Governing drug use through neurobiological subject construction: The sad loss of the sociocultural

With the development of neuroscientific molecular technologies, ''neuromolecular gaze'' emerged as a way to construct identities by the language of molecular neurobiology. As the notion of 'harm reduction' emerged, drug users were construed as people who make choices based on drug use risk information. 

  Muller & Schumann argue in their paper, that psychoactive drugs are used to adapt to the modern environment. They emphasize controlling drug use through education, screening and biographing.

  According to cultural neuroscience, brains interact with socioculture and can change through sociocultural experience. The neuroscientific description of brain reflects neoliberal thought paradigm. 

  Muller & Schumann's model lacks the sociocultural context that impact excessive psychoactive substances consumption. Adverse effects do not influence every group equally. The poor is the most risky group.

  Muller & Schumann should additionally examine what kind of sociocultural structures can stand the adverse impact of drugs before implementing their drug policy.

Optimal drug use and rational drug policy

Muller & Schumann suggested a different perspective on the use of drugs - they are normal part of human behavior. The reason for that is the big discrepancy between the evolved human nature and demands of the modern society. 

  The main approaches regarding drug policies debates are Criminal justice model, Public health model and Libertarian model. The first one is about prohibition of drugs' use. The goal of the Public health model is moderate use of drugs whereas the last model encourages usage of drugs for happiness purposes.

   Muller & Schumann support both the Publich health and Libertarian models. The benefit-maximization train of thought suggests that we are misdrugged and underdrugged, not overdrugged.  Muller & Schumann think that making legal more diverse options of drugs will lead to both greater individual happiness and educational/economic achievement. Leary suggests that psychologists could learn better the nature of perception if they tried hallucinogens themselves. For instance, LSD trips might lead to useful insights and clinical empathy in behavioral scientists. 

  Rational drug policy would allow every person to use psychoactive drugs as long as he does not harm other people. In other words, all drugs should be legal unless their benefit/cost ratio is zero. Furthermore, learning how to use drugs effectively should be taught from adolescence years onward. That education would include opportunities for exploring effects of different drugs - benefits and risks. Besides, research should make it a priority to discover beneficial drugs for dealing with the daily life hassles.

The Dangerous Professor

The neuropsychopharmacologist David Nutt is devoted on developing a new recreational drug that will act as a replacement of alcohol - it will provide the same benefits but will not have such harmful effects on health. According to Nutt, drug policy is based on the moral notion that people should not use drugs at all. The truth is that science has discovered a lot about the harms of different drugs— many are actually far less harmful than alcohol. Nutt found the Independent Scientific Committee on Drugs, in order to provide real and credible information on drugs. Caulkins argues that Nutt’s ranking of drugs is not valid or reliable. Nutt supports an evidence-based drug policy - a ''regulated'' market for alcohol and all substances less harmful than it. Dissimilar to other drugs, alcohol acts on receptors for GABA, NMDA, serotonin, and acetylcholine all simultaneously. Nutt identified several compounds that target subtypes of the GABAA receptor which might shed a light on creating a new better drug that mimicks alcohol. 

From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the “emperor’s new treatments” for mental illnesses?

In regard to short‐term outcomes, pharmacotherapy is clearly inferior to cognitive behavior therapy in treating anxiety disorders; for depression, the two methods are equivalent, drug treatments are superior to psychotherapy for treating psychotic disorders. Neither drugs nor CBT show convincing efficacy against ADHD. Lasting success after the end of treatment is shown for psychotherapy (CBT), whereas the effects of drug treatments vanish rapidly once the drugs are withdrawn. In fact, most selective serotonin reuptake inhibitors (SSRIs) to treat depression are both ineffective and harmful. Adding drugs to psychotherapy works less well than therapy alone. For instance, using neuroleptics, atypical antipsychotics, and clozapine for treating schizophrenia is associated with smaller brain tissue volumes that cannot be attributed to severity of illness or substance abuse. Most mental disorders begin before the age of 14 and continue to evolve over the whole life span. Brain development persists into the early 20s and coincides with a main risk period for negative effects of interfering with neurobiology. 

