The Dual Application of Neurofeedback Technique and the Blurred Lines Between the Mental, the Social, and the Moral
Recent neuroscience studies have reported that neurofeedback training with the use of functional magnetic resonance imaging enables the regulation of an individual’s cognitive, emotion-related, and behavioral states through a real-time representation of her brain activities. Since this technique has been applied not only to clinical research to, for example, mitigate mental or psychiatric symptoms but also to non-clinical research to, for example, change the cognition or preferences of a so-called healthy participant, neurofeedback-based cognitive and/or moral enhancements may be realized in the future. However, neurofeedback-based human enhancement is not the only issue that requires neuroethical consideration. I examine why and to what extent the dual application of neurofeedback technique will blur the lines between the mental, the social, and the moral, threatening some social norms, such as individual freedom and diversity. First, I consider the link between the mental and the social in psychiatry. Examining the definition of “mental disorder” provided by the American Psychiatric Association, I show that the mental is partly defined through social performance. Second, I make explicit the link between the social and the moral and argue that moral evaluation of an activity is gently but positively correlated with its social evaluation. Third, I demonstrate the links between the mental, the social, and the moral. In spite of a great deal of effort to distinguish these notions, the possibility of the dual application of this technique blurs the lines between them. Fourth, I examine whether such blurred lines signal sociocultural evolution or dystopia and argue that it can be understood as a beginning of the second advent of ethical virtue. I conclude that further cautious consideration of neuroethics is required because the establishment of this technique may have unique influences on our society.
KeywordsEnhancement Mental disorder Moral education Neuroethics Virtue ethics
Recent neuroscience studies have reported that neurofeedback training with the use of functional magnetic resonance imaging (fMRI) enables self-regulation of an individual’s cognitive, emotion-related, and behavioral (CEB) states by adjusting her brain states through a real-time representation of her brain activities (Watanabe et al. 2017). During neurofeedback training, neuroimaging devices monitor subject’s brain activity in real time, calculate the similarity between the current brain state and the target state, and display a metaphorical image of it, such as the size of a fire or circle which changes in corresponds to the degree of similarity. For example, the more similar the subject’s brain state to the target state, the larger (or smaller) the size becomes. Accordingly, the subject can train her brain to activate in a specific pattern only by trying to control their size. This technique is versatile because, in theory, any functional state can be regulated to some extent once the neural correlates and the target states are identified. At present, a survey shows that the efficacy of this training is reported against various mental or psychiatric disorders as well as several cognitive or emotion-related functions of so-called healthy people (Tachibana 2017a).
The dual application of this technique has led some neuroscientists and neuroethicists to discuss the possibility of neurofeedback-based enhancement (Jotterand and Giordano 2015; Scharnowski and Weiskopf 2015). These discussions show that neurofeedback-based enhancement has several advantages against other bioenhancements, such as safety in training, non-invasiveness of devices, and flexibility in target brain states such as emotion, cognition, and behavior. By virtue of these and other advantages, neurofeedback training can be a tool for moral neuroenhancement in particular and play a part of the traditional moral education network to which various educational scenes, such as upbringing at home, teaching in school, and relationship in local community, belong. The peripheral differences are observed between traditional and neurofeedback-based moral educations, such as the tools they adopt or the information they use. However, such differences would not be severe nor essential enough to prevent neurofeedback training from being a part of traditional moral education because traditional moral education is an amalgam of various interventions that are performed in different contexts. Such contexts include not only home upbringing, school environment, or local community but also friends and impressions from novels or movies. Some are performed intentionally, while others are not. Some are well reasoned, while others are not. Nevertheless, each is endorsed as a legitimate or traditionally approved tool for moral and character development. Any important difference cannot be found between neurofeedback moral training and those interventions in traditional moral education. Rather, they share many similarities: both are non-invasive, flexible but effective, physically safe, and drug free, appreciate the value of effort, and are compatible with moral diversity. Thus, neurofeedback training can be a part of the traditional moral education network (Tachibana 2017b).
