BOOK REVIEW

Book Review: Robert H. Blank. 2013. Interventionin the Brain: Politics, Policy, and Ethics. Cambridge,Massachusetts: MIT Press.

Kristi Giselsson

Received: 7 September 2013 /Accepted: 10 September 2013# Springer Science+Business Media Dordrecht 2013

This book begins well. Blank first gives, for the benefitof lay readers and those unfamiliar with the area ofneuroscience, a brief but informative description of thestructure and workings of the brain itself. He then goeson to offer an overview of the current state of brainintervention ranging from direct brain intervention(electroconvulsive therapy, electronic and magneticstimulation, psychosurgery and neural implants), psy-chotropic drugs, the use of virtual reality, nootropicsand neurogenetics. Blank offers a concise summaryand evaluation of each of these methods, outlining bothpotential benefits and risks. He makes the importantpoint that most of these methods, however, do notpresent a cure, but rather are aimed at altering behav-iour, raising the important question as the ethics ofbehavioural control for social convenience – particu-larly in relation to the vulnerable, such as the manage-ment of children with ADHD.

Blank then offers a well-researched and balancedoverview of the advantages and disadvantages of brainimaging techniques, and while he optimistically sug-gests that the accuracy and range of such technologiesare rapidly improving, he does, at this point at least,concede that “science has not yet been able to producean imaging technology that can be used to image moti-vation, responsibility, or propensity for behaviour” (54).

Even his following discussion in Chapter Three stilloffers a similarly balanced discussed on some of theethical and policy implications of such interventions,covering such areas as informed consent, whether inter-ventions can be viewed as experimentation or therapy,issues of autonomy, authenticity, mind control, stigma-tization, distributive justice and the issue of whether toact on incidental findings through brain imaging tech-niques. His focus is on policy within the United States,which means that not all of the issues he raises might beapplicable to other medical systems, however, for themost part they can be seen as having relevancy for othernations. There is, nonetheless, an important exception tothis, which I will address later.

However, it is in Chapter Four where Blank’s hithertocarefully modulated discussion begins to unravel, in hisalarming discussion on sex differences within the brain.After beginning somewhat modestly by stating thatdespite differences “there remains substantial overlapbetween the sexes” (106) and noting that “the questionof why male and female brains vary continues to bespeculative” (107) – he then attempts to offer a highlycontentious theory as to the origins of such differenceswith recourse to evolutionary psychology. He suggeststhat “our brains have remained essentially unchangedfor the last 100,000 years or so and reflect a division inlabour” in which “[m]ales were responsible for hunting”and “[w]omen had responsibility for raising children”(108). He then lists a whole range of apparent behav-ioural differences between men and women, endingwith studies that suggest differences in toy choices –with girls choosing dolls and boys choosing cars and

NeuroethicsDOI 10.1007/s12152-013-9194-8

K. Giselsson (*)Program of Philosophy and Gender Studies,University of Tasmania, Hobart, Tasmania, Australiae-mail: Kristi.Giselsson@utas.edu.au

objects “that can be propelled through space” (108). Heconcludes that these “qualities, it seems reasonable tospeculate, might relate to the behaviours useful forhunting and for securing a mate. Similarly, one mightalso hypothesize that females select toys that allow themto hone the skills they will one day need to nurture theiryoung” (109).

One might wonder why boys need hunting skills(worryingly) in order to “secure a mate,” but thestereotyping of sex roles here is clear; women are ge-netically determined by evolutionary processes to lookafter children and men to “hunt” and “secure mates.”Blank seems genuinely puzzled as to “why’ such find-ings might be seen as “explosive” (113), but it is pre-cisely such unfounded speculation that has made thestudy of sex differences so controversial. As CatherineVidal and scholars within gender studies have affirmed,it is not the fact that there are biological differencesbetween men and women that is controversial, rather,it is the significance that is attributed to these differ-ences; that is, whether or not they are used to affirmnegative gender stereotypes [1–3]. Indeed, as CordeliaFine persuasively argues, many apparent sex differencescan actually be dismissed as cases of sheer neurosexism[4]. Vidal further suggests that the “ideology of biolog-ical determinism typified by the extrapolations of evo-lutionary theory, currently designated as sociobiologyand evolutionary psychology” are used to account for“social inequalities of race, gender and class”[1], withShira Tarrant pointing out that such highly speculativetheories of evolutionary psychology have been used tojustify everything from male promiscuity to rape[3] (forother excellent critiques of the misuses of evolutionarypsychology see Neil Levy and David Buller [5, 6]).

