Stigma around technology use by older adults

Canadians are living longer, healthier lives, resulting in a rapidly growing population of older adults. It is projected that the number of adults aged 65 and over in Canada will grow by 68% over the next two decades (1). One way to support the quality of life of this growing demographic is through technology. Assistive technologies (AT) such as blood pressure monitors (2), wheelchairs (3), and fall detectors (4) can promote the physical health of older adults. Social robots, AT that can interact with users (Figure 1), can assist older adults by improving mood (5), decreasing blood pressure (6), and reducing the need for analgesic and behavioural medication (7). Everyday information and communication technologies (EICT) – including mobile phones, computers, and email services – allow for regular communication with social contacts (3) and the ability to look up health information (8). Telemedicine provides a unique healthcare solution for older adults who face barriers to in-person care such as isolation, severe illness, and functional challenges (9).

Figure 1 – Social robots such as MiRo-E can interact with users. Adapted from MiRo-E University Research

Despite the known benefits of these technologies, there is a wide range of barriers to technology adoption by older adults. Such barriers include privacy concerns (10), inappropriate device design (11), and a lack of familiarity with technology (12). Another barrier is stigma around the use of technologies by older adults (5,10,13). Negative stereotypes of old age include increased dependency, disability, and disconnection from society (13,14). Furthermore, within technology research, ageing is often regarded as a ‘problem’ that technology may address (15). In this piece, I will summarize the literature on stigma around technology use by older adults and how we might address this issue.

Older adults often associate AT with negative stereotypes about ageing. For example, some older adults have stated that they are not ‘disabled’ or ‘old’ enough to require AT (16). In one research study, older adults who stated that they did not need AT recommended these devices for people who experience isolation, dependency, and disability (17). Some older adults feel that adopting AT signifies a loss of independence (4), and others experience feelings of embarrassment and incompetency when using AT (12). Furthermore, some older adults have expressed preference for items that are not necessarily ‘assistive’ or ‘medical’ in nature, such as an umbrella in place of a walking stick (2), a smartwatch with assistive features (4), or a shopping cart in place of a walker (16). On the other hand, EICT such as smartphones and computers are often regarded by older adults as a way to keep up with society, and thus older adults associate non-use of these technologies with negative ageing stereotypes (13). However, when learning to use EICT, many older adults experience embarrassment, anxiety, or fear of making mistakes (2,18). Some have reported feeling ‘older’ after encountering vision and haptic-related challenges while using EICT (13). Altogether, the literature shows that technologies often remind older adults of negative aspects of ageing. As a result, older adults are less likely to adopt these technologies.

Non-use of the technologies described above raises several issues, including a key neuroethical problem: decreased access to mental health benefits. For example, several online services that can improve mental health – such as telemedicine and tele-counselling services – are accessed through technologies such as smartphones and computers. Research has shown that interacting with social robot technologies can improve mood (5), and technologies such as smartphones allow people to stay in touch with one another (3), especially during the current COVID-19 pandemic where in-person contact is restricted. These are just a few mental health benefits that older adults who limit their use of technologies have reduced access to. As a result, there is a need to address key barriers to technology adoption, such as stigma.

One of the most important things we can do to address issues of stigma and non-use is to engage end-users in the process of device development. Older adults are often not consulted when technologies are being developed for them, leading to devices that are often misaligned with their needs and priorities (19). A study by Federici et al. found that the most common reason for device abandonment was an inappropriate device design (11). Incorporating ideas and feedback from older adults about device design, features, applications, affective considerations, and ethical concerns into the creation and implementation of technologies will likely result in devices that this population is more comfortable using.

Bio: Jaya Kailley is an Undergraduate Research Assistant under the supervision of Dr. Julie Robillard in the NEST Lab, and she is pursuing an Integrated Sciences degree in Behavioural Neuroscience and Physiology at the University of British Columbia. She currently supports research projects that aim to include end-users in the process of social robot development. Outside of work, Jaya enjoys playing the piano, reading, and spending time with her family and friends.


