Social Control of the Brain 3: Surgery and Non-Invasive Techniques

June 6, 2023 by Donald Gorassini, howinfuenceworks.com

In this blog, I will continue my look at how people exert influence on the brains of other people. The focus will be on surgical and noninvasive techniques (SNT) performed to treat psychological symptoms, which could include movement or psychiatric disorders. Surgery in this case is neurosurgery and noninvasive techniques are performed without the need for surgery. These methods are discussed at more length in a previous blog. Presently, I address the following: Why does this form of influence on the brain reside exclusively in the medical domain? Might the influence generalize in years to come to areas beyond the medical, in particular to a lifestyle choice domain?

The possibility that these brain-altering procedures could generalize raises questions that society and the individual should address. When informed about what might be coming in the not too distant future, you might be struck by a sense of unease but also curiosity.

It is my contention that we could see SNT used in a lifestyle choice domain in the years to come. This will be the likely result of scientific and technological advancement. Some of the procedures will have applications that extend beyond restoring a medical patient back to a normal state, the primary medical agenda, to enhancing anyone’s normal capacities, a general matter. It is at such a point that demand to have the enhancing procedures will increase. As new general applications proliferate, so will the demand. Then it will be a matter of creating a supply niche, other than medical, to satisfy the demand. The question will not be whether a supply niche will emerge in an effort to meet the demand, but how soon.

In this blog, I will examine why past use of SNT has been confined to the medical domain. Then, I will look at possible future SNT to determine if the factors that have limited SNT to the medical area will continue to apply.

The purpose of this blog is strictly prediction of where the field of SNT for brain change is going. It should not be taken as my endorsement of the future procedures that are discussed.

The Present

Here I address three issues: why are SNT to alter psychological outcomes used in the medical context; why are the techniques used so infrequently, even by medical standards; and why are the techniques not used in other contexts? Answering these questions about what has constrained SNT to the medical domain will help us estimate the chances of SNT procedures generalizing in the future. The constraints that have operated up to now are not likely permanent.

Brain Surgery

It is easy to see why brain surgery for psychological change resides in the medical domain. The method solves an important medical problem. Patients can be provided relief of pronounced psychological symptoms, such as difficulty moving, obsessions and compulsions, and depression. Altruism and the profit motive drive the process.

Several sources are called on to help with the treatment solution, doctors to assess and treat the condition, companies to help fund the projects, make devices, and get in on the ground floor of what might turn out to be a profitable enterprise, scientists to offer and test solutions, patients in need, governments to help fund the projects and promote policies, and universities and hospitals to manage projects and provide settings and personnel. In addition to all the sources contributing to the solution, each source has its own agenda advanced in some way. The collaboration among all the sources requires extensive organization and coalesces into the setting of brain change we know today as the medical use of neurosurgery to treat psychological symptoms.

We can see why neurosurgery for psychological change is such a small domain, even by medical standards. The demand for and supply of the procedures are low. On the demand side, the number of patients requiring a procedure represents a small population. It is restricted to a few illnesses and only to patients who have proven unresponsive to other treatments, such as medications. On the supply side, there are few surgery slots available because a limited number of personnel are qualified to perform the operations, the procedures are one type among many for which operating rooms are needed, and the procedures are very expensive.

Why do we not see brain surgery for altering psychological outcomes outside the medical realm? There are currently no other problems existing in society for which the procedures would be a solution. Consequently, they are performed only in the medical context, where they are feasible. This does not mean generalization will not occur. Future scientific advances could result in viable lifestyle applications.

Noninvasive Techniques

We can ask the same questions about noninvasive techniques used to alter psychological outcomes as we asked about the neurosurgical techniques. Why are noninvasive techniques used in the medical domain, and infrequently even there, and not used outside the medical domain? The answers are the same here as for neurosurgery: the procedures effectively treat a few serious medical conditions and have no applications outside medicine at this time.

Even though surgical and noninvasive procedures are infrequent and strictly for medical use now, some of the structural differences between the two methods will likely be significant in the future. The noninvasive procedures, compared to neurosurgical, will likely become much more frequent, whether this be in the medical or general domain, because they do not require an operating room and its typical staff, the treatment team would consist of different and fewer personnel than would neurosurgery (for example, a technician could apply TMS), and there would usually be limited patient preparation and recovery time. Let’s now look at possible future uses of SNT.