  It was assumed that mental disorders result from chemical imbalance. However, in order to qualify as a causal factor, the pathophysiology have to exist before the onset of the mental disorder. In contrast to various psychosocial risk factors, there is not enough evidence for this. Besides, categories with dubious validity miss the relevant dimensions of human behavior. One prominent classification is based on behavioral dimensions and neurobiological measures, omitting the social level. Recent findings show that the effect of social factors depends on psychological mechanisms—sense of control, mental activity, delay of gratification. Also, improving social factors also improves mental health in a lasting way.

 We need to tighten the interlocking of etiological and therapeutic research strategies and of the bio‐, psycho‐, and social levels of analysis of mental disorders. Second, we need a broad and a narrow focus. the UK′s IAPT (Improving Access to Psychological Therapies) program provides evidence‐based short‐term psychotherapy for anxiety and depression. The problem in psychotherapy, in contrast to drug treatment, is not efficiency but availability for those in need and the quality of treatment. 

How should we define health? Letters

Huber and colleagues question the validity of the World Health Organization's definition of health. Health is affected by social, political, economic, and environmental factors. Individual actions like adaptation and self-management are insufficient in the poor countries to bring health. A new definition of health should emphasize change to policies and environment.

  On the other hand, there are people who have chronic conditions but on the surface they might be functioning well. Huber and colleagues define survival, not health. They apply the reductionist approach. In order to create a complete definition of health, areas other than healthcare need to help cultivate this definition of health. It calls on political and economic domains to contribute. The meaning of "wellbeing" vary between people, societies, cultures, and eras. However, the common thing is that health is the state of physical, mental, and social wellbeing, which gives a sense of completeness.

Subjective experience, heterophenomenology, or neuroimaging? A perspective on the meaning and application of mental disorder terms, in particular Major Depressive Disorder

Zeki claims that he and his collaborators managed to localize and quantify subjective mental states for the first time in human history. That means, to operationalize perceptions, thoughts, prejudices, biases, beliefs, desires, or emotions. When Semir Zeki refers to the localization of a subjective mental state, he means that methods such as fMRI identify statistically significant changes of brain activation. For example, ''neuro-realism'' implies that if a psychological construct cannot be associated with an identifiable brain response, then it cannot really exist. 

  Given the normative and institutional interests involved, it is understandable that many psychiatrists hope that genetic and neuroimaging research might yield biomarkers. However, out of the 150–600 disorders of the DSM-5, not a single one can be diagnosed reliably with a biomarker. It is difficult to objectify and validate the construct of Major Depressive Disorder since psychologists noticed a lack of specificity - a certain physiological signal or process can be associated with numerous psychological states or processes (reverse inference problem). When talking about Major Depressive Disorder, it is not clear how to be sure whether a person is diagnosed properly or not. Neuroimaging cannot replace the clinical expert’s diagnosis, as there are no reliable biomarkers. Dennett proposed the method of heterophenomenology to resolve this challenge - to scientifically test people’s accounts of their subjective experience. What could this process look like for MDD?

  Depressive mood, diminished interest in activities and loss of energy do have a subjective component. However, these symptoms also have an observable side - we would not expect somebody with them to cheerfully engage in many social activities or to make plans for the future. Also, a depressed person would not be able to complete cognitively demanding tasks. While the construct of MDD is not completely objectifiable, it is also not absolutely subjective either. 

How Realistic Are the Scientific Assumptions of the Neuroenhancement Debate? Assessing the Pharmacological Optimism and Neuroenhancement Prevalence Hypotheses

This article focuses on the issue of neuroenhancement – the improvement of healthy people’s cognitive functioning on the neural level, by stimulant drugs. That intellectual performance can be improved by drugs is called the “pharmacological optimism hypothesis” whereas the fact that pharmacological neuroenhancement is used commonly is called the “neuroenhancement prevalence hypothesis''. 

