Ogni discorso sul cervello deve fare i conti in realtà con due differenti oggetti: il cervello-organo, e il cervello metaforico. Le scarse conoscenze che tutti noi abbiamo della vera natura della relazione mente-cervello deve renderci cauti ed umili quando trattiamo di mente e cervello. E’ necessario soprattutto operare delle chiare distinzioni tra realtà e fantasie, tra cervello organico e cervello metaforico.

Summary:

Any reasoning concerning the brain must face two different objects: the organ-brain, and the metaphorical-brain. Because we know so little about the true nature of brain-mind relations , we have to be extremely careful and humble when coping with brain and mind. It is necessary above all to make a clear distinction between reality and fantasies, between organ-brain and metaphorical-brain

Parole chiave: Fantasie, Cervello-Organo, Cervello-Metafora, Etica.

Keywords: Fantasies, Organ-Brain, Metaphorical-Brain, Ethics

The worst fate for a fantasy is to become reality before a new one takes its place or to be thought of as reality. That's what happen to our fantasies on brain.

We are caught between two basic and opposite fantasies. The first one can be called the "Total Control Fantasy". According to this fantasy, all human behaviours, feelings, affects, values, fantasies, all human mental expressions could be totally understood and controlled. The best and easiest way of control is this of our senses, mainly eyesight. We would like to see all these functions right here where they have to be, in our brain. The fact that some of them have been already located is very encouraging and enable us, fantasmatically, to believe that sooner or later they will all be precisely situated in our brain and through our neurotransmitters; including the locus of Ethics. The champion of this fantasy and belief was Sigmund Freud. He believed that "biology is a domain of unlimited possibilities". He added: "We have to be ready to receive from it (biology) the more striking enlightenment and we cannot predict which responses it could give us in few decades to the questions we ask it. May be, these answers will destroy all our artificial theoretical edifice." More recently, Changeux [1]in his "L'Homme neuronal" proposes to build a bridge over the gap that separates Human Sciences and Neurology. This bridge can be perceived as abusive and exaggerated.

The second basic fantasy is the "Total Freedom Fantasy". It claims that every human being as such is the only master of all his psychic functions, brain is only the tool to express these functions. Spirit of mind or psyche is of another nature, immaterial, specifically human, linked or not to God. During human life, it elaborates its thoughts and fantasies through cerebral functions but not necessarily. According to this fantasy, man is totally free in all his wills and other psychic productions, limited only by his somatic nature.

Into this psychic nature, man can be limited by conflicts inherent to this psychic functioning. Every mental production is the result of urges, drives, and the solution of conflicts between levels: conscious, subconscious and unconscious. The champion of this position is Sigmund Freud. He elaborated this genius specifically its metapsychology that explains and interprets man’s behaviour and psychic functioning into itself.

It seems to be very hard for human thinking to get ride of this basic dichotomy between psyche and soma.

Brain research tries to bridge the gap. Its results give more and more evidence on brain complexity, not only in its motor sensory and vegetative functions, but also on cognitive, affective, memory, urges and so-called high-functions. This knowledge can be interpreted in different ways according to the basic belief of the researcher; either in a materialistic or psychic mode.

THE TWO BRAINS

By doing so, we make a terrible confusion between our "two brains": the anatomic/physiologic brain and the metaphoric brain.

Brain anatomy, histology, genetics, physiology, biophysics, biochemistry give us information but on the brain as an organ. The fact that a lesion in a specific place modify or neutralise a psychic function does not prove nothing but that this function, let say memory is impaired when such a lesion occurs. There is nothing to do with memory as such as, differentiated from recalling. In his book "matter and memory", the French philosopher Bergson [2] used Broca experiences on memory to establish the disconnection between brain and memory. Memory overcomes the "matter", the brain. If a lesion that impaired memory disappears or improves, memories will come back. Bergson used Winslow's descriptions in "On obscure diseases of the brain" to establish his position. The example of this man who forget a foreign language he knows prior to his illness, composed afterward the same poems he wrote few years ago.

