The Modern Reality of Human Salience and Reward

I recently had the pleasure of enjoying a talk by Dr Derek Tracey, a research psychiatrist, medical practitioner and member of the Advisory Committee on the Misuse of Drugs. His topic - the evolution of human consciousness - illuminating for both laypeople and experts alike, managed to reduce a very complex philosophical and practical question into a discrete series of categories. This reductionist view on the human psyche stunned me. How have I, a third year neuroscience student, managed to go through my university career without having a senior lecturer talk down at me for an hour regarding how each system of the human brain falls into place. What is the bigger picture of the electrical homeostatic environment that we all identify as our conscious world?

The brainstem controls breathing and the heartbeat, the mesolimbic area controls our reward and salience, and the cortex then came along and explained away these incredible physical properties as an act of god; our first modest organ. “What’s deep is ancient, whats ancient is important,” said Dr Tracey, alluding to the fact that it is irrelevant what the cortex thinks of itself or of its neighbouring brain regions. However, the fact remains that an organ attempting to rationalise its existence might no longer have its biological best interests at heart, as the path of least resistance might not be the most rational and vice versa. The philosophy of mind-body dualism has hindered psychiatry a great deal, and its effects, unlike other scientific fallacies that have been perpetuated throughout our history, remain today. How would one study the movement of the planets of our solar system if the central tenant of astronomy was that the earth was flat, situated on the shell of a tortoise balancing

on two elephants? Yet, despite our very clear understanding that who we are is contained within the neurones of our brain, psychiatric conditions are still often explained through the metaphysical domains of unpleasant feelings and bad thoughts. Break your leg and no one is going to tell you to just go and walk on it, pretend it’s not there.

Psychiatry in its modern form was probably revolutionised by William Battie in 1758, who, for the first time, acknowledged that mental illness did not have to be locked up in a jail cell and could be cured. The first steps towards acceptance that mental illness was not some bereavement caused by an act of the Almighty who was displeased about some inconsequential action, were indeed important. Prior to this, people who were suffering would find themselves locked up, tortured like animals to flush their bodies of the devil, branded as witches or subjected to all kinds of inhumane tortures to ‘cure.’ This is a historical reality for all scientific inquiry. Throughout our history, its easy to look back on the less knowledgeable and laugh, as it is a common theme for philosophy to precede science in an attempt to explain phenomena that we have no way of quantifying with current technology. This was the case with astrology, alchemy, medicine and, indeed, psychiatry. Today, philosophy struggles with questions of AI alignment, ethics and human behaviour as these are all things we cannot quantify yet. However, the trouble with modern psychiatry is that it is still influenced by the historical dualism that kickstarted the scientific disciplines of neuroscience and psychiatry.

Social mental health support is expensive, cumbersome and, at times, aimless. The NHS target

of successfully treating 50% of people is failed by one in seven areas in England, and a Royal College of Psychiatrists survey revealed that 25% of 500 patients surveyed, who were drawn from across the UK, waited longer than three months to see an NHS mental health specialist and 6% had waited over a year. Issues do not simply stem from the underfunding of the NHS - the fact is that money is disproportionately allocated towards other areas of the national health service. This shows how insincere efforts to conquer this growing issue have been, and this, coupled with the lack of strategy to tackle mental health at a grassroots level, unveils the dismissal by many of the issue. Too often people who are in crisis condition would find themselves hospitalised on a general ward, sedated and unable to make a decision for themselves. The new £2bn spend in the budget brings more than much needed finding to the area- it also provides a direction and structure to the treatment on offer. Crisis teams, specialist mental health ambulances, community and young people support, all show that the government is finally moving away from the old, dualistic manner of treating mental health, and embracing an informed and proactive approach to treatment.

I’m not here to tell you about the governments new budget, or explain to you the necessity of certain treatment methods - there are people at our university that can do that far better than myself. I am, however, here to underline the importance of moving away from prodding at the perceived unknown, from mechanistically following old rituals, and to embrace clarity of explanation. Dr Tracey showed me how vital it is to take a complex topic and break it down to its constituent parts to illuminate it not only for your audience but for yourself. We do not need condescending PR jargon like ‘mental health literacy’ to understand that people suffering from pathologies of the mind do not need to be talked down to, but instead need to be treated as any patient would be. Our emotional brains

evolved to deal with threats to our health, and rewards of our modern to our carnal needs. The threats and rewards of our modern world have become so much more nuanced that our mesolimbic system struggles to efficiently drive our higher executive functions. If we do not understand the specifics of our own mental health, and become self-aware to our own needs and realities, it won’t be the political climate, the environment, or some crazy engineered virus that will be the downfall of humanity - it will be our own minds.

by Robert Taylor