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Depression is the great illness of our time. Those who suffer its debilitating consequences generally feel that they can choose one of three routes: to ignore it and hope that eventually they will "snap out of it"; to take drugs, such as Prozac; or to enter therapy, in an attempt to address and overcome its psychological cause.
But imagine there was a fourth option. Imagine that not just depression but any other state of mind we feel to be complex and beyond manipulation - love, despair, joy, belief - could be flipped on and off in the brain like a light.
Unlikely? Consider this incident. A few months ago surgeons at the Pitie-Salpetrière Hospital in Paris were probing the brain of a patient with Parkinson's disease, trying to find the tiny clump of neurons that control tremor. The plan - which is known to work - was to "turn on" these neurons with a live electrode so the tremor would stop. Instead, the doctors touched by mistake on some neighbouring cells and the patient, who was conscious, began crying and moaning. For the next few minutes the woman exhibited all the symptoms of severe depression: "I don't want to live any more," she said at one point. "I am disgusted with life".
The doctors removed the electrode, and within 90 seconds the patient - who had no history of depression - was back to normal. Next day the surgeons stimulated the area a second time and again she responded with cries of despair. When the doctors touched the area with the current turned off there was no such reaction, even though the woman thought the current was on.
The stray electrode created the experience of depression by switching on a circuit in the woman's brain. There was no "reason" for her feelings - just a flurry of electricity in a neural pathway. Everything we see, think, feel and remember is generated by the activation and interaction of dedicated modules, circuits and systems. One brain area, for example, creates a feeling of disgust; another circuit makes everything seem funny. There is even a system which, when stimulated, produces a state of quasi-religious transcendence.
Most of the time these pathways are turned on by "appropriate" things - sensory experiences, memories or thought. But once we have a detailed map of the brain's components - something that is being built up fast - we will be able to bypass normal causation and manipulate our consciousness directly with targeted drugs, or even by implanted electrodes and magnets. If we choose to use these techniques, we will no longer have to strive to change our environment in order to be happy; or struggle to overcome mental frailty. We could select our moods, and even our personalities, in much the same way as we might choose to wear a certain outfit or get a new nose.
Talk like this inevitably arouses mutterings about Brave New World - it is always assumed that any movement towards mind control must be sinister. I believe, however, that it could ameliorate suffering and enhance our lives hugely, provided we can overcome our fears.
Again there are parallels with genetics: the panic we are in now about "tinkering with nature" will do little to stop commercial exploitation of genetics, but it may well slow down the development of genetic therapies and prevent many people from taking advantage of a wonderful chance to free themselves from a frail genetic heritage.
Similarly, brain manipulation could give us a breathtaking capacity for selfdetermination, but only if we embrace and steer the technology rather than allow it to be annexed by medicine and the (mainly drug) companies that supply their tools. Sadly, there is little sign of this: we are hurtling backwards into the neuroscientific revolution, swallowing psychotropic pills by the billion yet frightened, ignorant and mindlessly rejecting what it has to offer.
The potential for altering our lives is probably greater for neuroscience than for genetics, because genetic engineering in humans has proved very difficult in practice, while brain manipulation is turning out to be surprisingly easy. The very ease of it, though, is one of the things that makes people suspicious. We want cures for people who are locked into awful states of mind - depression, say, or obsessive-compulsive disorder, - but somehow we feel that the cures should not be too easy. This is not surprising. Our mental life does not feel as though it is underpinned by physical processes - it seems mysterious. And when our thoughts and feelings are disturbed, we assume there must be complex psychological reasons for it and that any remedy must unravel those reasons. But neither of these assumptions is correct. Mental states with complex causation do not necessarily require long-winded "cures".
This is not to say the human brain is simple. All psychological conditions, healthy or not, arise out of a complex interplay of genetics, environment and personal history; a train of events that could be traced back into genetic antiquity or extended to the breadth of human culture. But the final link in the chain is inside the skull: a spark passes from neuron A to neuron B and - multiplied a billion times - what emerges is a perception, a thought or a feeling. If you want to manipulate a person's state of mind and, ultimately, his or her behaviour, this is the best place to intervene. Why should we want to intervene? Because mental suffering is increasing at an alarming rate and social and psychological approaches to relieving it have failed.
The World Health Organisation claims that 500 million people are mentally ill and between one in four and one in seven of us - depending on the survey - will be treated for mental disorder at some time. In the grey area between mental illness and social disorder millions of lives are disrupted by their own and others' inability to control their rage, anxiety and addictions. Misery stalks the planet and no amount of getting richer, healthier or better educated seems to reduce it.
Millions of people already manipulate their brains by taking psychotropic drugs - prescription antidepressants, tranquillisers and stimulants. But even as we take the pills, we disapprove of them. We grudgingly admit that they work, but you hear far more talk of side-effects, risks and drawbacks than of these drugs' proven ability to alleviate mental suffering. It is true that the drugs are still crude, and have side-effects. But the real objections are intuitive. By contrast, therapies that claim to treat the "root cause" of mental distress - counselling, psychotherapy and social support schemes - are seen as good.
This has led to the growth of a huge, costly and mainly useless industry. A recent Department of Health report suggested that as many as two and half million people in Britain offer talking treatment to others, and psychotherapy is on offer for every twinge of mental angst. Yet there is practically no evidence that it works.
