Piano Repairmen

One of my biochemistry professors in college passed on to me a powerful metaphor that I have appreciated almost daily in my professional life. He and I were discussing one day my interest in how the brain works and the concept of consciousness; and whether it would be better for me to go to medical school or to apply to study graduate biochemistry.

Think of the brain as a beautiful, elegant, and melodious grand piano, he told me. Now imagine that someone had taken an axe to that lovely piano, chopping it into millions of tiny little pieces. Biochemisty, he said, is picking up one of those millions of pieces and attempting to appreciate the sound of the music that could be played on the piano. Imagine Beethoven's 9th Symphony being predicted from the study of dopamine and norepinephrine pathways!

His point, I think, was that biochemistry, while it is one path to understanding, cannot begin to describe the vastly complex and intricate functioning of the human brain; and that it seems inconceivable that anyone could imagine all that the human mind is capable of from just a study of the interaction the small molecules within. At some point, the level of complexity reaches a certain threshold that makes it surpass the mere sum of its microscopic parts. I decided to go to medical school and eventually wound up in psychiatry (with a detour to get a graduate degree in biochemistry along the way).

So, I read the other day that Psychiatrists are beginning to believe in the reality of evil. Somehow, I was reminded of that professor's anecdote.

For a long time now, behavioral scientists have been somewhat overly giddy with the many practical successes in medicine and psychiatry directly attributable to understanding a few of the pieces of the chopped up piano. But however much they know and understand, they are no closer to really understanding either the human capacity to create beauty or its capacity to do evil.

Outside the ivory tower, though--here in the real world--we are able to feel awe listening to the beautiful strains of a Beethoven symphony; and likewise, we are also able to feel revulsion at the all too frequent evidence of human evil

Psychiatry is the branch of medicine dealing with the diagnosis and treatment of mental disorders. We are the piano repairmen of the medical world. We willingly use the science of the biochemists who create the drugs; but we should never forget that we are dealing with more than a conglomeration of chemicals and electrical circuits.

Good and evil exist within all humans--the capacity to create life and the capacity to desstroy it. I don't think that antidepressants would have helped Hitler appreciate the Jews; nor would placing Saddam on antipsychotics have helped the Iraqi people. And, even if they might have helped, those two psychopaths and thousands like them in history would have been unlikely to agree to treatment. There are some things that medication cannot fix. Some pianos that cannot be tuned--maybe because there is a crack in the baseboard;or the materials used in construction were warped; or even that those same materials were irreversibly changed by exposure to malignant environmental factors.

Any piano repairman will also tell you that some pianos start out as lemons (just as some cars) and cannot produce the same sounds as their peers. Some are so broken that even after repair they are not much more than junk.

It is possible we will never adequately be able to explain fully every aspect of human brain function--expecially what leads to good or evil--by resorting only to the chemicals and the electrical circuits. But maybe we don't have to.

Maybe it is just good enough to nurture the good and fight the evil, whenever we observe either in ourselves or in others.