Looking inside our heads

André Aleman, Professor of Cognitive Neuropsychiatry at the University of Groningen in the Netherlands, has a head-to-head with Nigel Bovey.

Professor, what does your work entail?

My background is in neuropsychology. I conduct studies on psychiatric syndromes, such as schizophrenia and depression, by investigating the brain and its disorders. Increasingly, we are focusing on the ageing process and mild cognitive impairment, which might be the early phase of dementia and Alzheimer’s disease.

What is psychiatry and how is it different from psychology?

Psychiatry is a medical specialism about mental disorders. Psychology offers a broader view of human thought processes – perception, memory, cognition and so on. A psychiatrist is a medical doctor, who can prescribe medication. A psychologist is not medically qualified.

What is cognitive neuropsychiatry?

It is a research approach that blends neuroscience and cognitive psychology. It is used to explain psychiatric syndromes – for example, the hearing of voices – by comparing them with healthy thought processes.

What attracted you to psychology?

At first, I was interested in clinical psychology – how the mind works and how to help people who have problems. But during my studies, I became more interested in the mysterious machine known as the brain. Studying the brain is the way to discover the cause of the symptoms, so I went into research to try to discover what goes wrong and why.

What tools do you use?

As well as interviews and conversations, we use brain imaging. But the scanning side of our work is still at the research rather than the diagnostic stage. For example, the brain scans of two people with the same symptoms may well be different, and someone with schizophrenia may show normal activation.

One day, brain scans will form a reliable part of prognosis, but we will never get to the point where psychiatric disorders such as depression and schizophrenia can be detected just by a scan, as they constitute many small changes that are widely distributed across the brain.

How do dementia and Alzheimer’s happen and how can they be cured?

There are a lot of investigations into proteins within the brain. Some medications have been developed to stop the ageing process, but we don’t really know how these conditions happen. At present, if someone has Alzheimer’s – where the cognition is so deteriorated that they cannot function independently – the brain is beyond repair. That’s why research is shifting to the earlier phases – periods of forgetfulness – where the brain is not as damaged.

What impact does diet have on preventing dementia and will solving sudokus help our brains stay healthy?

There is no magic food we should eat, but eating less is very good for the brain. People in the West eat too much. In Holland, 40 to 50 per cent of people over 60 are overweight. That is not good for the brain. We should have a healthy diet even when we are young.

There’s some evidence that fatty acids – oily fish, omega-3 – are good for the brain, but they do not make a big difference. We can make the biggest impact on the brain by not eating too much bad fat and sugar. Research shows that being mentally active helps to postpone brain decline but people should not focus on activities such as sudokus, which use one small area of the brain. Rather, they should consider a range of activities that use more parts of the brain.

Learning to speak a second language or to play a musical instrument is very good for the brain. It is said that an older person cannot learn these things. They can. They just might be a bit slower than a younger person.

Physical activity is more important than mental activity. Being active enough to raise the pulse rate for just half an hour a day will help the brain enormously.

Does alcohol damage the brain?

Alcohol can damage the brain, especially when it exceeds the recommended daily intake of one unit for women and two units for men. Drinking too much alcohol is literally bad for the memory, as it blocks the memory areas within the hippocampus and is toxic to the nerve cells. If someone drinks too much too often, it can contribute to the onset of Alzheimer’s.

To what extent is having a faith good for mental wellbeing?

Studies on successful ageing show that having an active spirituality helps in later life. People who read the Bible, pray and go to church have been shown to have emotional wellbeing and are better at handling stress.

The founder of psychoanalysis, Sigmund Freud, described religion as an illusion. Is faith all in the mind?

I don’t think so, but for some people it could be. People can have beliefs that are wrong. Some beliefs can be helpful, even if they are wrong. Some beliefs can be unhelpful, but can be true. For example, if a child goes to sleep believing that their father is at home and will protect them, psychologically that helps the child go to sleep, even if the father has, in fact, left the house. That’s known as a false belief, but it has a function.

Evolutionary psychologists would say that religious belief is false but functional. But, in the example, it is also possible for the father to stay in the house, so there is a basis for the child’s belief.

I believe there is an objective basis for religious belief and for the existence of God. Science cannot discard the possibility that God exists. Psychologically, it is very difficult to delude a group of people.

Where is a person’s soul?

The soul is an aspect of brain function. I agree with John Polkinghorne’s idea of dual aspect monism, where the brain and the mind can be considered as one entity but the mind cannot be reduced to a collection of nerve cells and thus needs a higher level of explanation. Even though brain and mind go together during life, I believe the soul can exist independently after death. However, how that happens may not be amenable to scientific investigation, as the soul is non-material.

How would you describe your own faith?

I am a Christian who subscribes to the confessions of the Reformed Church. I believe in God as the Creator of the Universe and in Jesus Christ as my saviour.