We have the tendency to take the part for the whole and to go faster than scientific findings to realise our basic fantasies.

The metaphoric brain had have its vicissitudes. Psychic functions were localised in the heart according to this logical concept that the more important functions have to be placed at the most important place in the body.

When speaking on brain research and functions we have the tendency to confuse between these "two brains". No one will confound today between heart and love but in poetry or between choleretic canal and melancholia. Brain fantasy is a very resistant one because we need it to determine our human specificity as totally free and totally controlled or controlling.

This confusion has been expressed by the question if brain cells grafts will transmit, also, donor's personality. This question didn't rise in heart transplant! On the same coin, brain imaging gives us but only brain blood perfusion and intactness [3], and not "brain quality" or the patient’s personality. People could be selected according to their ''brain-quality'' in P.E.T or M.R.I. images as they were, 50 years ago by the shape of their nose or ears!

We speak about organ-brain and think about metaphoric brain.

The same difference exists between self-representation and self . One can be described anatomically, physiologically etc. but perceives himself quite differently. Self-representation as brain representation can be seen as an anthropomorphism. I speak about my body, my brain, my self as if it was a total human being somatopsychic, as if this body has a soul or this brain has. Does the brain think, feel, hallucinate, love, memorise etc.?

Brain-research is closing progressively the gap between brain-representation and brain-organ. Will this gap be totally erased some day, will this research succeed ultimately? The answer can be only based on belief and not on knowledge available today. Every answer will be an extrapolation.

This confusion is expressed in almost all fields of brain research.

BRAIN DEATH AND BRAIN LIFE

In order to respond to the concept of "brain-death", some authors [4] have develop the concept of "brain-life". As well known today, "brain-death" is a necessary concept when heart and lungs are still alive that gives doctors the right to take organs from this donor for transplantation. This concept of "brain-life" is much less necessary even useless [5]. Hans-Martin Sass claims that "Brain-life I" occurs around the 44th day after conception and "shows the first living cells, some of which will develop into the human cortex". "Brain-life II" begins around the seventieth day after conception and is characterised by the first formation of synapses, which provide the possibility of ever growing networks of interconnections". For Saas, brain-life II is the point "after which foetal life should be morally recognised and legally protected". Kushner [6] offers a psychological argument for brain-life. She distinguishes between a biological (zoe) and conscious (bios) life: The first for organic structure, the second, bios, for biography, referring to existence as "the subject of a certain life with its accompanying history." The brain-life theory simply stated is: whenever a functioning human brain is present, a human being is present, that is, when the thalamus becomes connected to the cortex around the 20th week, the nervous system is then physically integrated. According to these theories, Tauer [7] proposes a third definition of human-being: "the psychic person who has the present capacity to retain experiences as 'memories' through the building of pathways in the C.N.S.; and the potential to become a person 'in the strict sense '."

These developing concepts help us understand the critical interest raised by brain-research and brain peculiarities.

The C.N.S. is among the first systems to begin and probably the last to complete development. It is characterised by its "autistic nature": among its 10.10 cells, 99,98% are connected between themselves and only 0,02% are connected with the outside [8]. This to say that the brain invests almost all its energy and capacities in elaborating, in a close system, the little information it receives and in sending messages, motor or others, to the outside world. "As such" it is also painless. On the other hand, it is extraordinarily adaptable to external changes. The experiences on vision of new-born and young children are convincing proof of it. Plato himself explained the beginning of deficit in memory function by development of writing and reading. Cicero knew all his conferences by heart "even forward and backward!"

We foresee even a bigger loss of memorised information due to the development of computerised knowledge.

Do these fact modify the brain-organ or only the brain concept? If it is generally thought that structures reflect functions in biology in general and in human beings specifically, the brain seems to be an exception. Nothing in its macro and micro-anatomy let us imagine what its functions are. knowing how it functions does not mean ipso facto that all psychic functions take place in these cells and their connections.