As these and other scholars suggest, it is extremelydifficult to untangle just what is biological and what issocial. Blank goes so far, however, as to entirely dis-miss any social influences on gender at all (107).Moreover, his claims as to the differences in the brainsof homosexuals is similarly controversial and similarlyflawed; Blank argues that genetically determined dif-ferences can be found in both brain structure andneuronal mechanisms, however, whether any such ap-parent differences are a result of or the cause of homo-sexuality simply cannot substantiated.

Also highly disturbing are Blank’s further sugges-tions of genetic determination shaped by evolutionaryprocesses – including his views on pyschopathy, racismand amazingly, voter preferences. For example; “from

an evolutionary perspective, while it might be a disorder,psychopathy could also be seen as an adaptive strate-gy…. Certain psychopathic features, then, might notnecessarily be a bad thing for society, and in someprofessions, such as police officers or politicians, theymight even be beneficial” (140). Personally I think that itis in precisely such public offices of trust that psycho-pathological features might least be desired, but thatmay just be due to my genetic predisposition as a wom-an to prioritise “cooperation” and display “empathy”(110). It is in this section that Blank also raises thedisturbing suggestion that perpetrators of hate crimesagainst particular groups are not responsible for theircrimes – given that the “fear” located in their amygdalais at levels “inaccessible to consciousness or willeddeliberation” (142). Blank further elaborates on thistheory in Chapter Six by suggesting that socialcategorisation of other groups (‘out-groups’) springsfrom our supposed evolutionary adaptive strategy ofpreferring people of our own groups (‘in-groups’)(191).While Blank admits that at “their worst, however, thesereflex actions can result in racism and produce conflictbetween in- and out-groups, leading to social discontentand possibly physical confrontation” (186), he ultimate-ly affirms that such processes are based on “neuronaland evolutionary reasons for prejudices and stereotypesin intergroup relations” (190). Although he does alsoconcede that a “politically hostile context” (such as thatexisting between Arabs and Israelis) can acerbate suchhostility (190), he still suggests that “[b]ias in intergrouprelations is an automatic response across populationsbecause group conflict and prejudice are evolutionarytraits that improved overall fitness by enabling membersof a group to gain access to competitive reproductiveenhancing resources and detect coalitions and alliances”(190–191). To his credit, he does cite other research thatargues that “categorizing by race is not inevitable,” butthen concludes that such studies “fail to explain why,despite all the social programming and legislation toreduce racism in recent debates, a strong residue ofautomatic racial bias is found even in people who con-sider themselves unbiased” (191). Evidence for this issupposedly based on brain imaging studies (which ear-lier in the book were subject to question) which appar-ently reveal that people are essentially pre-programmedto experience ‘fear’, ‘hate’ and ‘disgust’ towards thosewho are different. However a recent study on the seem-ing discrepancy between implicit and explicit attitudeseffectively undermines such claims [7].

