In light of our tendency to equate good mental health with a kind of pleasure-sacrificing austerity, Cambridge neuroscientist Camilla Nord’s choice to open her debut book with the neuroscience of pleasure feels delightfully sinful. A whole chapter devoted to “natural highs” is a refreshing departure from popular recommendations for lives devoid of cake, alcohol, fats and screen time. While struggling to adhere to these rather joyless regimens that are almost inevitably punctuated by the sight of cake and a week’s worth of self-flagellation, we seem to have a surprising inability to appreciate the irony of it all. Nord, however, at once both down-to-earth and insightful, captures it rather succinctly: “It is not worth suffering through any of this if you hate it – that harm would outweigh any potential benefit.”
The young researcher talks about everything from the brain’s “pleasure map” – a distributed network of tiny “hedonic hotspots” – to the results of brain imaging experiments in which scientists, eager to visualise the brain’s experience of pleasure, deliver chocolate milkshakes directly into the mouths of volunteers lying in brain scanners. In the realm of both pain and pleasure, Nord offers a plethora of interesting facts, like the revelation that social laughter stimulates the same brain systems as heroin, as well as providing analgesic or pain-relieving effects. Incidentally, “stress-induced analgesia” – that paradoxical buzz or sense of giddiness you experience during brief exposures to highly stressful situations – is the reason why some of us are willing to run screaming into the ice-cold Atlantic Ocean.
By highlighting that each of us has a unique profile of likes and dislikes due to differences in our brain responses, Nord leans into what quickly emerges as a central theme: the importance of honouring natural variation. No single mental health treatment, whether an antidepressant or a psychological therapy, works for everyone – precisely because “there is unlikely to be a single biology of depression”. Inspired by a new paradigm of “personalised medicine”, she is highly sceptical about our efforts to apply universal treatments to discrete diagnostic categories. Instead, scientists could devise treatments that target the specific brain systems and processes underlying an individual’s unique constellation of physical and mental symptoms. Such a future, she is clear, would demand an “existential shift” in how we conceptualise both the diagnosis and treatment of illness.
[ Lonely people are not just sadder: they are unhealthier and die youngerOpens in new window ]
The value of Nord’s rather revolutionary vision comes more clearly into focus once she delves into her model of how the brain “constructs [our] mental health”. Intriguingly, the model she offers us builds upon some of the ground-breaking work of Canadian-American neuroscientist, Lisa Feldman Barrett, whose writing I had the pleasure of reading back in 2017.
Four children settle cases over claims they were over-medicated by South Kerry Camhs
It’s time for a reality check about certain ‘weight loss’ drugs, and here’s why
Patrick Freyne: I am becoming a demotivational speaker – let’s all have an averagely productive December
Coping at Christmas: ‘Not being a mother hurts more at Christmas, when a large part of the world is focused on a birth’
In Barrett’s book, How Emotions Are Made: The Secret Life of the Brain, she proposes that our emotions are neither hardwired nor universal, but rather the result of complex predictions based on past experiences, bodily cues and contextual information. That is why your racing heart and sweaty palms can be interpreted by your brain as either terror or excitement, and why so many of us appear to misattribute our hunger to anger (Hence the popular portmanteau “hangry”).
One of the most compelling ideas of the book is that our unconscious expectations shape not only our perceptions of the world but also the way we experience our bodily states
Extending this theory in her own distinctive way, Nord suggests that beneath our subjective experience of our own bodies, emotions and the world lies a constant stream of brain-driven predictions. Learning, from the neuroscientist’s perspective, happens when our direct sensory experiences contradict these predictions – an instance of what every software developer or AI expert will recognise as “prediction error”. The discovery that what you expected to be a disappointing cup of coffee turns out to be delicious, or that the gang whom you suspected were dangerous are, in fact, a perfectly polite group of carol singers – these are the quotidian surprises that recalibrate our expectations of both our internal and external environments. It is these cumulative calibrations, according to Nord, which play a pivotal role in shaping our “general perception of the world as a good or bad place”.
[ Ireland needs a centre of excellence for treatment of severe mental illnessOpens in new window ]
In conveying to her reader this central premise alongside other insights, Nord exudes an air of authority, largely because she avoids making sweeping scientific claims or getting caught up in the media frenzy surrounding miracle cures. “No silver bullet for distress will be discovered,” she asserts. Rather, she dissects the most up-to-date clinical trials and lab experiments, hovering long enough upon their limitations to establish a reassuring sense of scientific integrity. I will admit, it is hard not to feel warmly about a woman who, with the casual confidence of a friend inviting you into her lab for a cup of tea, has the gumption to challenge popular “neurobollocks” when the situation demands it.