However, neurofeedback-based human enhancement is not the only issue that requires neuroethical consideration. The establishment of the dual application of this technique, namely, clinical use of neurofeedback technique and neurofeedback-based human enhancement, may blur the lines between the mental, the social, and the moral, leading to further ethical and sociocultural considerations. I examine how this blurring occurs and assess its ethical implications. As discussed in the following sections, a key consideration is the conceptual, transitive relationship between the mental, the social, and the moral.
First, let me clarify the meaning of the word “conceptual” in the present article. A conceptual relationship between two notions or terms means that the collective usage of a notion by ordinary people is difficult to understand without understanding the other notion. Although a professional philosopher can articulate another kind of relationship between terms, such a relationship would not reflect their use by ordinary people. In contrast, I will consider how the dual application of neurofeedback techniques can change ordinary people’s way of thinking about the relationship among the mental, the social, and the moral. In this sense, a conceptual relationship between two notions held by ordinary people can also be considered to be a phenomenological relationship. Accordingly, the words “conceptual(ly)” and “phenomenological(ly)” are used interchangeably in the present article.
The Relationship Between the Mental and the Social
[A mental disorder is] a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning [and is] usually associated with significant distress or disability in social, occupational, or other important activities. […] Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. (APA, ed. 2013, p. 20; italics added by the author)
This definition suggests a close relationship between mental states and human performance in social activities in the way that the former is partly defined through the latter. This relationship seems to have three aspects. First, the distress experienced by an individual with a mental disorder occurs in her social, including occupational, activities. Therefore, this distress can be described as social distress. Second, social distress is caused by a disturbance in an individual’s CEB. Given that the performance deterioration in CEB causes social distress, it also causes the social performance deterioration because the CEB performance deterioration causes social distress if and only if the deterioration can be understood as social performance deterioration. In other words, CEB performance decides or, at least, influences social performance. Third, the disturbance must reflect dysfunction in the psychological, biological, or developmental processes that underlie mental functioning. Thus, social distress that does not reflect any such dysfunction is not regarded as the result of a mental disorder; a so-called healthy person may suffer from severe social distress, but she is not mentally disordered unless a psychiatric dysfunction is observed.
It is noteworthy that the APA’s definition does not deny that a healthy person can satisfy the first two features. She may suffer from social distress due to disturbances in CEB or social performance deterioration, similar to a person with a mental disorder. The only difference is what causes the distress and disturbance. In an individual with a mental disorder, they are caused by dysfunction of the psychological, biological, or developmental processes underlying mental functioning, whereas in a healthy individual, they are caused by other factors, such as culturally acceptable stress or loss. Accordingly, the APA’s definition of mental disorders permits the idea that healthy people and those with mental disorders may have similar social distresses, CEB disturbances, and social performance deterioration. This point is also supported by the dimensionally assessed continuity that exists between healthy and mentally disordered people (APA 2013; Blumenthal-Barby 2014).
The mental is conceptually connected to the social in that a mental disorder is partly defined as a social distress caused by CEB disturbance or social performance deterioration, which may also be experienced by healthy people. The mental and the social are linked because the mental state of a person is partly evaluated through her social performance.
The Relationship Between the Social and the Moral
The conceptual link between the social and the moral in ordinary people can be observed through the lens of a long-standing dispute among moral philosophers, including deontologists, utilitarians, and virtue ethicists, regarding the definition of moral. Here, I introduce Moore’s distinction between “good (or goodness)” and “the good,” which states that good(ness) is an abstract notion on what it is like to be good or, in short, the definition of good, whereas the good is that which is good (Moore 1903, Chap. 1, Sect. 9). Following Moore’s distinction, I distinguish between morality (or simply moral) and the moral. The former is an abstract notion on what it is like to be moral or, in short, the definition of moral, whereas the latter means that which is moral. Although Moore himself does not think that morality (or good) can be defined even if the moral (or the good) can be well listed, I use merely the distinction itself without committing myself to the (im-)possibility of defining morality (or good).