In 1996, however, three hospitals ran trials which showed that mentally traumatised people who were counselled ended up feeling worse than those who were not. Since then, further studies have cast doubt on the efficacy of all counselling, other than the rigorous cognitive and behaviour forms that avoid delving into the causes of a person's psychological problems.
Yet "talking things out" remains popular because it feels right. Even personal experience does not seem to dissuade people from the intuitive idea that it must work. In one study psychologists gave diaries to people who were receiving psychotherapy for a mental condition and asked them to keep a daily record of how things went. At the end of the therapy they took away the diaries, waited a year, then asked the same people to give a brief description of the course of their illness. In most cases the diaries written a year later had a neat narrative: the illness was brought on by some appropriate cause; it got worse until therapy was started, then got better until, by the end of the therapy, it was cured. When the original diaries were compared it was found that the patients' recollections were different from their contemporaneous reports - the reality was far messier. The diarists' memories seem to have been distorted by their need to make a narrative that fulfilled their prejudices.
Weaving events and experiences into meaningful, preordained patterns allows our brains to "make sense" of things, but it also makes it difficult for us to recognise that some things are not meaningful. It is practically impossible to feel an emotion without attaching a cause to it: worry is always about something; we get depressed because of something and become obsessed with something. But often these "causes" are just attendant facts - the brain casts around for reasons like some angry drunk looking for an innocent bystander to pick on. Another brain operation incident shows this. A couple of years ago Californian surgeons were probing the cortex of a girl with epilepsy, trying to find the focal point of her seizures, when she started, suddenly, to giggle. The surgeons asked her what was so funny. There was very little in the girl's situation to prompt laughter but her brain seemed forced to create a joke in order to explain itself.
"You guys," she said to the operating staff, "standing around . . . you're just so funny!" A little while later the surgeons touched the same spot and again the girl started to laugh. This time, when asked about the joke, she pointed to a dull drawing of a horse that happened to be in the theatre. "The horse," she said, almost falling off the bed with laughter, "it's so funny!"
In most cases, of course, the circuits that give rise to feelings are triggered not by electrodes but by things we perceive or that happen to us. A threat, for example, produces fear, an insult produces anger, and loss or overwhelming challenge sometimes triggers depression. These feelings evolved because they helped to direct our actions appropriately: fear is part of the physical process that gears us up for flight, and when the most likely threat was from a dangerous animal or a marauding tribe the reaction was useful. Anger, similarly, is associated with the urge to hit out.
Society, however, has changed far faster than our brains have evolved. Our anger, fear and depression circuits continue to be triggered by threats and challenges but the feelings and behaviour they induce are rarely useful. What is the advantage of fleeing from threat or hitting out at an insult if the cause is an overbearing boss or a rude neighbour? And what good does it do to be paralysed by depression if the loss that brought it on was the loss of your job? Detached from their evolutionary role as survival mechanisms, these feelings become pathological. This probably accounts for a lot of the unease we label mental illness.
Many people object to the "medicalising" of emotional responses and instinctive behaviours that are merely out of kilter with modern society. A focus of these objections is Attention Deficit Hyperactivity Disorder (ADHD) in children. Brain scans show that the behaviour that typifies this condition - constant flitting of attention; grabbing anything that comes into focus; continuous movement - is associated with relative inactivity in the frontal lobes, the part of the brain that gives us self-control and the ability to focus.
The frontal lobes are the last bit of the brain to mature and, left untreated, a large proportion of children with ADHD grow out of it. So it is reasonable to regard the condition as immaturity rather than an illness. In society, however, such immaturity is problematic.
There are two ways to stimulate a child's frontal lobes: either provide phenomenal amounts of environmental stimulation or give it an amphetamine-type drug that excites the cortical neurons. On the whole we have opted for drugs. British prescriptions for Ritalin and similar drugs have risen from 2,000 in 1992 to 92,000 in 1997, and today the figure is much higher. This has caused such concern that the International Drugs Control Board (a UN agency) has called for an investigation into possible excessive use of the drug by British doctors.
Concern at dosing children with amphetamines is natural, but consider the alternative. To focus a child with ADHD without using drugs you need to give it constant attention. At school it requires a one-to-one teacher-pupil ratio. It is not practical to provide this for all affected children. You could endure the child's behaviour and hope he or she will grow out of it - but although this might happen (especially for privileged children whose parents provide discipline and stimulation) many children won't mature spontaneously; they will go on to become drifters and criminals, unable to cope in the adult world any better than they did in the classroom. Is this better than giving them drugs?
From now on issues such as ADHD will proliferate. Cognitive enhancers - drugs that improve memory and speed of thought - are in the pipeline. There will soon be drugs to calm foul tempers, increase affection, amplify sexual response and heighten sensory perception. Should we use them? Later there may be drugs to enhance our appreciation of music, or give us a keener intellect or a sharper sense of humour. Who will decide if we may have them? We will find out how to turn off rage, reverse addictions, deter people from wanting to take silly risks or indulge in petty crime. Will we treat antisocial people with them - perhaps even without their consent?
Mind control is coming. If we turn away in distaste, it will be annexed by medicine and driven by the drug industry. Better by far to take the responsibility. We have only our minds to lose.