References

  1. Infographic: Canada’s seniors population outlook: Uncharted territory | CIHI [Internet]. [cited 2022 Jun 16]. Available from: https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory
  2. Chen K. Why do older people love and hate assistive technology? ‒ an emotional experience perspective. Ergonomics. 2020 Dec 1;63(12):1463–74.
  3. Tomšič M, Domajnko B, Zajc M. The use of assistive technologies after stroke is debunking the myths about the elderly. Topics in Stroke Rehabilitation. 2018 Jan 2;25(1):28–36.
  4. Caldeira C, Nurain N, Connelly K. “I hope I never need one”: Unpacking Stigma in Aging in Place Technology. In: CHI Conference on Human Factors in Computing Systems [Internet]. New Orleans LA USA: ACM; 2022 [cited 2022 Jun 10]. p. 1–12. Available from: https://dl.acm.org/doi/10.1145/3491102.3517586
  5. Hung L, Liu C, Woldum E, Au-Yeung A, Berndt A, Wallsworth C, et al. The benefits of and barriers to using a social robot PARO in care settings: a scoping review. BMC Geriatr. 2019 Aug 23;19(1):232.
  6. Robinson H, MacDonald B, Broadbent E. Physiological effects of a companion robot on blood pressure of older people in residential care facility: A pilot study. Australasian Journal on Ageing. 2015;34(1):27–32.
  7. Petersen S, Houston S, Qin H, Tague C, Studley J. The Utilization of Robotic Pets in Dementia Care. Journal of Alzheimer’s Disease. 2017 Jan 1;55(2):569–74.
  8. Vroman KG, Arthanat S, Lysack C. “Who over 65 is online?” Older adults’ dispositions toward information communication technology. Computers in Human Behavior. 2015 Feb 1;43:156–66.
  9. Frydman JL, Li W, Gelfman LP, Liu B. Telemedicine Uptake Among Older Adults During the COVID-19 Pandemic. Ann Intern Med. 2022 Jan;175(1):145–8.
  10. Pirzada P, Wilde A, Doherty GH, Harris-Birtill D. Ethics and acceptance of smart homes for older adults. Informatics for Health and Social Care. 2021 Jul 9;1–28.
  11. Federici S, Meloni F, Borsci S. The abandonment of assistive technology in Italy: A survey of users of the National Health Service. European journal of physical and rehabilitation medicine. 2016;52(4):516–26.
  12. Evans N, Boyd H, Harris N, Noonan K, Ingram T, Jarvis A, et al. The experience of using prompting technology from the perspective of people with Dementia and their primary carers. Aging & Mental Health. 2021 Aug 3;25(8):1433–41.
  13. Köttl H, Gallistl V, Rohner R, Ayalon L. “But at the age of 85? Forget it!”: Internalized ageism, a barrier to technology use. Journal of Aging Studies. 2021 Dec 1;59:100971.
  14. Dionigi RA. Stereotypes of Aging: Their Effects on the Health of Older Adults. Journal of Geriatrics. 2015 Nov 12;2015:1–9.
  15. Vines J, Pritchard G, Wright P, Olivier P, Brittain K. An Age-Old Problem: Examining the Discourses of Ageing in HCI and Strategies for Future Research. ACM Trans Comput-Hum Interact. 2015 Mar 4;22(1):1–27.
  16. Astell AJ, McGrath C, Dove E. ‘That’s for old so and so’s!’: does identity influence older adults’ technology adoption decisions? Ageing and Society. 2020 Jul;40(7):1550–76.
  17. Wu YH, Wrobel J, Cornuet M, Kerhervé H, Damnée S, Rigaud AS. Acceptance of an assistive robot in older adults: a mixed-method study of human–robot interaction over a 1-month period in the Living Lab setting. Clin Interv Aging. 2014 May 8;9:801–11.
  18. University of Massachusetts Lowell, McDonough CC. The Effect of Ageism on the Digital Divide Among Older Adults. GGM. 2016 Jun 16;2(1):1–7.
  19. Mannheim I, Schwartz E, Xi W, Buttigieg SC, McDonnell-Naughton M, Wouters EJM, et al. Inclusion of Older Adults in the Research and Design of Digital Technology. Int J Environ Res Public Health. 2019 Oct;16(19):3718.

The significance of non-pharmacological treatments for depression in people living with dementia

As part of my role in the Neuroscience, Engagement, and Smart Tech (NEST) Lab at Neuroethics Canada, I conducted a review of non-pharmacological interventions for mental health in people living with dementia. What are these non-pharmacological interventions, and why are researchers so interested in studying them?

Among the 50 million people worldwide with a diagnosis of dementia, roughly 32% (16 million) report symptoms of depression (1). Within this group, half will have received a formal diagnosis of major depressive disorder. You may already be familiar with pharmacological or drug-based interventions for depression (e.g., antidepressants). However, in recent years, there has been a push for non-pharmacological treatment alternatives for people living with dementia.