The Future

Might some future SNT be suitable for general use? One place to look for an answer to this question is at existing experimental SNT. I will look at two procedures, one surgical and one noninvasive. The surgical procedure consists of the implantation of an electrode into the brain’s pleasure circuit. The noninvasive procedure involves using transcranial magnetic stimulation (TMS) to increase intelligence.

Neurosurgery for Psychological Change

Surgery on the brain to produce psychological effects could occur in future within a lifestyle choice domain. It would be an analogue to cosmetic surgery. Unlike the medical domain, where the purpose is restoration, the purpose within the lifestyle choice domain would be enhancement. What would have to happen for neurosurgery for psychological change to materialize in a lifestyle choice domain?

The first case I consider is surgical implantation of a device for activating the brain’s pleasure circuit. This procedure was discovered 70 years ago but has not caught on as a method for gaining a pleasure experience. Examining why it is not used provides clues regarding the constraints that would have to be removed to make the technique viable in a lifestyle choice context.

In the 1950s, two researchers at McGill University³Olds, J., & Milner, P. (1954). Positive reinforcement produced by electrical stimulation of septal area and other regions of rat brain. Journal of Comparative and Physiological Psychology, 47(6), 419–427. Olds, J. (1956). Pleasure centers in the brain. Scientific American, 195 (4), 105-117. implanted an electrode into the septal region of a living rat’s brain. A mild electric current sent through the electrode produced what appeared to be a pleasure response. To test the notion that sending the current was indeed causing pleasure, a method was devised whereby the animals could press a lever to send the current to their own brains. The result was striking. Rats would press thousands of times per hour for up to 24 hours, after which they collapsed from exhaustion. In a related demonstration, food deprived rats preferred pressing to eating.⁴Olds, J. (1956). Pleasure centers in the brain. Scientific American, 195 (4), 105-117.

Electrical current sent to a similar area of the human brain (of patients who were having medical neurosurgery) tends to produce wanting without pleasure, although it is not ruled out that implantation in other areas might result in primarily pleasure.⁵Berridge, K. C., & Kringelbach, M. L. (2015). Pleasure systems in the brain. Neuron, 86(3), 646-664. In other research, an electrode placed in the upper spinal cord of patients for purposes of controlling pain frequently resulted in a pleasure response.⁶Meloy, T. S., & Southern, J. P. (2006). Neurally augmented sexual function in human females: A preliminary investigation. Neuromodulation: Technology at the Neural Interface, 9(1), 34-40. It seems that, if they wished to, scientists could develop simple surgical implant procedures that would allow humans to experience pleasure at will. This has not happened.

We can see why this procedure is not popular. Let us apply a supply-demand analysis to account for why we do not see the method used, whether for medical or lifestyle reasons. On the demand side: people have an aversion to having their skulls opened or drilled; there are already numerous easy ways to gain pleasure; unknown is how intensely pleasurable the experience would be; and also unknown are what side effects would ensue.

On the supply side, the procedure is not offered. There has been limited interest in creating an implantable pleasure device even though much work has been done since the 1950s on understanding how the pleasure circuit works and, separately, on developing neural implants for medical purposes. Some of the reasons why we have not seen much work on pleasure implants are that researchers have other priorities, a surgery for implanting a pleasure device would be extremely expensive because neurosurgery is extremely expensive, the patient would likely have to bear the full cost, and companies would find little reason to invest in developing and offering the service because of its high cost and anticipated low demand.

The question of whether a pleasure implant could be made viable is interesting. What is even more important for present purposes is determining what constraints would have to be removed so that a neurosurgical procedure could become viable in a lifestyle domain. If an operation’s result, in this case pleasure, was highly valued, not otherwise attainable (perhaps this was the most intense pleasure one could have), could be secured with limited trouble and cost, and was known to be safe, then there might be a significant demand for the operation and a supply put in place to meet the demand. The removal of such constraints made cosmetic surgery feasible.

