Neurology and intellectual stimulation

[Jorje286]

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I've always considered neurology a very serious option because it deals with the brain, and thus many "deep", philosophical issues: thought, consciousness, perception..etc. I haven't shadowed a neurologist though, so I'm not aware how much neurologists actually end up thinking or even delving in these issues in their work and clinical activity. Is it a significant part of what the neurologist does or even present in some way?

Of course I'm aware that by its own this is far from a good enough reason to pursue neurology. I'd appreciate your feedback on this.

 

[typhoonegator]

You certainly have the opportunity to deal with issues like consciousness and theories of thought as a neurologist, but in day-to-day practice these themes are typically approached more tangentially and pragmatically. Pontificating on concepts of self awareness is a bit decadent when you're just trying to see patients and manage symptoms.

But on the research side, there are many avenues to pursue these interests. The brain is poorly understood and is the only organ that you can study by talking to it. This interests many people, even though a lot of what we do is much more concrete on a daily basis.

 

[PETRAN]

You certainly have the opportunity to deal with issues like consciousness and theories of thought as a neurologist, but in day-to-day practice these themes are typically approached more tangentially and pragmatically. Pontificating on concepts of self awareness is a bit decadent when you're just trying to see patients and manage symptoms.

But on the research side, there are many avenues to pursue these interests. The brain is poorly understood and is the only organ that you can study by talking to it. This interests many people, even though a lot of what we do is much more concrete on a daily basis.

And then there is Behavioral Neurology/Neuropsychiatry (a fellowship) which is more directly related to "cognition" and sounds very fascinating (from a research/theoretical point at least). I wonder if general neurology though is related to these more "cognitive" issues? Do you mostly see headaches and weakness or there is a substantial portion of more "neurocognitive" cases like amnesia, aphasia etc. mixed into the practice?

 

[peppy]

When this topic came up on the psych forum the consensus was that a PhD in the humanities might be a better way to get into the "deep" side of these issues. In day to day practice, neurologists and psychiatrists are in my experience too busy doing hands on clinical work to really spend time on the philosophical side of these questions.
You certainly will see patients with aphasia on the neurology wards since stroke is such a huge part of Neuro but generally the main thing you'll do with that is make sure speech therapy sees them.

 

[PETRAN]

When this topic came up on the psych forum the consensus was that a PhD in the humanities might be a better way to get into the "deep" side of these issues. In day to day practice, neurologists and psychiatrists are in my experience too busy doing hands on clinical work to really spend time on the philosophical side of these questions.
You certainly will see patients with aphasia on the neurology wards since stroke is such a huge part of Neuro but generally the main thing you'll do with that is make sure speech therapy sees them.

Yeah, i agree with you. I think that a PhD in cognitive/experimental psychology/neuroscience to be the most appropriate (which is not "humanities" just a different scientific field) or maybe a career in clinical neuropsychology if you want to combine the basic science with a clinical aspect. I understand that the main concern of a clinical neurologist is to diagnose and treat conditions. Maybe it is a pity that doctors these days are like diagnostic-treating machines rather than the more intellectual/scientist-type they used to be in the old days in Europe e.g. founders of neurology like Hughlings Jackson, Carl Wernicke and Charcot among others. I guess that time and resources no longer allow medical doctors to pursue the "deeper thinking" leaving this to more academic/PhD fields.

 

[Enkidu]

I've always considered neurology a very serious option because it deals with the brain, and thus many "deep", philosophical issues: thought, consciousness, perception

If you're interested in studying deep philosophical issues, you might want to consider studying philosophy.

I can tell you that there is no room in basic neuroscience for deep philosophical issues, and as for cognitive psychology, I suspect that they spend most of their time thinking about psychology.

 

[PETRAN]

If you're interested in studying deep philosophical issues, you might want to consider studying philosophy.

I can tell you that there is no room in basic neuroscience for deep philosophical issues, and as for cognitive psychology, I suspect that they spend most of their time thinking about psychology.

