shared offspring, both in animals and in humans. Beyond this, the role of our so-called “mirror neurons” in comprehending the behavior and the emotions of one's fellow creatures, and in grounding one's capacity for social mimicry, has revealed a major brain mechanism for simultaneously sustaining both social perception and social behavior. And these brain-focussed disciplines have recently been joined by the social sciences from above and by evolutionary biology from below, yielding a multi-level and multidisciplinary portrait of our precious capacity for moral cognition. This capacity for morality, it now seems clear, is not unique to the human species; many other creatures display it as well. But none does so as thoroughly and intricately as we humans. It binds us together, and gives us collective (and individual!) wings, to a degree that is downright startling.

Most current research efforts in neural engineering focus on restoring health and functionality of the nervous system. In addition, there is considerable interest in developing neural engineering technologies for the purpose of enhancement. In the short term, the bulk of the neural engineering applications will likely continue to focus on curing disease and reinstating lost functions. In the medium or long term, however, the focus of neural engineering might slowly but surely shift from therapy towards enhancement. Although neural engineering has a huge potential to relieve suffering, its further development is likely to trigger difficult ethical questions as well. These challenges will have to be adequately dealt with so as to guarantee responsible further development and appropriate use of neural engineering technologies.

INTRODUCTION

Neural engineering is a promising new field of research that employs an engineering approach to the study, reinstatement, and enhancement of a wide range of nervous system functions. The first international neural engineering conference was held in Capri, Italy, in 2003. A year later the field's first academic journal, The Journal of Neural Engineering, was established. Though new, neural engineering synthesizes a broad range of older fields, such as experimental neuroscience, clinical neurology, computational neuroscience, electroconvulsive therapy, electrical engineering, robotics, computer engineering, and materials science.

Most current research efforts in neural engineering focus on curing disease and reinstating lost functions of the nervous system. Besides, several recent research initiatives demonstrate a significant interest in the development of neural engineering technologies for the purpose of enhancing human traits.

INTRODUCTION

When David Chalmers introduced the notion of the “hard problem of consciousness” (1995), he contributed to a revolution in the neuroscience of consciousness and cognition as well as in the philosophy of mind. The main point of the hard problem is that, even if we could discover the “neural correlates of consciousness,” we still would not have answered the “harder” question: Why do those physical events exhibit the property of consciousness, whereas other physical events do not?

I acknowledge that this “hard problem” notion should not be construed as an argument for mind-body dualism, or as a reason to reject physicalism. (More on that later.) None the less, Chalmers' point has important implications for neuroscience in general, as well as cognitive science in particular. There is a tendency in neuroscience to assume that if a brain process B correlates with a mental process M, then B is the physical process that produces M. But this reasoning can lead to gross oversimplifications. There may be a much more complicated process, P, that causes both B and M to occur, and therefore causes B and M to correlate with each other. To be sure, P may very well be a purely physical process. My point is that P often may be a more complicated physical process than just B. In some cases, it may turn out that B is actually a somewhat minor or even peripheral part of the more complicated process P that causes B and M to correlate.

AUTONOMY: A BRIEF HISTORY OF THE CONCEPT

No other concept has played such a decisive role in the history of ethical thought as that of autonomy. It reached maturation in modern moral philosophy, within a theory of the ethical subject, but in fact autonomy has a much longer history. Its origins can be traced to the culture of classical antiquity, which made use of the concept in a paradigm of thought distinct from that existing today. The approach was primarily of a political character in that the concept of autonomy served to characterize the nature and identity of sociopolitical entities (e.g. cities), which, albeit maintaining their relationship to the state (Athens) and recognizing its primacy, claimed their independence and the right to enact their own laws (Thucydides and Herodotus).

Later, in the European context of the seventeenth century wars of religion, the concept of autonomy returned in the form of a legal-political notion. It affirmed the ability of every individual to exercise his right to freedom of religion and conscience. Moreover, the social aspect of autonomy was claimed as a condition for the existence and development of single spheres of individual and collective life, within the community of states. As the modern idea of state developed in Europe, the concept of autonomy accompanied the history of emancipation and the liberation of individual life from the arrogant and destructive supremacy of dictatorial notions in politics as in social life.

What is a person? What is the self? These are tough questions, indeed. They are so tricky that it is difficult even to imagine what answering them would look like. A person, a self, is not something in the objective world that we could point our finger at. Look at that: a self! That sounds queer. We need a theory of the self – and a very special theory, too – in order to speak about something that lies exactly on the border between inner and outer, value and fact, subjective and objective. As selves, we make acquaintance with the interface between different logical spaces and we come out of this experience baffled. As Augustine used to say about time, we do not have trouble with such familiar notions until someone prompts us to make explicit sense of them. Then, we get stuck in a tangle of doubts. I know that I am a self. (I am myself! My very language is compelling me to admit it.) But I do not know much more about it. Well, of course, I understand that it is me the person who is writing the first tortuous lines of a chapter that will force me to come out into the open and take sides on subject matters that put our intellectual faculties to a hard test.