  Firstly, the paper discusses the pharmacological hypothesis. The failure to discover a reliable biomarker for any of the hundreds of DSM-5 classifications lead to the introduction of a new research paradigm, the Research Domain Criteria (RDoC), whose scientific superiority remains unclear. The neuroenhancement literature was optimistic that new drugs for dementia or attention disorders could be used for improving cognitive functioning in healthy people. In contrast to these hopes, the funding crisis of psychopharmacology became evident. The neuroenhancement literature covers well-known stimulant drugs - amphetamine, methylphenidate and modafinil. These drugs are still prescribed for some psychiatric indications. However, that the molecules have been investigated for a long time does not mean that they do not pose scientific challenges. The ethical issue of intervening in the brain chemistry is disputable in healthy people. Most of the so far tested substances have very limited effects on disturbed cognitive functions in psychiatric patient populations. The evidence is still low that so far discussed drugs broadly enhance cognitive performance in healthy people - we have to reject the pharmacological optimism hypothesis for now. 

  Secondly, the neuroenhancement prevalence hypothesis is discussed. It is debatable how high the percentage of consumers needs to be to speak of a “common” or “epidemic” use. However, there is currently no evidence that the numbers have really been increasing in the past 20 years. Many of the consumers responding positively in the surveys are young people trying out prescription stimulants for neuroenhancement or recreational use just a few times. Due to those reasons, the authors reject the neuroenhancement prevalence hypothesis for now. 

Masculinities and suicide

Most psychological explanations for men's higher suicidal mortality are unsatisfactory. The construction of 'masculinity' is one of the most important factors influencing the way in which suicide is discussed and contemplated by men. 'Role containers' means the notion of gender as singular female or male "personalities' or 'schémas'. On the other hand, social constructionist and post-structuralist theorists propose that gender is something that is repeatedly and constantly 'done'. If all behaviours are an expression of gender, doing 'masculinity' puts men at higher risk for suicidal bebaviours compared with women doing 'femininity'. An important difference in contempleted suicide between women and men relates to their method of choice. Because the society stigmatize suicidal behaviours, surviving a suicidal act is more likely to be perceived as something inappropriate for men. Besides, men are less likely to search for help for mental health conditions and emotional problems. For example, the association between depression and femininity may provide men with the motivation to hide their depression from others. Men are less likely to search to create a large, supportive social networks. For these men, marriage acts as an important protective factor. Any personal setback or traumatic event is likely to have a more damaging effect on the psychological well-being of men. Moreover, men are more sensitive to negative changes in their socio-economic and employment status. Contradictory evidence suggests that higher masculinity scores are related to lower suicidal ideation. The reason is because higher scores are associated with self-mastery. The psychologists need to focus on thorough investigations of gender differences in health-related behaviours and thoughts. This will help healthcare practitioners in tailoring suicide prevention strategies specifically for men and women. 

The Drug as an Instrument, Altered States

Psychoactive substances are with a known chemical structure that can significantly alter subjective feeling or behavior. The majority of habitual consumers of psychoactive substances are not dependent on them. How is it possible that people consume psychoactive substances on a regular basis with control during their lifespan? One answer to this question is that users consume drugs like an instrument. Mental states determine how we respond to stimuli and how effective our behavior is. The drugs act as an instrument by transforming our current mental state to a desired one within a predictable timeframe. We are not usually in the optimal mental state for a planned behavior, so we use drugs to perform the particular action more efficiently than in a drug­free state. Using drugs have an evolutionary origin - we use non­nutritional properties of the food. Knowledge about the pharmacological effects of plant substances and the ability to acquire them is called “zoopharmacognosy.” 

