Thursday, October 27, 2011

You mean its going to stay that way?

I was thinking about cognitive plasticity - not strictly the physiological neuroplasticity referred to in the link, although its probably grounded there - and the ease or difficulty with which people learn new habits or overcome neurological configuration issues like dyslexia.  Dyslexics learn to read lexically by "rewiring" some appropriate layers of cognitive functioning so they re-perceive the words in their legible order.  You could expect to see, more or less, the same thing happening if the roles were reversed: people who are not now dyslexics would need to read the newly lexical order, and maybe we'd read slower or faster than the basic competence criteria, but we'd learn to read if we were trained or trained ourselves and the people who are now dyslexics wouldn't think there was anything wrong with the world, just with us.

We see all kinds of similar sorts of cognitive plasticity.  Playing guitar is not a natural motion - there's nothing like a sociobiological just-so story you could tell, for example, that shows why evolution would select for fine motor skills in the left hand fingers and repetitive patterns in the right, and then co-create the appropriate neurological control systems.  In fact up until maybe Led Zeppellin started going on tour there really wasn't much of an evolutionary mechanism that might explain why guitar playing was something the universe would select for.  And yet people learn to do this completely unnatural behavior, which requires "rewiring" a whole bunch of physiological systems, all the time.  And some get quite good at it.

I conflate dyslexia and guitar playing for one big reason: you could make an argument that dyslexia is actually some kind of malfunction, because there's some neurophysiological linguistically-universal case to be made for morphological order and dyslexics are missing something that allows them to do things correctly, whereas guitar-playing ability occurs at a much higher level cognitively, and isn't reflected in neurological structures per se.  I don't know if anyone makes neurophysiological linguistically-universal cases anymore, given how thoroughly Chomsky's philosophy of mind has fallen out of favor.  But you could make that case.  If you did, then you might claim dyslexia is some kind of normative thing, and people need to learn to read words the right way.  And I might also claim you're a dick, but even though you're a dick let's not descend to calling each other names.  Even if dyslexia is a malfunction, learning to overcome it indicates that cognitive neuroplasticity creates a level of functioning high enough to allow someone to demonstrate not just competence, but performance.  Much like guitar-playing.

I was thinking all this, however, late at night, in the context of the disease theory of addiction.  (The site at the link is very polemical, even for me, so keep your asbestos mitts handy.)  We see tons of evidence of cognitive plasticity all the time, especially in our kids, but if you work in technology at all you know that life is one big rewiring party, all the time.  I learned to play the guitar a couple of years ago long after I thought it was possible; Umberto Eco wrote his first novel at 50; we see all sorts of physiological and anti-alzheimer's-disease promise in the idea of having older people exercise.  Keeping the nerves on their toes seems to have excellent benefits no matter what age you are.  But what if you believe you can't learn something?

We've all had that experience: I can't do proofs in classical first-order logic, or calculus is too hard, or I'll never learn to read like my big sister, or how can I possibly drive through lower Manhattan because its just too hard.  There's a debate in the addiction-treatment community between the people who think addiction is a disease, like leprosy or schizophrenia, and people who think addiction is a habit.  Much of the debate is more heat than light; there's a lot of terms with empty significance and there's a lot of unwritten assumptions and gaps in logic, but that's where the debate is taking place and the battlelines are pretty classically between Nature and Nurture, and we've all seen that show before.  It comes down to whether alcoholism or heroin addiction, for example, or chronic cigarette smokers, have a fundamentally cognitive problem or a fundamentally physiological problem.  If its the former, then a treatment program like SMART Recovery is sufficient for the "addict" to recover.  (I shudder-quote addict because if we're all cognitive then maybe addiction is more a folk-psychological term.)  If its the latter and addiction is a physiological or maybe more specifically neurophysiological problem triggered by abuse or use of some specific substance, then abstinence from any possible triggering substance is necessary to prevent addiction.  If its the latter then taking a drink is like being shot by a bullet: there's no trauma until the introduction of the foreign substance.  If its the former then taking a drink and taking twenty more at the same sitting is a learned behavior that needs to be unlearned.