K. Giselsson

Such an emphasis on genetic determinism of courseleaves no room for the acknowledgement that racialdifference has been used as an abominable excuse tojustify the systematic and institutionalised exploitationof other groups and the theft of their land in colonial andimperial expansion. Charitably, I am hoping that Blank’scomment about prejudice enabling group members togain “access to competitive reproductive enhancing re-sources” is not a veiled justification for just such racistideologies. That such a long history of systematic racismmight possibly still be manifesting itself in contempo-rary American society (socially, rather than genetically,that is) seems, remarkably, not to occur to Blank. Need-less to say, his theory rests not only on the entirelyspeculative ground of evolutionary psychology but alsoon the unsubstantiated claim that such prejudice is ge-netic. While he may not intend to justify prejudice – heinsists that developments in neuroscience “can providethe basis for better understanding of human variationand acceptance of difference” (275) – he does acknowl-edge that they also “can work to exaggerate inequalitiesand lead to repression of the most vulnerable membersof society” (275). He might insist that it is “ultimatelythe political climate that will determine to what endsthey will be put”, but as Vidal suggests above, it is justsuch theories of biological determinism that themselvescontribute to the justification of racism.

Blank’s argument in Chapter Nine that even politi-cal preferences are genetically determined actuallycomes as something of a bit of light relief. Althoughhe admits that “[a]cceptance that there are biologicaland even genetic precursors to political attitudes andbehaviour is a tough sell,” he still insists that the “past”view taken by political scientists – that ideology can beseen to be “emanating from particular cultures” – ismisguided; merely an “unfortunate vision of ideologythat must end” (264). Blank doesn’t seem to realise thathis own view – argued with references to brain imagingsurveys that apparently prove that voter choice andparticipation are “heritable” (265) – is committinghim to the implication that all of humanity has beengenetically programmed to vote either Republican orDemocrat. That is, that we are predetermined to actu-ally manifest American political ideologies – which iswhere his book’s orientation towards American policybecomes somewhat ridiculous.

Chilling, however, are the implications of Blank’sdiscussion on the definition of brain death inChapter Eight. Again, there is little attempt at presenting

a balanced discussion; his repeated references to thearguments of Jeff McMahan, Peter Singer and JulianSavulescu make clear his commitment to the utilitarianstance of equating personhood with the possession ofhigher-brain functions. This results in his promotion ofviewing patients with end-stageAlzheimer’s and demen-tia as essentially brain dead and candidates for euthana-sia, however he also brings up the issue of not just “theuse of organs from anencephalic infants” but, ominously,the “treatment of severely ill newborns with Down syn-drome or other brain-centered problems” (277). For me,this clearly raises the spectre of eugenics. Blank himselfposes the question at the end of Chapter One; “[w]hatcan be done to ensure that these technological advancesare applied within a social environment that is not con-ducive to eugenic motivations?” (24), however his over-all emphasis on genetic determinism leaves such a ques-tion rhetorically hollow. Clearly, in the light of seeming-ly intractable predetermined prejudices towards others in“out-groups”, along with the knowledge of “the geneticbases of mental disorders” (275) and a view of person-hood that actually excludes the most vulnerable in oursociety, there would appear little we can do with respectto creating ethical public policy. In such a world therewould appear to be little hope for the possibility thatgenetic determinationmight lead to “increased sympathyfor those dealt a poor genetic hand”, but rather wouldmost likely lead to “rigid screening programs designed toreduce the number of individuals with those traits in thepopulation” (275).What is perhaps most worrying is thatBlank does not seem to realise his own contribution tocreating just such a world.

References

1. Vidal, Catherine. 2012. The sexed brain; between science andideology. Neuroethics 5: 295–303.

2. Connell, R.W. 2002. Gender. Cambridge: Polity.3. Tarrant, Shira. 2009. Men and feminism. Berkely: Seal Press.4. Fine, Cordelia. 2013. Is there neurosexism in functional neu-

roimaging investigations of sex differences? Neuroethics 6:369–409.

5. Levy, Neil. 2004.What makes us moral? Crossing the bound-aries of biology. Oxford: Oneworld Publications.

6. Buller, David. 2006. Adapting minds: Evolutionary psychol-ogy and the persistent quest for human nature. Cambridge:MIT Press.

7. Payne, B.K., M.A. Burkley, and M.B. Stokes. 2008. Why doimplicit and explicit attitude tests diverge? The role of structuralfit. Journal of Personality and Social Psychology 94: 16–31.

Book Review: Robert H. Blank. 2013. Intervention in the Brain