Bridging Ethics and Scientific Research

Aug 5, 2010 by Richard Insel

My first course at CalSouthern was Ethics in the Helping Profession (PsyD7504). As I progressed in my studies, it occurred to me that often, one tends to create a theoretical dichotomy of ethics vs. empirical-based practice. But over the course of the past couple of years wherein I synthesized my training in guidance counseling and psychology, I strongly espoused the view that yesterday’s "ethics" or "right thing to do" is today’s "evidenced-based best practice for attaining positive clinical outcomes."

Let me explain.

Our schools are filled with individual children that carry multi diagnoses, including ADHD, Impulse Control Disorder, Oppositional Defiant Disorder, and MMR. Interestingly, thanks to modern medical technology, it has been shown that children who have experienced childhood trauma (physical, sexual, or emotional abuse) share common neural developmental anomalies in addition to common brain regional asymmetries with adults diagnosed with schizophrenia. Specifically, the HPA Axis (hypothalamic-pituitary-adrenal) is the major "response to stress network," which includes adrenal secretion of glucocorticoids as stimulated by ACTH from the pituitary.

When the HPA Axis is exposed to chronic stress, this results in hyper-sensitization to stressors as opposed to habituation. In addition, the hippocampus, due to its high density of glucocorticoids receptors, is also negatively impacted by this neural anomaly. In this regard, Walker & DiForio (1997) report finding higher baseline levels of cortisol, "demonstrating a unique neural response to HPA in schizophrenics." As opposed to pre-existing diathesis models of schizophrenia, hypersensitivity to stress is not only a consequence of a prior genetic disposition, but also part of the etiology of the disease itself. Interestingly, Heim, Newport, Graham, Wilcox, Bonsall, Miller, and Nemieroff (2000) have discovered the same HPA axis hyperactivity as a consequence of childhood abuse.

Another deficit shared by these two distinct populations is damage to the left hemisphere’s brain regional functioning. These findings should result in reduced verbal learning and memory in both schizophrenics and children having suffered abuse. Indeed, these are the findings of Heinrich & Zakzanis (1998) who studied childhood trauma victims and schizophrenics where both scored significantly higher on measures of non-verbal versus verbal learning.

The aforementioned findings have reinforced the theoretical underpinnings of recent research, including "The Contribution of Early Traumatic Events to Schizophrenia in Some Patients: A Traumagenic Neurodevelopmental Model" (Read, Perry Moskowitz & Connoly, 2001).

Before I relate these findings to Ethics in the Helping Professions, let’s return to the child in school diagnosed with multi diagnoses. To put it as simply as possible, a child that is hyper-vigilant for external stressors (as indicated earlier due to HPA axis hyper sensitivity) utilizes lower regions of the brain (mid-brain) related to the "fight or flight" phenomenon, as opposed to frontal cortical brain regions involved in executive functioning, abstract thought, and general cognitive processes. As such, the multi symptoms exhibited in school are perhaps all interrelated to familial stressors.

The implications for Ethics in the Helping Profession, in my opinion, are that ethics include not only that which is morally, ethically, professionally, or even spiritually correct, but an empirical imperative as well. "Principle ethics" such as beneficence and autonomy and "virtue ethics" such as benevolence and respectfulness are conducive to increasing neural symmetry in left/right hemispheric brain regions which should serve to facilitate the attainment of positive treatment outcomes.

Dr. Richard Davidson, while at Harvard (presently associated with Univ. of Wisconsin), in opposition to neuroscience dogma which held that the limbic system is exclusively responsible for emotion, took the position that the brain’s frontal lobes, normally associated with higher order cognitive functioning, create neural pathways to the limbic system, i.e., thinking can affect emotions.

To prove his theory, Davidson, in 2001, encouraged by the Dalai Lama, conducted an experiment with an abbot of a Buddhist monastery, in which he asked him—while he had electrodes attached to his head—to first think neutral thoughts followed by compassionate thoughts. During the compassion meditation, the left asymmetry was "off the charts," 97 percent higher than anyone had measured. Davidson’s conclusion was that we can train the mind to be happy.

Richardson subsequently used an FMRI, which is more precise in pinpointing exact brain region areas, asked novices and adept meditators to do compassion meditations. In all subjects (albeit adept meditators to a greater degree), results indicated heightened activity in left frontal brain regions (cognitive) and in the insula (empathy) of the limbic (emotional) system. In addition, regions which keep track of self versus other became quieter.

In another experiment, also using FRMI, Richardson used novice subjects (without meditation experience) and asked them to view a horrific scene of a child with an eye tumor. In this first segment of the experiment, the subjects’ amygdala (limbic system) associated with anger and fear, had significant increased activity. Subsequently, in a second stage of the experiment, subjects when exposed to the picture were directed to think of "aspirations for freeing suffering" which significantly reduced activity in the amygdala and the right hemispheric region of the pre-frontal cortex.

In 2006, Davidson and colleagues published a paper in which they noted that "drawing a casual line between left pre-frontal cortex activation and happiness was too simplistic. The casual strand takes a long and winding path…. People with this pattern of brain activation feel they have their life under control. They experience personal growth, feel they have purpose in life and good personal relationships. They accept themselves for whom they are. In contrast, subjects with increased right frontal region activity feel their life is out of control and feel discontented in work, relationships, and in how life turned out in general".

To simply rephrase Davidson’s findings in terms of the Jewish mystic Baal Shem Tov: "Think good and it will be good."

Clearly, the positive impact of increased left frontal lobe activity on autonomy (control) beneficence, justice, etc., sounds straight out of a handbook on ethical codes. In summary, I hope that advances in the neurosciences will increase our clinical motivation for servicing our clients with the highest level of aspirational ethics while simultaneously allowing us to maintain our heartfelt wish to do so. To cite Dr. Gerald Corey’s quotation of the mystic Rumi, "Out beyond ideas of right doing and wrong doing there is a field—I’ll meet you there."



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