Non-pharmacological treatments are defined as any activity or care plan to reduce symptoms of a given ailment. These interventions are often adjustable to accommodate the needs of the recipients, something traditional drug interventions lack.

The issues surrounding pharmacological treatments for depression

Various studies highlight some of the drawbacks surrounding the drug interventions commonly used to treat major depressive disorder. The findings of a 2013 study revealed that 69% of older adults from a data sample of 2 million received a prescription psychotropic without a formal psychiatric diagnosis (2). In addition, many were found to not be receiving any type of mental health specialty care (2).

Figure 1 – Weichers et. al (2013). Percentage of mental health care utilizers and non–mental health care utilizers without a psychiatric diagnosis who filled a prescription for psychotropic medication in 2009, by age and drug class. AD, antidepressants; AP, antipsychotics; ANX, anxiolytics; STIM, stimulants; MS/AC, anticonvulsant mood stabilizers; and LITH, lithium.

These results come with caveats. Not being able to qualify for a diagnosis does not negate the existence of a medical need, nor does it address the social barriers individuals may face in obtaining a diagnosis. Experiencing symptoms can drastically impact a person’s physical health and overall quality of life (3). Symptoms are expressed in a multitude of ways (e.g., lethargy, insomnia, changes in appetite, feeling discouraged or unhappy) and in varying intensities (4). Depression manifests itself differently for each individual and depending on their given situation, clinical treatment may have been the best course of action.

Nevertheless, the study results suggest that the current implementation of clinical approaches to treating depression may not meet the desired standards of care (2). Also consider the high relapse rates of major depressive disorder in individuals exclusively using pharmacological therapies (5).

The efficacy of drug interventions for treating depression in people living with dementia has been challenged by various studies (6,7,8). Evidence indicates that antidepressants are associated with an increased risk of recurrent falls, whereas non-pharmacological care alternatives have the potential to be just as effective as drug treatments with fewer risks (6,7).

Certain psychological treatments can match the effectiveness of clinical approaches to mood disorders (4), and a few are somewhat more effective (6). Drug interventions alone can be an effective treatment method for many (5,6,7). However, we must also assess the ethical considerations surrounding limited catalogues of treatment options only optimal for a subset of individuals.

Thus, there is unexplored potential in the application of non-pharmacological interventions as both a supplement to drug treatments and as their own form of care.

Sociocultural and ethical considerations

The myriad of issues related to treatments for mental health in people living with dementia are complex. A discussion regarding healthcare disparities and the socioeconomic and cultural barriers to care could warrant a post of its own. Here, I will attempt to summarize a few.

  • Stigma — There may be cultural stigma surrounding mental health and treatment (8,9). Individuals who inherit cultural values from their respective culture or community may not feel comfortable with western conventions of mental health. Thus, given how drug interventions are prescribed in Canada, pharmacological treatments may not be the most effective or accessible option.
  • Economic factors — Prescription drug costs contribute to the inaccessibility of treatment. Canada is the only developed country with a universal healthcare system that does not cover the cost of prescription drugs. Older adults without private health insurance may be left in a difficult position (10).
  • Location — Individuals living in rural or remote locations may face difficulty with filling their prescriptions over an extended period (11).

There are many more issues pertaining to the limitations of drug interventions in current healthcare models. Thus, there is value in exploring non-pharmacological treatment alternatives (6).

How non-pharmacological interventions for depression can be used

In recent years, there has been growing interest in social prescribing: the act of linking patients with non-drug interventions in their community (6). While non-profit organizations such as the Alzheimer’s Society of BC are unable to prescribe medication, they can provide low or no-cost services aiming to support mental health.

Implementing these non-pharmacological interventions can also be a quite simple. Some common, low-cost interventions that are easy to implement include:

  • Reminiscence therapy — Remembering or sharing details about the past or previous positive events, either alone or with a group. Reminiscence therapy can improve quality of life, cognitive functions, and lower depression (12).
  • Exercise — Exercising the body and the mind can reduce symptoms of depression and improve the overall quality of life (6).
  • Music therapy — Listening to music regularly with a music therapist can improve symptoms of depression (13).
  • Indoor Daylight Exposure —People living with dementia at a nursing home socialized with each other in an indoor setting with ample amounts of daylight each morning. Daylight exposure was found to significantly reduce symptoms of depression (14).

These interventions do not present as very psychological or medical in nature. By framing activities that may reduce symptoms of depression in an approachable, non-clinical manner, care providers could avoid the stigmas around treatment for mental health to encourage greater use of mental health services (15). However, this does not address the issues surrounding mental health perception and discourse. More research is needed to better understand how we can effectively tackle these stigmas.