I can tell you there is a BIG room in basic neuroscience for deep philosophical issues. E.g. studying the neural correlates of consciousness (Logothetis . etc.) would definitely shed light (and already has) to the "deep philosophical issue of consciousness". A lot of mental functions are considered "deep" (e.g. thinking processes) but with cog. neuroscience, neuropsychology and psychology you can conduct some clever studies and see what's going on under these complicated processes . What you possibly mean is that there is no room in "applied neuroscience" for these "deep (-er) philosophical issues" which is true (but there still could be some philosophical implications)


Yes, of course cognitive psychology spends most of the time thinking about cognitive psychology (doh!) which means conducting experiments on perception, attention, consciousness, thinking, language, emotions and memory. The experimental ("scientific study" not philosophical) of these processes is called "cognitive psychology". Sometimes, when computational models are developed in order to explain the experimental findings it is called "cognitive science". When you conduct these experiments on brain damaged patients (because you want to see what mental function declined because of the brain damage) it is called "cognitive neuropsychology" (when you apply some of this knowledge for the clinical-cognitive- assessment and cognitive rehabilitation of neurological patients it is called "clinical neuropsychology") . Lastly, when you conduct these experiments on (usually but not always) healthy volunteers while you have their brains scanned with fMRI, PET or by using cog. evoked potentials it is called "cognitive neuroscience" (which has boomed big time after the 90s).


"Systems/behavioural neuroscience" ( also known as "biological" or "physiological" psychology in the past) is also a related field, one which conducts similar experiments-but on animals (and usually employs lesion studies or single-electrode recordings). These fields sum-up a lot of modern basic neuroscience (and at the same time some fields of modern "basic psychology" since they are interchangeable with some fields of basic neuroscience at times). Add "molecular/cellular neuroscience" (which is not always directly related to cognition/behaviour/mind but to the detailed cellular/molecular intricacies of the nerve cell ,something which of course can have cognitive/behavioural implications e.g. "long-term potentiation" and its relation to long-term memory-formation, or various molecular mechanisms of synaptic plasticity, dendrite growth, nerve repair after damage etc.) and you get the whole picture (of modern basic neuroscience).

So, yes, science in general-and experimental psychology and neuroscience in particular- have a lot to do with the "deep philosophical issues" that the threadstarter talks about, even with the "wildest" ones such as consciousness, free will and religious experience. See the neuroscientist's Benjamin Libet's experiments on conscious free will for example


http://en.wikipedia.org/wiki/Benjamin_Libet


Or the experimental psychologist's Daniel Wegner experiments on the illusion of conscious volition

http://en.wikipedia.org/wiki/Daniel_Wegner


Or the neuropsychologist's michael persinger on the field of "neurotheology" (and what brain structures and functions are related to various forms of religious experience, how temporal-lobe epilepsy can generate mystical-like experiences etc.), or kosslyn's cognitive neuroscience experiments on visual mental imagery. There are countless examples which demonstrate how modern (psychological and neuro-) science tackles some of the "deepest philosophical issues". It is similar to how modern cosmology/theoretical physics dwell in "deep philosophical fields" as well (e.g. what is reality? was there a beginning? etc.).

 

[Jorje286]

^ This is all very true. In fact, philosophy of mind now pretty much works in conjunction with findings in neuroscience. There's also a neuroscience graduate program I know of (associated with the Max Planck institute) that incorporates philosophy courses as requirement.

The way I see it is that there's even more potential for neurologists to actually get in those issue - because humans are actually your subjects and you're treating "abnormalities" related to those deep issues. Where would our current empirical knowledge be without lesion findings? From what I understand now is that academic neurology would be more suited for this approach, as a combination of research/patient contact. The system probably doesn't encourage to actively think/pursue those interests (even though I still think they are relevant - how could your deconstruction of how these issues work not inform your clinical practice?) so you have to swim a little bit against the tide.

 

[Enkidu]

^ This is all very true. In fact, philosophy of mind now pretty much works in conjunction with findings in neuroscience. There's also a neuroscience graduate program I know of (associated with the Max Planck institute) that incorporates philosophy courses as requirement.