In fact, in spite of Moorean impossibility of the definition of morality, moral theories give their own definitions of morality. Utilitarianism defines morality as the greatest happiness of the greatest number, deontology defines it as the duty, and virtue ethics defines it as such a character as a virtuous person would have. According to their own definitions, they also give a list of the moral, that which is moral. Utilitarianism says a behavior which produces the greatest happiness of the greatest number most is morally good, deontology says a will which follows duty is morally good regardless of its consequences, and virtue ethics says will and behavior based on virtuous character are morally good. The longevity of this dispute suggests that these theories may provide “mutually exclusive” definitions of morality, implying that any of these theories could simply be false. This encourages skepticism to assume that neurotechnology cannot serve as a legitimate tool for moral bioenhancement so long as the notion of morality remains uncertain (Sparrow 2014).
However, it would be wrong to assume that major moral theories do not reflect any aspect of our collective understanding of morality; as Aristotle rightly states, well-known and long-lasting opinions on human morality include a true opinion on the subject matter (Aristotle 1998, Book VII, Chap. 1; Owen 1961). Rather, this dispute reveals a new perspective on the notion of morality that may have been overlooked by skeptics; that is, these divergent theories of morality highlight diverse aspects of human morality, each of which is taken seriously in our daily lives. We acknowledge not exclusive-disjunctively but conjunctively that notions, such as will—which can be understood as rational decisions based on emotion and cognition that occur prior to behavior—, behavior, and character (i.e., emotion and cognition), are emphasized as the core of human morality by deontology, utilitarianism, and virtue ethics, respectively. Additionally, these factors approximately correspond to CEB. An inability to solve the centuries of dispute among moral philosophers might indicate that our current notion of morality is not sufficiently sophisticated or coherent. However, we can still argue that this dispute does not merely carry a negative claim; it also permits us to draw a positive lesson. That is, the “mutually exclusive” definitions posited by different moral theories, which can be approximately summarized as CEB, represent different but presumably core aspects of our collective understanding of morality, and therefore, the ways in which CEB or CEB performance influences humans’ performance of moral activities (i.e., moral performance).
Once we establish the link between CEB and moral performance as well as the link between CEB and social performance, then we can also observe a link between moral and social performances, for CEB performance determines both. Yet, this does not imply that moral performance is equal to social performance because socially beneficial performances, such as prosocial behavior, can be morally bad in some cases (Chan and Harris 2011). Still, there is a link between them because moral performance is, regardless of the moral theory adopted, generally evaluated within a social context in which an activity occurs and is broadly and gently correlated with the social evaluation of the activity.
In fact, the positive correlation between moral and social evaluations of an activity can be observed, at least, in two contexts. First, it can be observed in the complementary relationship between moral and legal judgments (Tachibana 2008). As Judith Shklar (1986, pp. 109, 144) stated, “law and legalistic morality [are] not separate entities but a single continuum,” because legal evaluation, “like all political acts, does not take place in a vacuum. It is part of a whole complex of other institutions, habits, and beliefs.” In other words, legal decisions are also moral decisions, and laws are a device to accomplish moral ends (Lee 1986; Kaufmann 1997, Chap. 14). This sort of link between legal and moral evaluations does not deny that some laws can be immoral. For example, laws supporting slavery that used to be observed widely are at present assumed to be immoral now. Another example would be laws supporting (or forbidding) abortion, which are under dispute: some argue that legalizing abortion is immoral, and others say that prohibiting abortion is immoral. However, these examples do not suggest legal and moral evaluations are broadly not relevant nor correlative. Rather, they show that we do think these evaluations should be relevant and correlative. When a law is immoral, the law will be accused as immoral. The accusation means that the law should be rectified and represent our moral evaluations. If law and moral were irrelevant, such an accusation would not occur. Therefore, law and moral are relevant and should be correlative. Through thousands of accusations and rectifications, a large proportion of legal evaluations at present does harmonize with moral evaluations, such as the crimes of assault and perjury. Statements like “law and legalistic morality are not separate entities but a single continuum” or “laws are a device to accomplish moral ends” should be carefully understood in this context. Given that a legal judgment represents an aspect of the value system of a society (Kelsen 1973), the link between moral and legal evaluations reveals the link between the moral and the social.