Providing evidence-based, low-complexity care can also enable people living with dementia to form deeper bonds with their local community and create their own support network. The low cost of execution makes these interventions a great option for treating mild symptoms of depression.

Complex interventions that target more severe symptoms of depression and aim to create lasting effects also exist. These require a higher degree of training from providers and thus are more costly, but evidence highlights their value as potential treatment options (6, 16, 17, 18). Examples include:

  • Cognitive-behavioral therapy (CBT) — Breaking down existing negative cognitions and replacing them with more positive functionally adaptive ones (16) can reduce symptoms of both depression and anxiety (6, 17, 18).
  • Multidisciplinary care — A care plan developed in collaboration with multiple qualified healthcare providers can match the efficacy of drug treatments (6).

There are many other approaches: animal-assisted activities, psychotherapy, cognitive stimulation, and environmental modification, to name a few (6). Non-pharmacological interventions also have the advantage of being flexible and adjustable to one’s individual needs. For example, Shiatsu could be an interesting approach for people with dementia of East Asian descent.

  • Shiatsu — A holistic complementary practice that draws on the principles of traditional Chinese medicine. By applying pressure to certain pressure points, symptoms of depression were reduced when utilized in combination with exercise (19).
Figure 2 – a man performs Shiatsu therapy (left) with a focus on key acupressure points (right).
Credit: Shiatsu Tokyo School, 2021.

Many treatment options exist where traditional drug-based interventions are not appropriate. Individuals could develop a personalized care plan with careful guidance from a qualified medical professional.

There is still an important need for drug interventions. For a subset of the population, it remains quite effective (5,6).

The value in exploring various non-pharmacological treatments has much to do with the agency it gives the individual and how it makes mental health care more attainable to people of all socioeconomic and cultural backgrounds.

Looking to the future

Non-pharmacological interventions may reduce the burden of depressive symptoms in older adults with dementia. Within the next few decades, the global population will continue to age and the number of people living with dementia is expected to increase to 152.8 million cases by 2050 (20). Thus, the need for programs supporting the well-being of older (and younger!) adults with dementia is greater than ever.

In neuroethics research, the way non-pharmacological interventions are received and their overall effectiveness can be studied to highlight healthcare disparities and bring insight into public discussions surrounding brain health and aging. This research may inform initiatives that aim to address the gap in services related to mental health in people living with dementia.

By deepening our understanding of how people living with dementia respond to non-pharmacological interventions, we can improve current treatment approaches and the standard of care. Every individual should have the option to receive the type of care that best suits their specific medical needs.

Special thanks to Dr. Julie Robillard and Viorica Hrincu from the NEST Lab for all their guidance and support in the last year!

Bio: Yu Fei Jiang is a 4th-year undergraduate student studying Behavioural Neuroscience at the University of British Columbia. Her research interests primarily lie in the interaction between technology use in patient care and neuroscience research. She’s also very passionate about science communication and sharing knowledge with others. Outside of work, Yu Fei enjoys all things nerdy; you’ll probably find her either reading books of wildly different genres or playing video games late into the night.


References

1. Goodarzi ZS, Mele BS, Roberts DJ, Holroyd-Leduc J. (2017). Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta-Analysis. J Am Geriatric Society, 65, 937-48. Doi.org/10.1111/jgs.14713

2. Wiechers, I. R., Leslie, D. L., Rosenheck, R. A. (2013). Prescribing of psychotropic medications to patients without a psychiatric diagnosis. Psychiatric Services, 64(12), 1243–1248. https://doi.org/10.1176/appi.ps.201200557

3. Ruo, B., Rumsfeld, J. S., Hlatky, M. A., Liu, H., Browner, W. S., & Whooley, M. A. (2003). Depressive symptoms and health-related quality of life: the Heart and Soul Study. Jama, 290(2), 215-221.

4. Spitzer, R. L., Kroenke, K., Williams, J. B., Patient Health Questionnaire Primary Care Study Group, & Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Jama282(18), 1737-1744.

5. Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatment. University of Pennsylvania Press.

