The Sopranos ♥ brains: part 1

Since actor James Gandolfini died of a heart attack last month, cultural critics have been obsessing over his name-making turn as Jersey mobster Tony Soprano, protagonist of the HBO hit The Sopranos. The show’s been credited as a game-changer for cable TV, launching it into a celebrated art form and making Tony an iconic antihero.

But one piece of the Sopranos legacy gets less play: its portrayal of psychiatry and research on the brain. Before wrapping in 2007, the show drew a lot of plot points and complexity from Tony’s anxiety issues. So The Sopranos wasn’t just ahead of its time in its sophisticated storytelling. It also tapped into issues surrounding mental health and psychiatry that are still relevant today.

One of those issues is public perception of what science can say about the brain. This is an important topic for pretty much all consumers of American media, who will continue to get flooded with information about their brains. In fact, we’re probably going to get more, since this past April President Obama pledged $100 million in government funding for neuroscience research. With those stakes in mind, it seems only fair to let fictional strip club-lounging mobsters kickstart this discussion.

The first Sopranos brain moment that stood out to me comes from the season 2 episode “Big Girls Don’t Cry.”  During a poolside chat with Tony, mob adviser Hesh Rabkin explains that Tony’s father experienced panic attacks much like his son’s. The difference is, Hesh claims, that Tony lives in an age with the technology to address his problem:

 “You know, there was an article in the New York Times Magazine. They got this machine. You can see images of the brain and how your brain responds to fear…You see a person listening to a tape of a parent criticizing them. I’m talking about an adult, mind you. Their fear center kicks right in. You can see it in an MRI.”

Then Hesh and Tony pause to marvel at this description.

This quote captures an intuitive understanding of fMRI, or functional magnetic resonance imaging. By their end, fMRI studies produce pictures of the brain with colorful chunks. It looks like those colorful chunks “lit up” during the experimental task and therefore represent the parts of the brain that control whatever actions were involved. Hesh and Tony aren’t alone in marveling at this idea. Reports from major newspapers and networks, as well as science-focused publications, have also treated fMRI as a direct window into the workings of the brain.

The reality is, though, that fMRI results shouldn’t be taken so literally. In a good study, the images do reflect significant activation patterns in parts of the brain during a task. But researchers have to be careful about their inferences from this information. Just because an experiment shows pronounced activation in a certain brain area doesn’t mean that area is always necessary for the task at hand. Take the notion of a “fear center,” the label given to the amygdala. There’s evidence that brain-damaged individuals can experience fear and panic without functioning amygdalas. Pictures of the amygdala “lit up” during a scary task, then, do not reveal it to be the brain’s only route to fear.

So depending how you take his statement, Hesh is right and wrong. He’s right that fMRI studies provide images of brain activity. But he’d be wrong to interpret those images as complete, or even obvious to interpret. They’re just snapshots. And different neurotechnologies produce snapshots through different filters.

fMRI, for example, measures brain activity by looking at changes in the oxygen content of blood in the brain, tracking which brain areas are recruiting more or less blood across periods of seconds. A method called functional near-infrared spectroscopy also measures blood flow in the outer cortex, but indirectly — and it may one day allow for more neuroimaging in clinical settings. The newer technique of optogenetics allows researchers to get more specific by using pulses of light to influence neural circuits, across milliseconds. And President Obama’s neuroscience initiative hopes to expand on existing techniques. Just imagine all the cool neuroscience stuff future mobsters will be able to discuss at the Bada Bing.

In part 2 of my Sopranos posts, I’ll look at Tony’s relationship with his therapist and the state of psychotherapy in the U.S. Hello, Dr. Melfi! Stay tuned.


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