Second, the positive correlation between moral and social evaluations of an activity can be observed in moral theories themselves. Deontologists believe that the concept of “will” is exemplified by people’s admiration for the goodwill of an office worker who, upon discovering a set of secret financial accounts, tells the truth to the police, even though doing so sacrifices his social standing. Utilitarians provide an example of “behavior” in which citizens endorse the behavior of a rescue squad that chooses to save five people at the expense of one person. Virtue ethicists believe that “character” can be observed in the admiration of school teachers and classmates for a student who bravely defends a classmate who is bullied at school. These examples show that social activities such as whistleblowing, rescuing, and standing up to bullying are both socially and morally praiseworthy. Therefore, both moral and social evaluations of an activity, both of which are involved in CEB performance, are broadly and positively correlated.
The Relationship Between the Mental, the Social, and the Moral
The links between the mental and the social and between the social and the moral suggest the existence of a transitive, latent relationship between the mental, the social, and the moral. In particular, the link between the mental and the moral is noteworthy because, for decades, a great deal of effort has been devoted to distinguishing them. On the one hand, people have strived to eliminate the tendency to moralize those with mental disorders from psychological and psychiatric approaches to and treatments of mental disorders. On the other hand, people have also strived to remove the tendency to medicalize moral education of individuals who have morally different states or cultures from educating their morality. At present, a sharp line has been drawn between moral education and mental treatment, which can be observed in the differences between the methods and jurisdictions of moral correction and mental treatment. On the one hand, moral correction adopts the method of education and falls within the jurisdiction of pedagogy. Mental treatment, on the other hand, adopts the method of medical procedures and falls within the jurisdiction of psychiatry. Therefore, it seems to have succeeded in establishing the line and accordingly in eliminating the threats of moralizing mental treatment and medicalizing moral education.
The emergence of neurofeedback training of CEB may blur this line. In general, therapy for people with mental disorders aims to mitigate social distress caused by a disturbance in the individual’s CEB performance. Although such therapy can be conducted in a variety of ways, including pharmaceuticals and psychological treatment, neurofeedback training can also be such an option because it can alter the state of CEB by regulating the brain activities that affect CEB performance. Since CEB performance determines both moral and social performances, which are broadly and positively correlated with each other, neurofeedback-based mental treatment not only mitigates social distress but also alters moral performance. Therefore, the dual application of a neurofeedback technique will reveal that the same device is effective for both treating mental states and enhancing sociomoral performance. In this way, the dual application of the neurofeedback technique will blur the line between mental treatment and moral education.
One may think that the neurofeedback technique does not bring about unique ethical issues concerning the relationship between mental treatment and moral education because what blurs the line between them consists not in the fact that the neurofeedback technique is applied to both situations, but in the fact that human morality has a biological or neurological basis. One could argue that even a drug can bring about similar ethical issues if it works to both treat mental impairment and to enhance moral performance. For example, if a fidgety child who is constantly walking becomes calm in his or her classroom by taking such a drug as Ritalin, the drug not only mitigates his or her ADHD symptoms but also enhances his or her sociomoral performance. This can also blur the line between mental treatment and moral education.
I agree that such drugs can blur this line and that the dual application of the neurofeedback technique is not essential to conflate mental treatment and moral education. However, the neurofeedback technique is unique in that it has the wide range of what it affects. For example, Ritalin can affect one or more aspects of an individual’s CEB performance, such as steadiness and concentration. In contrast, the neurofeedback technique can, in theory, change any aspect of his or her CEB performance. Due to the versatility of the range of application of the neurofeedback technique, ordinary people will have an impression that it blurs the lines between mental treatment as such and moral education as such. As a result, compared to the case of pharmaceuticals, the neurofeedback technique has a unique power that can change the dichotomy between the notion of mental treatment and the notion of moral education understood by ordinary people.