6. Watt J A, Goodarzi Z, Veroniki A A, Nincic V, Khan P A, Ghassemi M et al. (2021). Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis BMJ; 372 :n532 doi:10.1136/bmj.n532

7. Marcum, Z. A., Perera, S., Thorpe, J. M., Switzer, G. E., Castle, N. G., Strotmeyer, E. S., Simonsick, E. M., Ayonayon, H. N., Phillips, C. L., Rubin, S., Zucker-Levin, A. R., Bauer, D. C., Shorr, R. I., Kang, Y., Gray, S. L., Hanlon, J. T., & Health ABC Study (2016). Antidepressant Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study. The Annals of pharmacotherapy50(7), 525–533. https://doi.org/10.1177/1060028016644466

8. Ng, C. H. (1997). The stigma of mental illness in Asian cultures. Australian & New Zealand Journal of Psychiatry, 31(3), 382-390.

9. Ciftci, A., Jones, N., & Corrigan, P. W. (2013). Mental health stigma in the Muslim community. Journal of Muslim Mental Health, 7(1).

10. Morgan, S. G., & Boothe, K. (2016). Universal prescription drug coverage in Canada: Long-promised yet undelivered. Healthcare management forum, 29(6), 247–254. https://doi.org/10.1177/0840470416658907

11. Hippe, J., Maddalena, V., Heath, S., Jesso, B., McCahon, M., & Olson, K. (2014). Access to health services in Western Newfoundland, Canada: Issues, barriers and recommendations emerging from a community-engaged research project. Gateways: International Journal of Community Research and Engagement, 7(1), 67-84.

12. Lök, N., Bademli, K., & Selçuk‐Tosun, A. (2019). The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial. International journal of geriatric psychiatry, 34(1), 47-53.

13. Li, H. C., Wang, H. H., Lu, C. Y., Chen, T. B., Lin, Y. H., & Lee, I. (2019). The effect of music therapy on reducing depression in people with dementia: A systematic review and meta-analysis. Geriatric Nursing, 40(5), 510-516.

14. Konis, K., Mack, W. J., & Schneider, E. L. (2018). Pilot study to examine the effects of indoor daylight exposure on depression and other neuropsychiatric symptoms in people living with dementia in long-term care communities. Clinical interventions in aging, 13, 1071.

15. Corrigan, P. (2004). How stigma interferes with mental health care. American psychologist59(7), 614.

16. Taylor, F. G., & Marshall, W. L. (1977). Experimental analysis of a cognitive-behavioral therapy for depression. Cognitive Therapy and Research, 1(1), 59-72.

17. García-Alberca, J. M. (2017). Cognitive-behavioral treatment for depressed patients with Alzheimer’s disease. An open trial. Archives of gerontology and geriatrics, 71, 1-8.

18. Tay, K. W., Subramaniam, P., & Oei, T. P. (2019). Cognitive behavioural therapy can be effective in treating anxiety and depression in persons with dementia: a systematic review. Psychogeriatrics, 19(3), 264-275.

19. Lanza, G., Centonze, S. S., Destro, G., Vella, V., Bellomo, M., Pennisi, M., … & Ciavardelli, D. (2018). Shiatsu as an adjuvant therapy for depression in patients with Alzheimer’s disease: A pilot study. Complementary therapies in medicine, 38, 74-78.

20. Nichols, Emma, et al. (2022). Estimation of the Global Prevalence of Dementia in 2019 and Forecasted Prevalence in 2050: An Analysis for the Global Burden of Disease Study 2019. The Lancet Public Health. 7(2):105–25.

Experimental Neuroethics

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Photo credit: Timothy Epp, Shutterstock

Four years ago, Neil Levy gave the concluding lecture at the first Brain Matters conference in Halifax. He alerted the audience of neuroethicists to the fact that the field of philosophy was undergoing a revolution – rather than muse from their armchairs in the ivory tower, a group of renegade philosophers were carrying out real experiments, asking people what their intuitions were about central issues in philosophy. Dubbed experimental philosophy, the new initiative was met with more than passing resistance from traditional philosophers. The apostate experimental philosophers responded by developing a logo of a burning armchair.

The landmark experiment was carried out by Josh Knobe, and its findings subsequently became known as the Knobe effect (you can watch a great recreation of the phenomenon in this YouTube video). Essentially, what Josh did was repurpose an old method from social psychology called the contrastive vignette technique (CVT) [1]. At its simplest, the CVT involves designing a pair of vignettes that carefully describe a particular situation (in the case of experimental philosophy, one that is often morally charged) but crucially differ in one detail, hence the term contrastive. Respondents see one and only one version of the vignette, and are then asked questions about what they have just read, with responses commonly recorded as a numerical rating on a Likert scale. By comparing the averaged responses between separate groups of people who have read the vignettes, the experimenter can systematically investigate the effects of small changes (of which the respondents are entirely unaware) upon attitudes towards nearly any topic. The experimental philosophers tend to use the technique to explore the meaning of concepts. Neil Levy pointed out that this same approach could, in principle, be applied to the full range of issues in neuroethics.