BRAIN MANIPULATIONS

This discrepancy between our "two brains" becomes explicit in the different modalities of intervention on brain: psychosurgery, embryo-cells transplants, psychotropic drugs, psychotherapy, brainwashing.

Monitz's surgical technique to treat the most severe mental disorders had have its successes and is still used; in some countries quite intensively. Without denying its scientific basis, this technique is linked to the "Dibbuk" fantasy. Trepanations had been performed in the Antiquity by Greeks and others to take away the wrong part of the psyche out of the brain, in this case thought to be the mind. If this fantasy is not necessary to the surgeon, it is certainly referent’s and family's fantasy. The fantasy of "take it (bad ideas, bad behaviour, insanity etc.) out of your/his/her head!"

The transplant of embryonic cells to Parkinson's or Alzheimer's patients is relevant to other fantasy processes. Again, all this has nothing to say about the well proved efficiency of this technique nor to the ethical dilemmas it raises. Moving part of a brain to another one is an as long as humanity fantasy. The wish of mixing personalities between friends, allies and spouses was formulated by mixing blood. The fantasmatic "real proof" that mind and brain are one will be shown by brain transplantation!.

Psychotropic drugs revolutionised psychiatry in the sixties. Mood, hallucinations, thoughts, cognition: all are drastically modified by these molecules. Today, their pharmacokinesis and sites of action are well-known. Does it mean that mood, hallucinations, etc. are products of biochemical processes? or are these processes only the condition for expression of these psychic functions, from psychic elaboration to external expression?
Psychotherapy raises the same question. By no doubt, psychotherapies, (being, speaking and listening to someone according to a certain theory and technique), modify his/her thoughts, mood, cognition, behaviour, etc. Is this psychotherapeutic process entirely dependant upon neurological processes, listening, seeing, cortex projection, frontal integration, thalamic regulation etc. or is it "only" a "mind to mind dialogue"?

Brain-washing is of the same vein; it differs by its aims, intensity and techniques. It proves how much the brain is adaptable and flexible.

CONCLUSIONS

All these examples cannot convince us of the organic nature of mind nor of the contrary. We cannot replace a "theory of mind" [9] by a "theory of brain". They are still two different theories. The challenge is to bridge the gap between them by brain and psychological research walking hand in hand.

This uncertainty on one hand, and the extraordinary specificity of the brain, the cerebrality on the other hand, confronts us with specific ethical duty. Because we know so little about brain/mind relations and because we cannot manage totally every manipulation on brain and mind, from psychotherapy, we have to be extremely careful and humble when coping with brain and mind, and make a clear differential diagnosis between reality and fantasies, between organ-brain and metaphorical-brain.

References:

1. CHANGEUX J.P. 1958, L'Homme neuronal, Payot, Paris
2. BERGSON H. 1963, Matiére et Mémoire, P.U.F., Paris
3. SALVATORE M. 1994, Advances in Brain Imaging: a New Ethical Challenge. In Proceeding of the European Multidisciplinary Workshop on Ethics of Brain Research. 8-10 December 1994. G.Agich, E.Mordini (Eds), J Theor Med Special Issue. In press.
4. SASS H.M. 1989, Brain-Life and Brain-Death. J Med & Phil, 14: 67-75.
5. MOUSSA M., SHANNON T.A. 1992, The Search for the New Pineal Gland, Brain Life and Personhood. Hastings Center Report. May-June, 106-113.
6. KUSHNER T. 1984, Having a Life versus Being Alive, J Med Ethics 10: 25
7. TAUER C.A. 1985, Personhood and Human Embryos and Fetuses. J Med & Phil 10: 15-22
8. BOURGUIGNON A. 1981, Fondements neurobiologiques pour une théorie de la psychopathologie. Un nouveau modéle. In Psychiatrie de l'Enfant. XXIV, 2,
9. COHEN D.J. 1993, Understanding Other Minds. Oxford Medical Publications, London.