How and when did you become a Christian?

I grew up in a Christian family. My father was a licensed lay preacher. I always believed that God existed and the Bible was always powerful for me, but it was more of an intellectual faith. When I was 24, faith became much more personal. I felt the need of a saviour and that Jesus’ death on the cross was for my sins and for my forgiveness.

What convinced you that Jesus is the Son of God?

If you read the Gospel accounts of Jesus, you have to make a decision: Jesus is an important person and what he said is true and you have to take him seriously, or he was a lunatic. The Gospels convince me about Jesus.

What does your faith give you?

It gives me a relaxed attitude. God leads my life. I don’t have to worry about everything. I am inspired by my faith to treat others as I would like to be treated, and to be a peacemaker.

How does your faith affect your science?

I want my science to help other people, I want to be honest and ethical and to work as well as I can. When I see the intricacies of the brain and how it works, I am amazed at the ability of the Creator – not that I could write that in an academic paper!

New atheism claims that science has all the answers. Is that right?

Science uses blinkers and spectacles to see nature. Science is a powerful method of looking at and measuring the material world. As such, science is a limited enterprise – limited to measurable things.

But other things exist outside of the blinkers. You get a more complete view of the world by taking off the blinkers. As long as you are aware that science cannot explain everything, then there is no conflict between faith and science.

The Bible describes humankind as being made in the image of God. How are we made in God’s image?

The ability to think ahead, plan, organise and change our environment with a certain sense of autonomy is unique to humankind. Humans also uniquely self-reflect, have a sense of justice and are rational. Such high-level functions are reflections of God.

Talking to oneself is colloquially regarded as the first sign of madness. Is prayer a form of mental aberration?

Not even anti-Christian psychologists would say so, because they see that in most people, prayer is healthy. Schizophrenia patients talk to themselves, but in most cases they’re talking to their voices. That is associated with dysfunction, whereas prayer is not. If there is no objective evidence for the ‘object’ to which one is speaking, then that might be called a delusion, which is how someone who believes only that material things can exist might view it. If, however, you believe that non-material beings exist, then it makes sense that you might be able to communicate with them.

Christians believe that they hear God speaking to them. Are they mentally ill?

No. Psychiatric studies suggest that up to 10 per cent of healthy people sometimes hear voices giving advice or guidance. A common one – up to 25 per cent of people – is hearing your name when there is no one there who’s calling you. The voices that schizophrenics hear are usually nasty, abusive voices, criticising their behaviour.

There will also be physical indications. If a person hears God speaking to them, there will be activity in the speech-reception areas of the brain. This doesn’t mean they made it up, any more than brain activity in a concertgoer indicates that they made up the music.

Is there a spiritual part of the brain?

There is no separate section that is devoted to religion. Studies into religious experience show that a lot of the brain is involved – areas to do with emotion, attachment, bonding and spatial positioning.

To what extent is a spiritual experience just a chemical reaction?

It is, but that reaction can be triggered by the existence of God. Not all religious experiences are triggered by a higher being. There are many beliefs I don’t adhere to. For me, the Bible defines those that are God-inspired.

To what extent is evil a product of malfunctioning brains?

I believe that evil exists, but science does not make a judgment. Some evil people have healthy brains, others hear voices that command them to do hurtful things. Most schizophrenics are not dangerous. Sadly, they are often the victims of violence.

Does Christianity offer a distinctive view of mental health?

Christianity emphasises compassion and treating people, whoever they are, with respect and dignity. Such an approach helps to break the stigma of mental illness. Studies show that at some time one in five people will suffer from one of the 100-plus conditions listed in The Diagnostic and Statistical Manual of Mental Disorders – the bible of mental health professionals. So it is quite normal to have mental health problems.

Was ‘demon possession’ simply a biblical expression for mental illness?

It is not a mental disorder. The Bible often describes it as being accompanied by physical problems. For example, it describes a woman who couldn’t walk upright because of a demon. Many theologians suggest that while Jesus was active on earth the evil powers reacted strongly.

Is it a recognised condition today?

I do not exclude the idea that evil spirits can be at work today but I am very cautious because I do not want psychiatric patients to be regarded as though the Devil and the occult are behind their behaviour. Also, medication can be quite effective, and we wouldn’t think that you can send an evil spirit away with a pill.

Is it healthy to feel guilty?

If there is a basis for it, yes. But some people with depression feel guilty all the time and that’s not good. There are scientific indications that feeling guilty about something you’ve done wrong will improve your behaviour. As a Christian, I think guilt is important, as forgiveness is connected with confessing one’s sin.

This interview was conducted by Nigel Bovey and first appeared in The War Cry. It is used here with permission

Photo by Nigel Bovey