Neil’s presentation struck me like a thunderbolt. I had come to the field of neuroethics with a background in cellular and molecular biology, and had spent much of my career as a card-carrying reductionist: as a graduate student in the 1980’s, I championing the then-novel technique of recording from single neurons in freely moving animals, and as a postdoc I moved on to the better controlled (if less naturalistic) technique of patch clamp analysis of identified neurons in slices of brains. My subsequent rise through the ranks of academia was one in which I applied quantitative rigor to every question that I asked, and in the circles in which I traveled, this was lauded as the ultimate way to provide reproducible (and by inference, meaningful) results. I saw at once that the CVT opened the door towards doing something similar in the field of neuroethics.

My research group at the National Core for Neuroethics has embraced the use of contrastive vignettes wholeheartedly, and with a nod to the experimental philosophy camp, we call the approach Experimental Neuroethics. The team is applying the technique to a range of issues in contemporary neuroethics, probably best exemplified by our recent publications exploring public attitudes towards cognitive enhancement [2] as well as the acceptability of overt and covert nudges [3].

If the vignettes appear simple, I can assure you that properly crafting them is hard work. We begin with a carefully considered hypothesis and regularly find that the hypothesis morphs substantially (usually into something much more insightful) as the process unfolds. We then compose two or more contrastive vignettes, working hard to have the vignettes as minimally contrastive as possible (one word differences between vignettes is the ultimate goal, but this is often not feasible). Finally, we develop questions; we like to have the wording of the questions always be identical irrespective of the contrastive nature of the vignette.

Then the real fun begins. After a day or two, we assemble as a team and attack our previous work. Inevitably, we find it wanting in some respect. Sometimes, embarrassingly so. We find it best to begin by asking whether the vignette and the questions directly address the hypothesis. Sometimes that means that the hypothesis changes. Nearly always, that means that the vignette changes. This process is repeated again and again, over days and weeks and sometimes months (yes, and even sometimes years!) until we have a set of vignettes that get to the heart of the matter.

At some point late in the process we carry out cognitive pre-testing. This involves sharing the vignette and the questions with someone who has no particular expert knowledge (friends of friends are likely culprits), and debriefing them about what they read. We are sometimes amazed to find that what we intended for people to glean from a vignette is at odds with their reading of the vignette. That sends us back to the drawing board.

We also run some metrics to determine whether the words we have used are understandable by a general audience. We use online readability tests such as this one to establish the educational level required for understanding the vignette; our goal is that no more than a high school education is required. Finally, we launch the survey, recruiting respondents from amongst the thousands of people who have signed up on Amazon’s Mechanical Turk – they’re more representative of the real population and aren’t as blatantly WEIRD as typical undergraduate samples. And then we hold our breath.

Once the data is analyzed, we get mired once again in deep discussion. For it is not just the quantitative aspect of Experimental Neuroethics that it satisfying (to me), but also that the data gives us an entirely new benchmark for engaging in the process of wide reflective equilibrium. Throughout this process we remain aware that an ought can not derive from is, but having the data at hand, our version of ought is very much informed by the is. Ultimately, our data emerge in concert with our normative insights, and then one more advantage of Experimental Neuroethics is realized: it is easy for others to replicate our experiments, or even to improve them by taking our vignettes and modifying them to further test their own. This iterative process of replication, critique, and systematic modification has proven to be a robust strategy for advancing insights into the nature of biological and physical phenomena. Only time will tell whether Experimental Neuroethics catches fire in our discipline as it has in the field of philosophy (where it remains controversial). If it does, we can trace it back to Neil’s presentation in Halifax….

[Cross posted at the Neuroethics Blog]


[1] Burstin K, Doughtie E, Raphaeli A. Contrastive Vignette Technique: An indirect Methodology Designed to Address Reactive Social Attitude Measurement1. Journal of Applied Social Psychology. 1980;10(2):147–65.

[2] Fitz NS, Nadler R, Manogaran P, Chong EWJ, Reiner PB. Public attitudes toward cognitive enhancement. Neuroethics. 2013 doi: 10.1007/s12152-013-9190-z.