  Can we improve all desired behaviors through psychoactive drugs? No—they work for only specific behaviors. The first behavior is improvement of social interactions. Consumption of alcohol makes it easier to switch between professional sphere (where social interaction is suppressed) and our personal life. Alcohol causes an increase in dopaminergic activity, which leads to increase in the reward effect of social stimuli. Cocaine leads to increased arousal and longerlasting attention.You can be active at a party for a long time without feeling fatigue. Cocaine also leads to loosening of learned fears. However, alcohol and cocaine are not the only drugs used for social skills. Other drugs known in this context are marijuana, amphetamine, methylphenidate and caffeine. The second goal for which drugs are used is to facilitate sexual behavior. Another goal is to improve our cognitive performance through caffeine/nicotine and amphetamines. Still there is not any drug that can  enhance the cognitive abilities of a healthy person with normal intelligence. For relaxation purposes, the best drugs are alcohol, anxiolytics and cannabis. Cannabis helps to temporarily erase from memory an unpleasant experience. Drugs can also aid people in artificially experiencing the feeling of novelty. The drawback is that you cannot act within this imagined 'new world' and cannot establish purposeful and rewarded behavior. Substances used for this purpose include hallucinogens and ecstasy. Surveys have found that young women consume nicotine out of a desire to control their body weight. On the other hand, men are more likely to consume androgenic anabolic steroids to build muscles. Other goal is spiritual activity - improving communication with the deity one believes in. 

  Drug addiction begins when someone had established consumption and instrumentalization, often for many years. Drug instrumentalization only works in a relatively small dosage and range of frequency. If one constantly exceeds it, toxic effect gains the upper hand - neuroplastic processes disrupt established behavior and only promote the behavior of consumption. 

Medicine and the Mind — The Consequences of Psychiatry’s Identity Crisis

The prevailing message remains that the solution to psychological problems involves matching the “right” diagnosis with the “right” medication - like a trial-and-error process. However, there is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders. Over the past century,  the brain-mind link has been accepted as plastic, in which cognition closely connects to emotion and the social world strongly impacts well-being. The field of psychiatry seems to have abandoned its social, interpersonal, and psychodynamic foundations. Harrington claims that psychiatry concentrates only on severe, psychotic disorders. Moreover, biologic research is more dominant than other forms of psychiatric research — like psychosocial, cultural. Psychiatric knowledge creation and training changes are necessary. Biologic psychiatry has failed to produce a theoretical model of any major psychiatric disorder or any tests that can be used to diagnose disorders. Psychiatric trainings need to promote social science, cultural expertise, prevention and psychotherapy. 

How common is intersex? A response to Anne Fausto-Sterling

When a child is born with both female and male genitalia, that is called intersex. Fausto-Sterling suggests that human sexuality is best understood as a continuum. "Deviation from the Platonic ideal" is a criterion for defining intersex created by Fausto-Sterling. However, some people are mosaics - some cells in their bodies have both the male and female chromosomal complements. According to Wiener, a more useful definition of intersex is: (a) the phenotype is not classifiable as either male or female, or (b) chromosomal sex is inconsistent with phenotypic sex. The main intersex conditions are congenital adrenal hyperplasia and complete androgen insensitivity syndrome. In the first condition, a defect in an enzyme involved in the synthesis of adrenal hormones gives rise to excessive production of androgenic hormones. These androgens will masculinize a female (XX) fetus in utero. In the second case, the individuals are genetically male, but owing to a defect in the androgen receptor, their cells do not respond to testosterone - they do not form male genitalia. Later on in the paper, the non-conditions for ''intersex'' are discussed. In late-onset congenital adrenal hyperplasia, the defect in the enzymatic pathway does not manifest until late adolescence or even later. From a clinician's perspective, LOCAH is not an intersex condition. The most salient features of Turner syndrome are infertility and short stature. Girls with Turner syndrome can achieve normal adult heights if daily doses of growth hormone are administered. Babies born with Klinefelter syndrome have normal male genitalia. Most men with Klinefelter syndrome are infertile, but an unknown proportion are fertile. Fertile men with Klinefelter syndrome are likely to go completely undetected. The procent of intersex cases is 0.018% - approximately 100 times lower than the number provided by Fausto-Sterling. Szasz suggested that mental disorder is not a natural phenomenon but created concept by society. However, this type of thinking is not useful in clinical practice.