The Second Advent of Ethical Virtue: Sociocultural Evolution or Dystopia?
I have argued that people who witness neurofeedback-based mental treatment would link the mental with the moral since the same device, namely, neurofeedback technique, can regulate both mental and sociomoral performance in the same procedure at the same time. The link may change our collective understanding of the mental, the social, and the moral. For instance, moral education may turn into moral treatment. In-detail research cautious deliberation will be required to assess this and the other ethical, legal, and social implications (ELSI) of the link. Here, as an aspect of the ELSI, I examine whether such a change would signal sociocultural evolution or the beginning of a dystopia.
Apart from the above-mentioned efforts that have strived to distinguish mental and moral issues, philosophers have examined the conceptual relationship between mental health/disorders and morality from antiquity to the present: some argue the positive aspects of the relationship between them (Jaeger 1957; Martin 2006), whereas others emphasize the negative aspect of the relationship (Foucault 1961; Szasz 2010; Wiseman 2014). However, the emergence of the neurofeedback technique will blur the lines between the mental, the social, and the moral, and accordingly, ordinary people might come to develop the idea of the practical links between them. Therefore, even if we maintain a conceptual distinction between them or see the negative implications in the conceptual relationship, such a practical link would be established by the fact that the same device is effective for the mental, the social, and the moral in the same procedure. This results in producing a gap between our conceptual and practical understandings of the relationship between them. In short, our traditional understandings of the relationship and its practical reality will turn out not to mesh with each other.
This gap will bring various ELSI of neurofeedback technique. In general, advancements in technology have often left existing notions behind and produced friction in society. Such a fraction gradually changed not only the related conceptions that ordinary people have had but also the laws and institutions in society so that they fit with the reality created by the technology. For example, the Internet and social networks have changed our understanding of distance and communications, and various social systems; electric books and articles changed our notions of “book” and “article,” and the publishing communities that had existed since Gutenberg’s printing press; and organ transplantation and brain death changed our understanding of the relationship between mind and body, the notion of life and death, and the medical system.
As these technologies have changed not only our ways of understanding the world and ourselves but also institutional and legal systems in our society, and so too will the neurofeedback technique. The dual application of this technique, namely, neurofeedback-based mental treatment and moral enhancement, will first produce friction between those who accept the blurred line between mental treatment and moral education and those who criticize it. Then, society will need to take actions to harmonize this technique with the existing social system. Legal decisions, lawmaking, policy planning, and regulation would be required. A council for the President regarding the ethics of neurotechnology may also be created to allow a variety of voices and opinions to be heard and establish ethical guidelines. The council report may mention various possible threats of this technology. For example, the report may say that individual freedom and diversity can be threatened due to the medicalization of moral education. It may also say that religious beliefs can weaken once we can control our morality through neurofeedback training.
While examining these possible social changes, we must also consider what such changes imply or whether it brings a sociocultural evolution or dystopia. The clue for considering this problem can be found in the notion of virtue, with which we used to understand our society and ourselves. Virtue, as the English translation of the original Greek word “ἀρετή,” is the notion based on which human excellence qua human is measured. In the ancient Greek culture, human virtue or excellence consists not in moral excellence but also in physical health, mental toughness, and social extroversion. The philosophical founder of this notion, Aristotle, followed this tradition and posited in Nicomachean Ethics that the excellence of an individual consists of her mental (or psychological), social, and moral performances. Aristotle himself names such a widely excellent performance “ethical virtue (ἠτικὴ ἀρετή)” (1103a14–15; 1152b5). Therefore, in its original meaning, the ethical performance covers three sorts of performance which have been considered here, namely, mental, social, and moral performances. Focusing on such a wide range of the virtue or the ethical performance, the notion of virtue was revisited by G. E. M. Anscombe (1958) under the name “virtue ethics” as the alternative theory to major moral theories such as deontology and utilitarianism that focus on the notion of morality. The succeeding philosophical movement that started in Oxford in the 1950s succeeded in reviving virtue ethics and in emphasizing the importance of examining our lives not morally but ethically or holistically (Chappell 2013). By virtue of this philosophical movement, moral philosophers have become sensitive to the conceptual difference and relationship between the mental, the social, the moral, and the ethical. The ethical is now understood as the integrative notion of the mental, the social, and the moral.