[3] Felsen G, Castelo N, Reiner PB. Decisional enhancement and autonomy: public attitudes towards overt and covert nudges. Judgment and Decision Making. 2013;8(3):202–13.

Graphic Warnings on Cigarettes: Nudge or Shove? A Neuro-Perspective

Although the topic of cigarette packaging regulation may not leap immediately to mind when one thinks “neuroethics,” this Bob Greene opinion piece over at CNN nonetheless touched off a stimulating discussion among some of us at the Core recently. The neuroethics connection, in fact, struck us as quite natural: our group has researched (and blogged about) the ethics of “nudging” frequently of late, and, as I worded it when I first emailed the article around, “certainly the images at issue here are a kind of behavioural nudge.” The question that we grappled with was whether the kind of nudge that the graphic warning labels provide is warranted in the case of cigarettes. And, indeed, that discussion called my original characterization into question. Do these labels truly constitute a nudge – a subtle biasing technique that makes a particular option more cognitively accessible than another while preserving the freedom to choose between them – or are they something more akin to a “shove?”

One of the least gruesome of the proposed images for cigarette packs.

As with any highly politicized issue, the question of whether cigarettes ought to be labeled with disturbing imagery is likely to be filleted into oblivion by pundits, bloggers, legal experts, economists, et cetera, et cetera. All I hope to do here, then, is sketch some ways in which the view from neuroethics – informed as it is by philosophy and the cognitive sciences – can shed some interesting and hopefully useful light on the question. Continue reading

TDCS does not reduce the authenticity objection

In an essay in recent issue of Current Biology, a team of neuroscientists and philosophers examine the neuroethics of transcranial direct current stimulation (TDCS), a relatively inexpensive means of modifying human brain activity that is touted as potentially being at the forefront of a new wave of cognitive enhancement. The article has garnered a great deal of interest in the press (for example here and here and here), and the reasons are unsurprising: the prospect of a device that is cheap (probably), safe (maybe), and effective (time will tell) is something akin to the holy grail of cognitive enhancement. If the initial claims for TDCS hold up, the device may have an impact the practice of enhancement in the relatively near term. As a result, the urgency with which our community must think through the relevant ethical issues intensifies. Continue reading

The trolley problem and the evolution of war

The trolley problem is a famous thought experiment in philosophy, and runs something like this.

A runaway trolley is hurtling down a track. Five people have been tied to the track directly in front of the trolley, but there is a switch which allows the trolley to be diverted to an alternative track where one person has been tied to the track. You are standing at the switch and see the disaster unfolding. What do you do?  Most people answer that they would flip switch, killing one to save five – classic utilitarian thinking. The trolley problem has been embellished in a variety of interesting ways. The most famous of these is called the fat man problem: 5 people are tied to the track as before, but now there is a fat man on a bridge over the track, and if you push him off, he will fall before the train, stopping it and saving 5 people as before; of course, the fat man dies in the process. People who were willing to pull the switch to save 5 people tend to be reluctant to push the fat man off the bridge. Philosophers suggest that this reluctance is based upon deontological thinking, where one’s deep-seated values determine one’s actions rather than cool rational thought. Continue reading

Neuroethics Journal Club: Judging Mens Rea

The National Core for Neuroethics had a lively journal club discussion recently on a paper by Bertram Malle and Sarah Nelson that dealt with “the tension between folk concepts and legal concepts of intentionality.” As I was presenting the paper and facilitating the discussion, I decided to blog about it to share some of the highlights with our readers and crystallize my own thoughts on the matter, stirred up as they were by the proceedings.

The basic gist of the paper is as follows. Malle and Nelson identify “the valid and precise use of the concepts of mental states in reasoning about the defendant’s actions and in assigning responsibility, blame, and punishment” as a central challenge in creating a system of criminal adjudication. (One interesting point to consider going forward is how these same issues might apply to the context of torts, where instead of the epistemic criterion being “beyond a reasonable doubt” one is instead prompted to consider “the balance of evidence.”) In legal contexts, the term used to refer to the mental states in question is mens rea, Latin for “guilty/sinful mind.”

The specific mental state that the paper is concerned with is intention, especially as it relates to intentional action. In the grand tradition of experimental philosophy (though it really wasn’t yet a tradition in 2003!), Malle and Nelson find the by-now familiar faults with how these concepts have been developed in legal theory and philosophy – with theories of intentional action checked primarily against the intuitions of a small, non-representative group of participants in the debate, leading to a confusing mismatch between how the law asks us to use concepts, and how we (generally) are inclined to actually use them.