Introduction

The abilities to talk, to carry on a conversation, and to tell stories are central to us; they are constitutive acts through which we create, embody and perform our selves. Conversation is ontogenetically prior to narrative, developing in tandem with language: two and three year olds can carry on simple conversations: story telling develops around four years of age, co-incident with the emergence of episodic memory and theory of mind. Because of their centrality in our social and cognitive lives, narrative and conversation tasks are increasingly used in study designs to investigate linguistic, discoursal and cognitive patterns. Narrative and conversation tasks provide naturalistic, ecologically valid data which can be used to identify both positive and negative features in discourse.

In this chapter, we explore narrative and conversation tasks for three commonly investigated areas: linguistic structure, narrative and memory. We outline issues in study design based on the models presented in previous chapters. Linguistic structure is commonly investigated in contexts of language development and in speech disorders and is central in the evaluation of speech performance in educational and clinical settings. We discuss morphology and syntax as two areas of linguistic structure in interaction with information processing load as represented in the conversation of speakers with AD and an ASD in Section 6.2. Narrative occurs universally and is important in our cognitive representation of events (van Dijk and Kintsch 1983; van Dijk 2006).

Introduction

This chapter is intended to situate clinical discourse analysis in terms of relevant linguistic and non-linguistic fields and to orient readers to the developmental and degenerative disorders discussed. Sections 2.2 and 2.3 briefly sketch diagnostic criteria, epidemiological information, current treatment options and potential associations with neurophysiology in each area. Section 2.4 focuses on the theoretical background and sources for clinical discourse analysis. These include conversation analysis, ethnographic and interactional sociolinguistics, functional linguistic discourse analysis, cognitive and philosophical pragmatics, and formal (generative) linguistic models. Section 2.5 addresses the roles of neurology, neuropsychology, psychiatry and neuroimaging as essential in developing understanding of relationships between discourse behaviours and neurological disorders. Finally, section 2.6 addresses the role of normative discourse patterns in evaluating descriptions of the discourse of clinical groups.

Autism spectrum disorders

Autism spectrum disorder (ASD) is an umbrella term for a continuum of neurodevelopmental disorders, the causes of which are unknown. ASD manifests during infancy and is estimated to affect one in every 165 children (Fombonne et al. 2006). The first account of autism was published by Leo Kanner (1943). Since that time, an expansion in diagnostic criteria has led to the inclusion of more diagnostic categories in the autism spectrum. ASD now includes autism, Asperger syndrome and pervasive developmental disorders not otherwise specified.

ASDs affect more than one domain of functioning and are generally characterized by three core deficits:

1. 1) impairments in socialization and interaction (e.g. lack of shared attention, lack of peer relationships).

2. 2) impaired language and communication (delay or lack of functional speech, difficulties with conversation and pragmatics),

3. […]

This book is predicated on the relatively uncontentious notions that discourse patterns – what people do when they talk or write – can provide trained observers with information about cognitive functions and affective states in speakers and, further, that cognitive functions and affective states may be signs of integrity of neurological function and structure. Neurolinguists, psycholinguists, aphasiologists, psychiatrists, psychotherapists and speech pathologists all take some variation on assumptions like this as their point of departure in studying brain–behaviour relationships and treating some neurological and affective disorders. However, discourse – people's talk and text – is inherently complex and apparently unstable and, worse, the neurological substrate and processes that support even superficially simple things like ‘how words are represented in the brain’, let alone ‘what happens in brains when people talk’ are matters of active debate and investigation rather than scientific givens. In the face of so much uncertainty and complexity, most of the work done on language–brain relationships has, very sensibly, centred on theoretically discrete and/or methodologically isolatable phenomena associated with particular semantic, morphosyntactic or phonological structures or processes. Work on discourse in clinical environments as another means of investigating neurocognitive (dys-)function, although often called for, has been less common.

This situation is changing now because of technological developments and, we think, a sea-change-like shift that is taking place in attitudes to brain–behaviour relationships.

We wrote this book because we thought a description of the work we do could be helpful for people who want to investigate and understand discourse in clinical contexts. In modelling comprehensive discourse analyses and showing how such analyses may be systematically related to aspects of neurocognition, we hope to have illustrated the usefulness of taking a unifying approach to investigating natural language behaviour, and particularly extended discourse, in relation to neurocognition. Our practice of hybridizing techniques from functional and formal linguistic models, from conversational analysis, ethnomethodology, situational linguistics and pragmatics, as well as from structuralist and semiotic discourse models, artificial intelligence and neuropsychology and bundling them together in order to account for all the different aspects of language that potentially contribute to discourse patterns is driven by the need for comprehensive accounts that are beyond the scope of individual frameworks or discourse models (that we know). We have suggested ways in which the resultant hybrid methodology for clinical discourse analysis can be combined with neuropsychological and neuroimaging techniques and adapted to different situations and cultures. While we have been most concerned to address the need for comprehensive analyses, we have also shown that the amount of detail included in analyses can be adjusted according to the scope and purposes of particular investigations.

We have further suggested that clinical discourse analysis has at least the following potential applications.