Nearly four years ago, we ran a news story that asked, “Is the neuroscientific study of pain lagging?” From the 2011 story, by Kayt Sukel:
Earlier this year, scientists, politicians and other healthcare advocates came together to share their hopes for the next decade of neuroscience research at the One Mind for Research (OMR) Summit in Boston. At a session highlighting the neurobiological consequences of war, Clifford J. Woolf, a pain researcher at Harvard Medical School and Children’s Hospital Boston, stated, “We have made enormous progress in promoting survival…but, in fact, an area that has really lagged behind relates to the pain associated with combat injury.”
The word that many locked on to in that statement was lagged. In a variety of publications and meetings in the past few years, the idea that the study and treatment of pain, particularly chronic or neuropathic pain, is somehow behind where it should be keeps coming to the surface—and that is whether it’s pain associated with combat, cancer, or some other disease state. But with more than a dozen research journals dedicated solely to the topic of pain and thousands of new pain-related papers being published each year, does a word like lagged accurately reflect the state of its study?
When researchers Arvid Carlsson, Paul Greengard, and Eric Kandel shared the Nobel Prize in Physiology or Medicine in 2000, we commissioned memory researcher John H. Byrne to write an essay on what their achievements meant to the field. In his 2001 essay, “How Neuroscience Captured the Twenty-First Century’s First Nobel Prize,” Byrne starts with a good chunk of Kandel’s acceptance speech; gives a cogent review of each scientist’s separate path and how their discoveries eventually entwined; describes how this changed the field; and considers what it might mean for the future. As you might suspect, it’s a long essay, but full of gems.
Whether overdue or just in the nick of time (as the Decade of the Brain closes), this Nobel Prize celebrates an achievement different in kind from previous observation, speculation, and investigation of the brain. For the ﬁrst time, an unambiguously mental phenomenon—memory—has been explained in wholly material, mechanical terms. The hypothesis of a separate, nonmaterial, otherworldly realm has become superﬂuous. A banquet is not the place to spin out these disturbing implications, but Kandel does acknowledge them, for those who will hear, by returning to where his story began—“Know thyself.”
At the end of her recent essay in the New York Times, “To Know Suicide: Depression can be treated, but it takes competence,” Dana Alliance member Kay Redfield Jamison mentions, almost in passing, her own suicide attempt. She wrote vividly about her experiences and those of others in her book, Night Falls Fast. Ellen Frank and David Kupfer reviewed the book for us in 2000; the review includes part of the book’s epilogue:
I was naive to underestimate how disturbing it would be to write this book. I knew, of course, that it would mean interviewing people about the most painful and private moments of their lives, and I also knew that I would inevitably be drawn into my own private dealings with suicide over the years. Neither prospect was an attractive one, but I wanted to do something about the untolled epidemic of suicide and the only thing I knew to do was to write a book about it. I am by temperament an optimist, and I thought from the beginning that there was much to be written about suicide that was strangely heartening.
As a clinician, I believed there were treatments that could save lives; as one surrounded by scientists whose explorations of the brain are elegant and profound, I believed our basic understanding of its biology was radically changing how we think about both mental illness and suicide; and as a teacher of young doctors and graduate students, I felt the future held out great promise for the intelligent and compassionate care of the suicidal mentally ill.
All of these things I still believe. Indeed, I believe them more strongly than I did when I first began doing the background research for this book two years ago. The science is of the first water; it is fast-paced, and it is laying down, pixel by pixel, gene by gene, the dendritic mosaic of the brain. Psychologists are deciphering the motivations for suicide and piecing together the final straws—the circumstances of life—that so dangerously ignite the brain’s vulnerabilities. And throughout the world, from Scandinavia to Australia, public health officials are mapping a clearly reasoned strategy to cut the death rate of suicide.
Still, the effort seems unhurried. Every seventeen minutes in America, someone commits suicide: Where is the public concern and outrage? I have become more impatient as a result of writing this book and am more acutely aware of the problems that stand in the way of denting the death count. I cannot rid my mind of the desolation, confusion, and guilt I have seen in the parents, children, friends, and colleagues of those who kill themselves. Nor can I shut out the images of the autopsy photographs of twelve-year-old children or the prom photographs of adolescents who within a year’s time will put a pistol in their mouths or jump from the top floor of a university dormitory. Looking at suicide—the sheer numbers, the pain leading up to it, and the suffering left behind—is harrowing. For every moment of exuberance in the science, or in the success of governments, there is a matching and terrible reality of the deaths themselves: the young deaths, the violent deaths, the unnecessary deaths.
The field of neuroethics has come a long way fast. This month, as part of the 2013 federal BRAIN Initiative, the Presidential Commission for the Study of Bioethical Issues released its first report, Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society. Only a dozen years ago, more than 150 scientists, philosophers, lawyers, and other policy experts were meeting in San Francisco at the first formal conference to “project the boundaries, define the issues, and raise the initial questions appropriate to a field that probes the ethical implications of advances in brain science.”