Tuesday, May 29, 2012

May 29, 2012 

Explanation and Understanding

As stated earlier, in psychiatry, the all too obvious philosophical dilemma is the so-called mind-body problem. It is often asked, "Is my experience (or problem, if you like) mental or physical? Am I having psychological problems or a brain chemical problem/imbalance?" The answer to this question is not as easy as it may appear to some.  Psychiatric sufferers are often quite consciously confused about this.  Others are confused in that they are certain they know the clear answer (which in current times is more often the brain chemical ideology).  We will try to address the form of what a truer answer might look like for an individual person.  And the particular answer does very from one particular experience to another.

When this question comes up in the office, I often ask patients to reflect on the fact that every time we have a thought or a feeling something is going on in the brain. Even as we are communicating at the moment, something chemical or physical is also going on in our brains; the chemical changes are probably quite small ones and not susceptible to micro-modification. At least not yet, thankfully! But larger changes, more brain-global "chemical or neurological changes" such as significant and disabling moods, can possibly be modified. For the moment, let us put aside the important question and individual judgement of whether such problems should be addressed with medication.

Some philosophers make a distinction between explanation and understanding, which I think is useful. Some mental experiences are better explained chemically or biologically, while other experiences are better understood psychologically through their meaningful connections to other psychological or social experiences. Most difficult of all (and my true "sub-specialty" in psychiatry) is that some mental and emotional experiences can definitely benefit from being looked at from both perspectives.

Now, everything I've just said begs for endless elaboration and conversation. Feel free!

May 16, 2012 

Importance of the Mind-Body Problem in Psychiatry

How does philosophy figure into the practice of psychiatry and psychoanalysis? In a variety of ways. And often quite dramatically.  By a person's "philosophy", we may refer to their ideology.  And a ideology can be something one applies without thinking.  Philosophy in the best sense of the word is the opposite of ideology: it is the activity of thinking itself.

One clear psychiatric ideology and the dominant one today is that psychiatric conditions are brain chemical disorders.  The other ideology, in descent for so long that we have to be near a bottom of the market, is the view associated with psychoanalysis and other psychological theories.  Here the psychiatric disorders, or suffering, is all the product of emotional development and conflict.  Psychiatry is the realm of mental disorders or products of the mind.  Both ideologies can bear interesting fruit alone.  A compromise between these two approaches can be a silly as giving the depressive disorders to the biology of brain chemistry and the anxiety disorders to psychological conflict of mind.   A true bipartisan approach is the most  fruitful.  This may all seem quite obvious and boring to some, but let me assure you that I am confronted with these ideologies on a continual basis.  And not just from colleagues.  The sufferers themselves often are strong believers in one  ideology or the other.  Currently, more people believe, or want to believe, that everything is brain chemical disorder.  It is a kind of denial of mind.  So then my job is pulling strongly in the other direction for the truth.  But the other ideology is not rare.  Sometimes this all is psychological ideology is driven by a desire to deny that the problems are severe enough to be impacting the brain.   If an individual wants to approaches self-improvement totally from the psychological side, I am not opposed if this is not dangerous; it is more in the service of the truth, however, if the person realizes that the brain has been affected as is usually the case with more severe suffering.  I do not want to argue at all that medication is the answer.  The research supports the possibility of success without medications, even in severe disorders.  We'll explore these facts in later posts.  On this blog in general, I hope to work out what true ideological bipartisanship means by looking in detail at particular cases.  It varies from one particular case to another.