Offering us a glimpse behind the curtain, Nord exposes the pitfalls of brain imaging techniques and the curious dilemma of trying to decipher whether a rat’s lip licking signifies pleasure (Apparently, the latter is known among scientists as the “mental inference fallacy”). With a clearer grasp of the tenets of sound science, the lay reader is empowered to digest wild scientific claims with a sprinkle of scepticism. As Nord wisely notes, confusing correlation with causation is a cardinal sin in statistics – one that is likely to lead to those possessing an affinity for statistics, but “less affinity for social interaction”, to “shout at you”.
What truly captivates about Nord’s writing is her refusal, in the pursuit of accessibility, to sacrifice the complexity and inherent uncertainty of science – something which few others manage to achieve with the same degree of flair. For a woman who runs the Mental Health Neuroscience Lab at the University of Cambridge and was named a “rising star” by the US Association for Psychological Science in 2022, Nord is, most refreshingly, devoid of hubris.
One of the most compelling ideas of the book is that our unconscious expectations shape not only our perceptions of the world but also the way we experience our bodily states. In the case of functional neurological disorders or chronic pain, for example, a physical injury may trigger the brain to become hypersensitised to signals of danger or sensations of discomfort. This heightened sensitivity can, according to Nord, lead the brain to unconsciously “anticipate, enhance, or even generate [physical] symptoms” such as infection, pain or neurological impairment, which persist even after the injury has healed.
Compared to their neurological counterparts such as epilepsy or Alzheimer’s disease, where physical symptoms correspond to structural damage measured in the brain and body, functional disorders lie at what Nord describes as “the intersection of this arbitrary divide” between the physical and the psychological. In her vehement rejection of the antiquated yet pervasive notion of “body-mind dualism”, she reminds me of psychiatrist Veronica O’Keane at Trinity College Dublin, or Canadian physician Gabor Maté, both of whose writings contain similar ideas. “Debilitating pain driven by the brain feels just as real as an injury” Nord writes, and “To a patient, having functional neurological disorder does not feel notably different than if they had weakness, paralysis, tremor, seizures or blindness caused by a neurological disease.”
[ Is love necessary for survival? And if so, how do we help the lonely?Opens in new window ]
One of the consequences of separating “mental” from “physical” illness is that so-called functional disorders, including chronic pain, have historically been divested of their social, cultural and medical legitimacy. Nord, who herself experiences chronic pain, appears to commit heresy when she says, rather unexpectedly: “In the end, chronic pain can certainly be ‘all in your head’, even if it feels entirely outside your head.” Yet, what is truly clever is how she reclaims that infamous phrase “It’s all in your head” and reframes it within a non-dualistic context, thereby imbuing it with newfound credibility: “The real problem is the idea that something that’s ‘all in your head’ is any less real – whether we are talking about pain or depression, something that is ‘all in your head’ is still very much real and just as physiological as an injury or infection.”
There is nothing quite so off-putting as a clever writer... who is driven to camouflage her real self behind a sort of cringey obsequiousness
Though compassionate and ever-cautious not to alienate her readers, Nord is not afraid to take a somewhat controversial stance.
Former UK government drug adviser David Nutt’s provocative claim that alcohol was “more dangerous than many illegal drugs” was based on “accurate, scientifically sound” research. Placebos, which account for the benefits of homeopathy, are extraordinarily underrated. Electroconvulsive therapy, despite its negative public perception, is “more effective for severe depression than any other treatment”. Culture shapes mental illness, and conditions such as Morgellons disease, though real in causing debilitating symptoms, are likely “spread contagiously via the internet”.
Her expression of such opinions – unpopular to some – endeared her to me. There is nothing quite so off-putting as a clever writer who, preoccupied with the need to be liked by her audience, is driven to camouflage her real self behind a sort of cringey obsequiousness.
In this sharp-witted and intelligent popular neuroscience book, Nord provides an understanding of the brain which readers can leverage to conduct their own mental health-enhancing experiments. As a self-professed introvert who dreads prolonged social gatherings, I unexpectedly found myself in the middle of one such event after having read Nord’s section on “Learning to Expect Wellbeing”. To my partner, who was more than a little surprised by this uncharacteristic display of gregariousness, I offered the following apparently cryptic explanation: “I’ve just had a positive prediction error.”
In less cryptic lingo, I explained to him that going out that night was not nearly as insufferable as I had predicted it would be. Thanks Nord.
Further reading
How Emotions Are Made: The Secret Life of the Brain (Macmillan, 2017) by Lisa Feldman Barrett. Barrett presents, with persuasive clarity, a new model that challenges the idea that emotions are pre-programmed and universal.
The Rag and Bone Shop: How We Make Memories and Memories Make Us (Allen Lane, 2021) by Veronica O’Keane. A compassionate, vibrant exploration of human memory which dismantles the enduring dichotomy of “real” versus “false”.
When The Body Says No: The Cost of Hidden Stress (Vermilion, 2019) by Gabor Maté. A humane and passionate re-examination of the mind-body link.