However, the success was partial because the ethical, the integrative notion of the mental, the social, and the moral, remains to be the conceptual or academic stage. Different from ancient Athens, the mental, the social, and the moral are still divided and not unified into the ethical in our social system nor custom. The establishment of neurofeedback technique, which regulates humans’ CEB performance, will advance merging these notions into the ethical again. Therefore, a society in which the neurofeedback technique blurs the line between these notions could be seen as the revival of ancient Athens. Here, we can observe the link between the 21st neurotechnology of neurofeedback technique and the ancient Greek notion of virtue ethics. However, it remains uncertain whether the second advent of virtue ethics by neurofeedback technique would undergo sociocultural evolution or become a dystopia. A certain part of the ELSI of neurofeedback training can be identified by referring to the criticisms against virtue ethics, such as criticisms against elitism and communitarianism (MacIntyre 1984). Both criticisms claim in common that the notion of the ethical virtue would not be compatible with the notion of moral pluralism which has been approved by contemporary societies.
The cautious study is thus required to consider this problem. Here, I propose one solution to the problem, which focuses on a feature of neurofeedback technique. The criticism based on moral pluralism would be persuasive if neurofeedback-based ethical virtue training defines the ethical, that which is ethical or virtuous, namely, the contents of ethics or virtue, because the training that holds a certain normative position will threat moral pluralism. However, the cogency of the criticism will decline if the training would not commit itself to hold any specific normative position on the content of ethics or virtue because the training itself will be open to any moral inclination or culture. We have a reason to assume that neurofeedback-based training can be open to any moral culture because neurofeedback is a technique that enables self-regulation of an individual’s CEB states by fitting her brain states with its target states which can be set freely once the neural basis of target function is identified (Tachibana 2017a). This suggests that neurofeedback-based ethical training can be used for any moral culture. In this sense, the neurofeedback technique can be compatible with moral pluralism.
The neurofeedback technique is a new method of mental treatment as well as human enhancement. Establishment of this technique may blur the lines between the mental, the social, and the moral. This produces not only conceptual or technical but also philosophical problems. The blurred lines between them can change our understanding of our living world and ourselves and will lead us to become sympathized with the notion of the ethical, which virtue ethics has argued is an appropriate notion to understand human qua human, being different from the moral. In spite of such advantages, a cautious and multiangled examination will be required to assess the possible ELSI of this technique, including the medicalization of moral education, the moralization of medical treatment, and the threat of moral pluralism. Since these issues would have serious influences on our society, the realization of these issues might seem to signal the beginning of a dystopia. However, as I have emphasized, what makes it difficult to consider this problem is the possibility that we may not be able to recognize the signal itself. Having developed different notions of them and its relationship, we may have already changed our way of understanding the notions of the mental, the social, and the moral when we have to deal with these problems. Then, we would not be able to recognize the beginning of a dystopia. Accordingly, a genuine dystopia might be that we cannot recognize the dystopia will be a genuine dystopia.
Neurofeedback technique is a genuine topic that requires neuroethical considerations. We have to untangle the awkward relationship between the notions of the mental, the social, the moral, and the moral on the one hand, and on the other hand, we also have to examine in advance whether such changes in society would signal sociocultural evolution or the beginning of a dystopia.
This paper is supported by the Japan Society for the Promotion of Science (JSPS) Overseas Research Fellowships and the JSPS KAKENHI (Grant Number 17K13318).
Compliance with Ethical Standards
Conflict of Interest
The author declares that there are no conflicts of interest.
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