We Are Our Brains (56 page)

The long-established idea that we're completely free to choose our sexual orientation not only is wrong but has also caused a great deal of misery. It has led to people being punished for homosexuality, which all religions castigate as a sin—that is, as a wrong choice. There's nothing optional about our sexuality, which is programmed in the womb. So it's ridiculous to persist in attempts to “convert”
homosexuals into heterosexuals, a practice that still goes on in countries like the United States and Britain.

Pedophilia is also programmed into the brain at an early stage of development. The risk of pedophiles harming children can be reduced by teaching them how to control their impulses better. In addition to cognitive therapy, anti-androgens can sometimes also help. Providing sex offenders with a social network after they have been released from prison strongly reduces the risk of reoffending. Conversely, hounding and isolating pedophiles can have disastrous consequences.

The signal for the onset of labor comes from the fetus, when it registers that the mother can no longer provide its growing body with sufficient food. A number of psychiatric disorders in adulthood turn out to be heralded by problems around the time of birth. It was long thought that schizophrenia resulted from brain damage caused by prolonged and difficult labor. We now know it to be an early developmental brain disorder that's largely genetic in origin. Intense interaction between the brains of both mother and child is necessary for labor to proceed well. So the difficult labor associated with babies that go on to develop schizophrenia could be seen as an early sign of the disorder. It's a counterintuitive conclusion, given that the typical symptoms of schizophrenia usually only manifest themselves in adolescence. (Though if one asks parents when they noticed that their child was different from other children, they often say, “Oh, he's always been different.”) The same connection applies between a difficult birth and the subsequent emergence of autism, another early developmental brain disorder. A link has also recently been established between problems at birth and anorexia or bulimia. Again, these problems could be seen as the first symptom of a malfunction
of the hypothalamus that later takes the form of an eating disorder. Consequently, a close eye should be kept on children whose birth was difficult to see if they develop a psychiatric disorder in early adulthood. Therapy in the early stages of schizophrenia has proved beneficial in preventing brain damage, and the same might apply to other developmental brain disorders.

Stimulation during the earliest phase of life in surroundings that the child perceives as safe and familiar is crucial for optimum brain development. Neglect or abuse of young children can permanently impair such development and increase stress axis activity. It then only takes a relatively small problem in the child's surroundings for its stress axis to become hyperactive and cause depression. It's crucial that youth services act promptly to help children growing up in such circumstances, and they need to be much better organized than at present. A child's ability to bond also passes through a critical stage in which oxytocin, the “bonding hormone,” plays an important role. Oxytocin levels are lowered for a long period, possibly even permanently, when children are deprived of parents or foster parents for too long. So the transfer from a children's home to a foster home should take place as early as possible to ensure that a child can still bond properly with its foster parents. A child's brain needs a stimulating and enriched environment to develop optimally after birth, and the linguistic environment plays a key role. Language stimulates many brain areas in a way that is culturally specific. As a result, Chinese or Japanese brains are configured differently than Western brains, seemingly without genetic factors being involved. Stimulation is perhaps even more important in the case of children with mental disability, as the effect on their developing brains can make a difference for the rest of their lives.

Young children have no religion; religious beliefs are imprinted in
them by their parents at an early stage of development in which they accept without question anything they are told. In this way, beliefs are passed down from generation to generation and become fixed in our brains. Children should be taught not what to think but how to think critically and how to make their own ideological choices in adult life. Segregating young children in belief-based schools is pernicious—it not only prevents them from learning how to think critically but it also fosters an intolerant attitude toward other beliefs.

Politicians have never lost faith in the misconception that social engineering can reprogram the brain. On the contrary, as of the 1980s, alarmed by recession and the top-heavy welfare state, they began to stress individual responsibility for prosperity and welfare. People were told that their fates lay in their own hands—a claim at odds with the many studies showing that people's capacities are largely determined by genetic factors and environmental influences in early development. An educational disadvantage is hard to eliminate. An innate lack of capacity can't be entirely compensated for. And more and more people are unable to meet the increasingly high demands placed on them by today's rat race society. Those whose capacities are lacking or who have mental health problems are now being unjustly blamed for their own failure. Young people with mild learning disabilities (IQ 50 to 85) are an especially vulnerable group. They make up 16 percent of the Dutch population but are strongly over-represented among those tried for criminal offenses (accounting for 50 percent of them). They are held responsible for their own choices despite their inability to compete in the employment market. In the current repressive climate, misdemeanors that would previously
have incurred a strong warning have now been criminalized. This group is easily influenced, a characteristic that often gets them into trouble. It's also the characteristic that should make it easy to help them to stay out of trouble. Unfortunately, the structures and facilities that would make this possible have fallen victim to budget cuts.

Children of poorly educated, poorly paid parents are more likely to drop out of school and end up in low-paying jobs; they also run a higher risk of poor health, criminality, addiction, gambling, and unemployment. There is a life expectancy gap of six years between the lowest- and the highest-educated. This discrepancy is largely due to lifestyle. Making tobacco and alcohol more expensive to encourage the former group to change their habits has proved ineffectual. Negative lifestyle factors are most pronounced when people live in deprived areas.