Pretty simple dichotomy.  Sometimes reading the literature seems eerily familiar.  That doesn't make the struggle any less of a struggle; its a clear example of how a philosophical issue has real, painful ramifications for self-understanding.  (I'm not of the school that thinks every philosophical issue is existential, but that's where I bum my smokes.)  And while there are a great many researchers who think the notion of addiction as a disease can bear very little evidentiary weight, there are also a great many realists who think that it speaks and strolls duck-like.

But enter my thoughts on cognitive plasticity.  If dyslexics can rewire their brain to deal with unexpected morphology, why couldn't the same thing happen with addicts?  Well, it does.  People tagged as addicts give up their addictions all the time; in fact they pretty much have to give it up, or they often die.  And they give it up by abstaining, going to meetings for social support, doing a lot of self-examination to understand their behavior and what triggers the negative aspects of it.  Sometimes they take pharmacological inhibitors like Chantix to give themselves little shocks whenever they engage in the addictive behavior.   And they end up, often enough, not being addicted to their trigger substance.  They may struggle for decades with the desire for alcohol or nicotine or heroin, but they adjust enough cognitively to prevent them from ingesting the locally banned substance.  And often enough, they don't.

But why is it that difficult?  If its a disease, then of course its impossible - its a chronic condition manifested later in life, on the order of lupus or pernicious anemia or Crone's disease.  It can be managed cognitively and pharmacologically, its triggering states can be avoided, but if alcoholism is a disease then the use of alcohol exacerbates the disease.

If its not a disease, though, then calling it a disease makes cognitive plasticity impossible.  I'm not talking necessarily about using cognitive plasticity to enable moderation - moderate use of alcohol, cigarettes or heroin, for example - but rather using cognitive plasticity to ever deal with addictive cravings for the trigger substance.  (Or situation, given that gambling or more generally risk-taking is also considered addictive, and thus possibly a disease.)  Theoretically you couldn't use cognitive plasticity to kill the addiction, because it would always be with you.

The AA literature is full of complaints about the addiction-as-disease model, because people find the notion circular.  They also don't like the tendency of some AA practitioners to argue that if you can quit alcohol without AA or drink moderately and successfully, then that's evidence you don't have the disease.

I think part of our understanding of the problem lies in a category error.  When the "disease" label was first applied people weren't as likely to think of phenomena like dyslexia as a configuration; they thought dyslexia was something wrong with an otherwise normally functioning brain, a disease.  We understand now that dyslexia is not something the brain is doing wrong, except in respect to the statistically-average lexicographic orientation - its only wrong if we think that normal is what everyone else is doing.  In which case guitar-playing is also wrong because most people don't have the skills to do it (and nobody is born playing guitar, as I need to keep reminding myself).  But in the intervening decades between the application of the term "disease" to alcoholism and now, the notion of disease has changed.  When it was first applied one of the major benefits was that you could convince people they needed help changing their behavior, instead of just applying moral approbation to alcoholics.  Now we know that many alcoholics need help, that its not a moral failing, that its not a failure of willpower.

And yet, maybe it is, in the same way that dyslexia is a failure of willpower.  Certainly not a failure you can reasonably assign blame to a struggling ten-year-old for, because they'd need enormous amounts of willpower to figure out their issues with lexicographic order.  With the proper training and support, it seems that if addiction wasn't a disease you could train addicts not to be addicts.  But telling people its a disease, that its something they have no control over, that its like being shot with a bullet, would make any intentional exercise of cognitive plasticity to get them to tolerate use of the previously addictive a virtual impossibility.  Because if its a disease, there isn't anything they can do about it, except avoid it.  They may end up avoiding it anyway, but that would be intentional and not because they figure there is nothing that can be done about it.

More on this as it occurs to me.

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