Noninvasive Procedures for Psychological Change

In recent testing, researchers applied transcranial magnetic stimulation (TMS) in an attempt, successful, it turned out, to alter global mental performance. The technique consists of holding a device resembling a computer mouse outside a person’s skull and adjacent to the part of the brain meant to be affected. A magnetic field is emitted when the device is switched on. (I describe TMS in more detail in a previous blog.) Demonstrations of this type suggest that lifestyle choice applications of noninvasive brain change techniques might not be far away.

The finding is new and experimental. For these reasons, the method has not been offered in a public domain, medical or otherwise. Here is a closer look at what the researchers found. I will then consider what this might portend for a possible lifestyle choice application of the procedure.

A considerable amount of work on enhancing cognitive skills using TMS has been done and yielded positive results.⁷Luber, B., & Lisanby, S. H. (2014). Enhancement of human cognitive performance using transcranial magnetic stimulation (TMS). Neuroimage, 85, 961-970. In a recent study in this area, researchers demonstrated TMS-induced gains in fluid intelligence, the ability to solve novel problems.⁸Momi, D., Neri, F., Coiro, G., Smeralda, C., Veniero, D., Sprugnoli, G., … & Santarnecchi, E. (2020). Cognitive enhancement via network-targeted cortico-cortical associative brain stimulation. Cerebral Cortex, 30(3), 1516-1527. The study was built on previous advances in theory, methodology, and technology in this area.⁹ Haier, R. J. (2016). The neuroscience of intelligence. Cambridge University Press. Each member of a sample of young adults was given several novel problems of reasoning to solve. At selected junctures during the test-taking, either TMS or a control procedure was administered, in either case for a 15-minute duration. Performance rose after TMS but did not change after the control procedure. A noninvasive procedure was thus shown to improve general mental performance.

What sort of demand might we see for something like this? There is potential for a considerable demand. Intelligence is a highly valued property, instrumental in educational achievement, occupational success, and longevity. The property is resistant to modification by other means. If offered, the TMS procedure would be sought by those who could afford it.

It should be possible to deliver a supply to meet the demand. The method would not require the personnel and setting of neurosurgery, where a highly trained staff and an operating room would be necessary. Applying TMS would require a TMS machine located on a cart, a trained technician, and an office. Entrepreneurs would market the methods because a profit could be made. If you could run 8 clients per day over a 5-day week over 48 weeks of the year at, say, $1,000 per procedure, gross annual revenue would be $1.92 million, from which capital expenses, maintenance costs, and salaries would come. A TMS machine would cost about $100,000. It certainly seems that there would be satisfactory expected profit.

Will a TMS procedure, such as the one used to enhance fluid intelligence, generalize to a lifestyle domain? Some of the factors that currently limit SNT to the medical domain would no longer apply. The procedure brings about a valued psychological enhancement that can apply outside the medical domain. It is noninvasive. It is brief. It could be easily marketed. Other constraints remain in place. Foremost, the finding of TMS effectively raising fluid intelligence would have to be replicated. If reliable, the strength, persistence, and safety of the phenomenon would have to be examined. If the method was found viable for general application, it seems certain that demand would be considerable and the procedure would be marketed within a lifestyle choice domain.

Who would have thought a magnetic field aimed at a person’s head would make them smarter? It now looks like it might be possible. Beyond alerting us to this possibility, the TMS study fosters all sorts of questions. How many general use procedures will come available in the years to come? What techniques besides TMS are being tested (e.g., gene editing)? If we can enhance intelligence, will we be able to enhance agreeableness and conscientiousness and reduce neuroticism and criminality? Should we do these things? Who will decide? The individual? A parent? A doctor? A court? A government? A company?

Summary

Might SNT procedures for altering psychological outcomes generalize from the medical to the lifestyle domain? We have seen SNT in only the medical domain because the procedures apply to a few pressing problems of a medical nature. There is reason to believe that the procedures will generalize to the lifestyle choice domain. The research demonstrating the enhancing effect of a simple TMS procedure on fluid intelligence suggests that a general application may well be feasible. This likelihood is enhanced by the facts of constant scientific innovation, the ease of application of some of the techniques, the attractiveness of the applications to the general public, and the ease in which the procedures could be marketed.