The way I see it is that there's even more potential for neurologists to actually get in those issue - because humans are actually your subjects and you're treating "abnormalities" related to those deep issues. Where would our current empirical knowledge be without lesion findings? From what I understand now is that academic neurology would be more suited for this approach, as a combination of research/patient contact. The system probably doesn't encourage to actively think/pursue those interests (even though I still think they are relevant - how could your deconstruction of how these issues work not inform your clinical practice?) so you have to swim a little bit against the tide.

Of course, some neurologists and neuroscientists have a philosophical bent, but I think it would be a mistake to go into those fields primarily out of an interest in philosophical questions.

If you ask a question about qualia during a neuroscience research presentation, you will get blank stares and possibly be laughed at. The "philosophical issues" that you are interested in may be tangentially related to basic neuroscience, but most neuroscientists don't care about them. I don't know about psychology or neurology, but I suspect that they are the same.

If you really want to focus on philosophical issues of neuroscience or neurology, you will find a group of like minded people in the philosophy department. If you like, you could try to do a PhD in philsophy and go to medical school, but if it is primarily philosophical questions that are pulling you into science or medicine, I think you will be disappointed.

 

[Jorje286]

The "philosophical issues" that you are interested in may be tangentially related to basic neuroscience, but most neuroscientists don't care about them. I don't know about psychology or neurology, but I suspect that they are the same.

Well, I've had lots of exposure to "basic neuroscience" as I was previously enrolled in a neuroscience PhD program and I don't think that is safe to say at all. I presume most of your experience in neuroscience has been in molecular biology/neurobiology of disease, and in that case this may apply. But when it comes to systems neuroscience/theoretical neuroscience/cognitive neuroscience many of these questions are actually inescapable since a lot of researchers are simply doing empirical investigations of those "philosophical" questions, and that's precisely something I'm interested in (which is why my interest in philosophy here is more tangential than you assume) . There are people out there who work on models of perception in psychophysics, in circuits underlying intention and decision making, fMRI studies about the nature of self-consciousness, cognitive neuroscience of emotion and empathy..etc. Qualia is not addressed scientifically yet because we simply don't know enough about the brain and the brain/mind connection to venture that deep, even though Christoph Koch might have something to say about this. PETRAN's post has more details about this.

And yes, I'm in agreement with you that neurology shouldn't be done just because someone has those interests. The same applies for neuroscience, since you have to be primarily into the process of scientific research. Even though those issues mentioned are serious motivators for a lot of neuroscientists.

 

[PETRAN]

Well, I've had lots of exposure to "basic neuroscience" as I was previously enrolled in a neuroscience PhD program and I don't think that is safe to say at all. I presume most of your experience in neuroscience has been in molecular biology/neurobiology of disease, and in that case this may apply. But when it comes to systems neuroscience/theoretical neuroscience/cognitive neuroscience many of these questions are actually inescapable since a lot of researchers are simply doing empirical investigations of those "philosophical" questions, and that's precisely something I'm interested in (which is why my interest in philosophy here is more tangential than you assume) . There are people out there who work on models of perception in psychophysics, in circuits underlying intention and decision making, fMRI studies about the nature of self-consciousness, cognitive neuroscience of emotion and empathy..etc. Qualia is not addressed scientifically yet because we simply don't know enough about the brain and the brain/mind connection to venture that deep, even though Christoph Koch might have something to say about this. PETRAN's post has more details about this.

And yes, I'm in agreement with you that neurology shouldn't be done just because someone has those interests. The same applies for neuroscience, since you have to be primarily into the process of scientific research. Even though those issues mentioned are serious motivators for a lot of neuroscientists.

+1 very good post.

I don't know if people lough with "qualia" (which is a philosophical entity but not laughable. Is it laughable to try and understand the relation of the sensation/phenomenology of pain to neural structures and functions? Or if one "feels anything" under anaesthesia? Or how consciousness is disturbed in epilepsy? All these could clearly have implications in clinical medicine and of course consciousness is a really BIG theoretical question in itself-nothing to laugh at), but the neural correlates of consciousness is nowadays a much respected field. Christoph Koch, Nick Logothetis, Rodolfo Llinas and many other respected researchers have dwelled into the field including Francis Crick.