Deprivation often appears to be inherited, contagious even, since these problems accumulate in certain neighborhoods. According to the Netherlands Institute for Social Research, almost one hundred thousand Dutch children, 4 percent of the total, are socially excluded. They aren't members of a sports club, are almost never taken on outings, don't go on vacation, and hardly ever visit the homes of friends. If this definition is applied slightly less strictly, 11 percent of Dutch children can be considered to be socially excluded. This is largely because of their parents' financial situation. But their parents, too, are marginalized, and such families live in neighborhoods devoid of proper playgrounds and plagued by vandalism and antisocial behavior. These aren't circumstances in which a child's brain can develop optimally.

There's no quick fix for this problem. We can do our utmost to foster optimal development and to prevent damaging influences. But we must also accept that in a complex process like brain development things occasionally go wrong. As a result there will always be a small proportion of people who aren't properly equipped for life, who suffer from mental disability or have neurological or psychiatric problems. This can happen to any child in any family, and society
must shoulder its responsibility by providing sheltered jobs, social benefits, and good, practical supervision. As things stand, there is a lot of room for improvement. Better education and public information are also needed to prevent society from laying the blame for failure at the door of those who, through no fault of their own, incurred a developmental brain disorder.

There's a similar tendency to assign blame to people struck by brain diseases in adulthood. They are often told that a positive attitude toward, say, MS, will promote healing. It's an appealing notion. However, not only is there absolutely no evidence for it, the result is that if the disease worsens, the poor patient will be blamed for not doing his best to overcome it! It's high time we abandoned the “own fault” myth.

Aggression levels are determined by gender (little boys are more aggressive than little girls), genetic background (tiny variations in DNA), fetal nourishment, and pre-birth exposure to smoking, drinking, or medication. The likelihood of boys displaying uninhibited, antisocial, aggressive, or delinquent behavior increases in puberty, as their testosterone levels rise. The level of violence shown by adult male criminals is also testosterone-related. So there are many factors beyond one's control that determine whether someone gets into trouble with the police or ends up in court. That doesn't mean that criminals shouldn't be punished, but criminal law should take these neurological factors into account. The development of the prefrontal cortex is a slow process, continuing at least until the age of twenty-five. It's only at that age that an individual is fully equipped to control their impulses and make moral judgments. On the basis of neurobiology, therefore, the age at which offenders are tried under adult criminal law shouldn't be reduced to, say, sixteen, as some politicians are urging in an effort to woo voters, but should rather be raised to
an age at which the brain structures are mature, at around twenty-three to twenty-five. People who commit a minor offense as teenagers shouldn't have that held against them later on in life.

Some children are markedly more aggressive than others. A strikingly high incidence of psychiatric disorders is found among delinquent youths imprisoned for violent crimes—as high as 90 percent of the total group in the case of adolescent males. Genetic factors are also influential, as studies of twins have shown. The application of criminal law should be confined to individuals with healthy brains. But our criminal law system continually sins against this “M'Naghten rules” principle. Can a pedophile be held morally responsible for his sexual orientation, which he owes to his genetic background and atypical brain development? Can a child be deemed culpable for the combination of his genes and his mother's smoking during pregnancy, causing him to develop ADHD and to get into trouble with the police? We know, too, that malnourishment in the womb increases the likelihood of delinquency. And can an adolescent whose brain has just been completely reconfigured by sex hormones be considered fully responsible for committing a crime?

Moral responsibility is a tricky concept in these situations, free will an illusion. This doesn't mean that criminals shouldn't be punished, simply that punishments should be effective. In the field of medicine we have learned that to reach truly scientific conclusions, the effects of a drug or other therapy need to be ascertained in a properly controlled study. However, criminal law clings to the notion that punishment must be determined on an individual basis, rather than thinking in terms of well-defined groups. In point of fact, the criminal justice authorities are using the same arguments that psychoanalysts did in the days before it was systematically established whether a particular form of psychiatric therapy worked or not. As a result, it's impossible to determine the effectiveness of a punishment. Moreover, the criminal justice system is increasingly being pressured by politicians to devise ever more penalties, from community sentences to boot camps for young offenders, without establishing
how they measure up against traditional forms of punishment. In the absence of a proper study involving a control group, the efficacy of measures will always be contentious. However, politicians have little interest in scientific methods. They only think in the short-term—particularly of the coming elections.

Although all efforts in the medical field are focused on delaying the end of life, death always wins in the end. If at all possible, we want our brains to be healthy as death approaches, so that we can continue to make our own decisions in this final stage of our lives, right up to the last moment. People in the Netherlands who have cancer or some other serious illness are fortunate to have the option of euthanasia, which Dutch law considers acceptable as a means of preventing pointless suffering. If someone suffers from a brain disorder, however, assisted dying is a problem. Patients who are in a coma or similar state can no longer communicate their wishes, and patients with dementia or psychiatric disorders present doctors with the difficult task of assessing their mental competence. Views on euthanasia or assisted dying in these two latter categories are progressing, although the decision to perform euthanasia, which remains extremely difficult for doctors treating patients with chronic psychiatric disorders, is rarely made. Yet it can prevent horrible suicides. In general, Alzheimer's progresses so slowly that you have time to seek out and consult with a physician who can help you choose the right moment to end your life. But there are other forms of dementia, like vascular dementia, which can overwhelm you before you have had time to organize matters. So it's important that those close to you know your feelings on the subject, and that you make sure that your
doctor will give you the assistance you want in the final stage of your life and that over time you can both prepare for this moment.