The paper explores the possibility of replacing the contorted and awkward legal concept of intentionality (here used as a synonym for intentional action) with a “folk” theory, one which Malle and a then-lesser-known Joshua Knobe had already undertaken to construct via several studies. Malle’s rationale is that, should the folk concept of intentionality prove to be consistent in its use and appropriate to the goals of law, it will be a natural successor to the status quo. Continue reading

Does the Science of “Prosocial Behaviour” Smuggle in a Political Prior?

Over at Pharyngula, PZ Myers’ reliably lively ScienceBlogs province, a recent post offers some incisive treatment of a philosophically arresting debate between Sam Harris and sundry interlocutors, most prominently Sean Carroll. The topic – whether science can answer moral questions, or, more perilously rendered, whether one can, in fact, derive “ought” from “is” – exerts a tidal attraction upon my blogging muscles, but I can resist for now; Myers’ relevance to this entry issues specifically from a choice bit of phraseology in his write-up.

When Harris claims that the discernment of human well-being (and hence of utility-maximizing courses of action) is a purely empirical matter, Myers finds him guilty of “smuggling in an unscientific prior in his category of well-being.” What I want to explore after the jump is the following possibility:

It may be that the developing body of work in neuroscience and psychology probing various morally charged phenomena has been smuggling in a politically loaded prior under the terminologically neutral guise of the category “prosocial behaviour.”

Continue reading

Neuroethics, qu’est que c’est?

I’ll admit that it may seem odd, or perhaps even unnecessary, to begin a post on a neuroethics blog to query the meaning of neuroethics. Although barely into its 8th year as an academicized field of study, the area of inquiry called “neuroethics” has developed a professional society, an academic journal devoted to issues that fall within the bioethics-neuroscience scope, another bearing its namesake, books (e.g., here, here, here, and here), and a few blogs (e.g., here & here) — including this one. Although the Dana Foundation’s “Neuroethics: Mapping the Field” conference is often credited as jump-starting neuroethics, it appears others have being ‘doing neuro-ethics’ well before the conference took shape (see, for instance, Gillett and also Churchland).

In an influential paper, Adina Roskies attempted to define neuroethics by demarcating the “ethics of neuroscience” from the “neuroscience of ethics”(Roskies does note, however, that these two aims can be pursued independently but also tend to affect one another). Roskies original account described the ethics of neuroscience as being somewhat akin to what has been a traditional focus of bioethics research, namely, the ethics of something, e.g., conducting neuroscience research with humans, the ethics of neurotechnology (e.g. deep-brain stimulation) and guidelines for research and clinical practice. The neuroscience of ethics focuses on how philosophical notions of free will, identity and other aspects of moral cognition can be explored through understanding how the brain works. Perhaps a simplistic explanation, since the paper was published in 2002 Roskies’ conception has had an impact on how neuroethics has taken shape. Continue reading

The Science of Love: A Neuroethics Journal Club

Last week, the Core celebrated an early Valentine’s Day by breaking open a box of chocolates and engaging in a lively journal club discussion on Love. The paper, a seminal piece by Aron et. al (Reward, Motivation, and Emotion Systems Associated With Early-Stage Intense Romantic Love), set the stage for a rich exchange on topics ranging from the neurobiology of love and sex, to the rise of folk neuroscience and potential applications of a “love potion”.

The conversation opened with an anecdote from my experience as a research assistant at Stanford, where I worked in conjunction with Art Aron on a exploration of romantic love and analgesia (Younger et. al, in submission).

The story went something like this:

When I began working on the ‘love project,’ I was a nineteen year-old who, like most people of my age and generation, believed that romantic love was nothing short of supernatural. Raised on a steady diet of Disney Princess stories and bubblegum pop, my first exposure to the neurobiology of love was shocking and uncomfortable.

The body of scientific literature seemed to taunt me from the pages of PubMed. ‘Of course there is no cupid shooting arrows! Unless ‘cupid’ is a cute way of saying, “dopamine-rich areas associated with mammalian reward and motivation systems” (Aron et. al). Love happens in your brain!’ Not only that, the literature snickered, love is not special to your brain; it happens in everyone’s brains via roughly the same mechanism.

It was like finding out that ‘Santa’ is just your mom in a red bathrobe.

Although I was certainly disillusioned,  my discomfort ran deeper than the discovery of a tangible truth behind love’s mystery. Below are some of the questions that plagued me during my initial investigation, as well as a some of the journal club musings in response. Continue reading