I think that with the applied fields such as clinical neurology i guess that it depends on how much the person wants to look "deep" into a clinical manifestation. This i believe is not easy in the context of the modern fast-paced clinical medicine (as the previous posters said, you have to be more "practical" in these cases). A clinician has to make a correct diagnosis, ask for the right tests and suggest for the appropriate treatment. This in itself can be a difficult a daunting and time-consuming task and in the context of a busy inpatient (or outpatient) unit is more than enough. It is also bad that as far as i understand many medical departments don't encourage this (developing more critical/theoretical/abstract thinking) and push for a almost purely mechanistic view of medical practice. Maybe if you work part-time, you are self-employed or work in a more relaxing outpatient unit you could combine the clinical work with some research in neuroscience. In this way you can definitely get some insights from the clinical work, at least if you look carefully and deep enough (in the context of a more slow-paced clinical work i believe you could).

I'm currently doing a PhD in neuropsychology (it is still an applied field but more "cognitive") because i thought i could be more directly exposed to these issues that i love. I have thought of going into medical school and specialize in neurology because i also like the more applied, "dry/shallow" aspects of neuroscience and clinical medicine in general because you can also help people and make a good living ( lets not lie here, clinical medicine has very good financial prospects in relation to a pure researcher) but i thought it would be difficult to depart from the field for so long 😛 I see the difference like working in a company as an electronic engineer (clinical neurologist in a hospital) and conducting theoretical research on quantum computation or something (neuroscience research at the university). Sure the best would be some combination of everything but (practically) it would be difficult nowadays. Unfortunately the system sucks 😛 (the system always 😛)

 

[IT514]

Since neuropsych has been brought up, I'll speak as a clinical neuropsychology student (3rd year Psy.D) who did a MA in higher education with a focus in humanities just for fun. In neuropsych, the degree to which you integrate the philosophical implications of neuroanatomy and neuropathology into your day to day work is sort of up to you.

I say sort of because the majority of my clinical training has been focused on very pragmatic stuff (nuances of testing, differential diagnosis, patient safety and advocacy, learning about insurance practices, etc). However, I always have tried to integrate my education in neuroanatomy & pathology with my thoughts about the nature of humanity, consciousness, etc.

My guess is that these kind of topics are more likely to be brought up in the course of a neuropsych eval as opposed to a neurology eval due to the different length and content of the evaluations. In the 4 hour outpatient neuropsych eval, all kinds of questions come up. I'm not saying its the norm, but it happens. My favorites include a patient with parkinson's who asked about how his visual hallucinations occur, and a TBI patient who asked about the implications of his soul with his minor personality change. In the dementia clinic where I have just 45 minutes to do a history and a 1/2 battery of neuropsych tests, they never come up simply due to time constraints.

 

[Mattchiavelli]

here's another way to think of it- going to med school and through a neurology residency, barring major catastrophe or personality issue or whatever, you will be a neurologist in the end. Going and getting a PhD in philosophy is going to get you making coffee at starbucks. Humanities programs in this country are getting totally gutted and you pretty much need divine intervention to get a job in your field.

That being said, I think having your interests will give you a leg up in understanding neurology and psychiatry, and I say this as someone getting ready to go into neurology residency next year that had similar interests to yours coming into med school. I say this because we deal with a lot of complex processes that other docs have trouble breaking down into their component parts- for example, seeing an object and naming it, hearing and responding appropriately to a question, standing from a chair, etc. To me, it is extremely rewarding to break down those complex processes, find specifically what the problem is, and then use that as a jumping off point to help patients find workarounds for their specific deficit. A lot of the cognitive processes are dealt with on a conceptual level that I guess you could say "works the same brain muscles" as thinking about philosophical issues.

In a more general way, physicians sit in an excellent position to inform philosophy of science [my undergrad institution had a small department called History and Philosophy of science], which had people that dealt with issues like rationing of healthcare, liberty vs public health in quarantine situations, ethical practice of medicine, the relationship of medicine with the pharmaceutical industry, etc. In your shadowing of neurologists try to talk to at least one person in academics, as they usually have a little more time to sit and ponder than in the cutthroat world of private practice.