We Are Our Brains (57 page)

There is, however, a large and rapidly growing category of people for whom assisted dying still falls outside the scope of the legislation on euthanasia: elderly people who simply feel that their time has come. We're trying to address this problem by means of a civil society initiative whose aim is “to legalize assisted dying for elderly people who believe their time has come, under the proviso that this takes place at their express request, with all due care and in a manner that's open to scrutiny.” The initiative, which was set up by Yvonne van Baarle, is called Uit Vrije Wil (By Free Will). Not wishing to complicate things unnecessarily, I refrained from mentioning to the group my view that free will is illusory until we had secured the forty thousand signatures that were needed to ensure discussion of this question by the Dutch parliament. In fact that only took four days. It would seem that people in the Netherlands are very concerned about this issue. We will see how politicians respond and how long it takes for the law to be amended.

When I started work as a student doctor in 1966, brain research was the domain of a few mavericks who were regarded with considerable suspicion by society at large. These days, the great social significance and huge potential of this field appear to be universally recognized, and neuroscience has become a top priority at universities and research institutes all over the world, where hundreds of thousands of scientists explore a wide range of technologies. The highly complex research techniques call for specialized scientists, who must work in multidisciplinary teams to achieve new insights. Networks are becoming ever larger and more international, as can be seen from the growing number of authors and affiliations cited at the top of publications.

In the years to come, insights into the molecular biology of brain disorders will produce new objectives for therapeutic strategies. Stimulation electrodes implanted at precise sites in the brain are being used to treat not just Parkinson's disease but also obsessive-compulsive disorders. Their effect is also being studied in such areas as minimally conscious states, obesity, addiction, and depression. As with all effective therapies, there are side effects. And these can be considerable in the case of Parkinson's patients undergoing stimulation of the subthalamic nucleus, ranging from obesity to changes in character, impulsive behavior, and even suicide. Psychosis, lack of sexual inhibition, and compulsive gambling have also been reported. Researchers are looking at the effect of transcranial magnetic stimulation on depression and tinnitus. This technique is also used to prevent hallucinations among schizophrenic patients. It's still too new for its side effects to be known. Neuroprosthetics—devices that can replace sensory systems—are becoming ever more sophisticated. One paraplegic had a plate with electrodes implanted into his cerebral cortex that allowed him to control a computer mouse and a prosthetic arm with his mind. Visual prostheses are being developed for the blind. Attempts are being made to carry out repairs in the brain and spinal cord by implanting fragments of fetal brain tissue or stem cells and by initiating gene therapy.

New discoveries are constantly being made, thanks to the huge growth in neuroscience and the technical advances made in the field. And they are vitally important, because 27 percent of Europeans suffer from one or more brain disorders. In the Netherlands, over 30 percent of the health care budget is spent on patients with brain diseases. You would expect that at least a proportionate amount of research funding would be earmarked for brain research, but in Europe only 8 percent of this budget is allocated to neuroscience. When will governments finally develop that much-needed long-term vision to ensure healthier brains for generations to come?

This book came about after the Dutch newspaper
NRC Handelsblad
asked me, in 2008, to write a column in which I answered readers' questions. I'm grateful for the help I received from Jannetje and Rinskje Koelewijn during this process. Portions of these chapters appeared in the
NRC.
I could never have written this book without being immersed in the international network of brain researchers and benefiting, in my own research group, from an amazing amount of new data and feedback supplied by a great many excellent, critical, and talented students, analysts, PhD students, postdocs, and staff members. Patty Swaab corrected all the chapters before I dared show them to anyone else and had her work cut out in doing so. I'm also indebted to the following people for suggestions and corrections: Bao Ai-Min, Els Boelens, Martijn Boelens, Kees Boer, Ruud Buijs, Wouter Buikhuisen, Hans van Dam, Marcel van Dam, Gert van Dijk, Cisca Dresselhuys, Frank van Eerdenburg, Tini Eikelboom, Michel Ferrari, Eric Fliers, Rolf Fronczek, Anton Grootegoed, Michel Hofman, Jan van Hooff, Witte Hoogendijk, Inge Huitinga, René Kahn, Bert Keizer, Felix Kreier, Jenneke Kruisbrink, Paul Lucassen, Martijn Meeter, Joris van der Post, Liesbeth Reneman, Carla Rus, Erik Scherder, Reinier Schlingemann, Eus van Someren, Roderick Swaab, Martijn Tannemaat, Unga Unmehopa, Joost Verhaagen, Wilma Verweij, Ronald Verwer, Geert de Vries, Linda de Vries, Frans de Waal, Katja Wolffenbuttel, Zhou Jiang-Ning, and many others. I
enjoyed working with the staff of Uitgeverij Contact on this book, particularly Mizzi van der Pluijm, Bertram Mourits, Cindy Eijspaart, Kirsten van Ierland, Bieke van Aggelen, and Jennifer Boomkamp. I would moreover like to thank Maartje Kunen for her excellent drawings. Finally, I am extremely grateful to Jane Hedley-Prôle for her excellent English translation, the improvements to the text, and the most pleasant collaboration.