A Tale of Two Substances

One of which isn’t

These posts examine modern psychiatry from a critical point of view. Unfortunately, mainstream psychiatrists usually react badly to any sort of critical analysis of their activities, labelling critics as “anti-psychiatry,” whatever that is. Regardless, criticism is an integral part of any scientific field and psychiatry is no different. As it emerges, there is a lot to be critical about.

If you like what you read, please click the “like” button at the bottom of the text, it helps spread the posts to new readers. If you want to comment, please use the link at the end rather than email me as they get lost and nobody sees them.

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Psychiatry has long had a fascination for hormones. For example, it was only a few years after the discovery and isolation of insulin in 1921 that psychiatrists began using it to induce seizures for their “shock therapy.” Every time a hormone became available, somebody tried to apply it to psychiatry: testosterone and aggression, thyroid hormone and anorexia nervosa, endorphins and depression, cortisol and everything… Most of this very expensive research is based in a sublime ignorance of hormonal function and goes nowhere but there never seems to be any shortage of money to finance it. The reason it is financed, and the reason it fails and will always fail, are one and the same reason: a failure to appreciate that ancient problem called the “mind-body problem.”

In its modern form, this goes back 400 years to the French polymath, René Descartes (1596-1650) who suggested that the mind and body are separate and distinct substances existing independently of each other. With what is now known as Cartesian dualism, he bequeathed us this very sticky question: If mind and body are separate substances, how can they interact? If the mind has all the substance of smoke, how can it do the equivalent of rolling a boulder uphill? Its fingers would slip. The philosophical complexities of this question were endless and kept philosophers amused and bemused for centuries, until in 1879, Wilhelm Wundt (1832-1920) broke with tradition when he established the first experimental laboratory in psychology. Wundt was an interesting person. He studied medicine then worked in the laboratory of the renowned physiologist, Hermann von Helmholtz (1821-1894), after which he decided to apply Helmholtz’s methods on human and animal psychology. He was the first person to refer to himself as a psychologist, started the first psychology journal and wrote the first textbook in psychology. He had very broad interests including psychophysiology and anthropology and wrote extensively on what he called folk psychology, the huge set of beliefs that ordinary people have about minds. However, he quickly ran into Descartes’ problem, that of separating mind from body and how they interact.

By 1913, this was getting out of control so a bold young American psychologist, John B Watson (1878-1958) threw down the gauntlet. All this talk about minds and bodies and souls, he shouted, was going nowhere; psychology needed to divorce itself from such talk and stick to what it could see and measure. We can’t see or measure minds but we can certainly see behaviour, so that has to be the raw data of a genuine science of psychology:

I can state my position here no better than by saying that I should like to bring my students up in the same ignorance of (the mind-body problem) as one finds among the students of other branches of science (1913, more details in [1, chap. 4]).

Thus was born behaviorism, the idea of a mindless psychology which, after a delay due so that imperial society could stage a world war, dovetailed very neatly with the developing philosophy of science known as positivism (1929). The version developed by Burrhus F Skinner (1904-1990) tersely said we should ignore the fanciful “mind” as all behaviour is under the control of the environment. If a behaviour is positively reinforced (rewarded) by the environment, it will increase; if negatively reinforced or punished, it will cease. There is no place and no need for minds, the environment tells us all we need to know. Meantime, most psychiatrists had long had the same idea, that we can’t and needn’t talk about minds as such. Instead, they talked about “mental disease as brain disease,” i.e. physical diseases which rendered people incapable of making decisions for themselves and required physical treatments. Mainstream psychiatry adopted the general principles of positivism without even noticing it, and definitely without considering the larger issues involved.

One reason for this was that psychiatry had long been seen as disreputable, a case of the incompetent leading the deranged, and it desperately needed the aura of orthodox science and medicine to rehabilitate itself. Psychiatry as biology seemed to promise this, so Watson’s call to arms was soon adopted. Granted there was the small diversion of Freudian psychoanalysis but this was brief, about 40 years at most, and was largely restricted to the US (see [2] for an interesting and readable account). Part of the excitement of a biological psychiatry was what seemed to be the endless promise of the newly developing field of endocrinology. For example, when insulin, the hormone governing glucose metabolism, went astray, the patient died. If other hormones played up, could that cause the brain to malfunction such that mental life became disordered? Oh boy, let’s go!

Let’s say we’ve now had a hundred years of investing in biological psychiatry. The longest-serving director of the NIMH, Thomas Insel (a very biological psychiatrist), said that in his 13 years running the show, he disbursed about $20billion in research funds, almost all of it directed at hard core biology. When he retired in 2013, he had to admit he had nothing to show for it; in the dozen years since, still nothing. Compare that with the Manhattan project, or the human genome project, or the campaign to identify Covid19 and develop immunisations: very complex problems were brought to heel in a few years of concerted effort. Psychiatry is just not in the same class, hardly even on the same planet, and the reason is Descartes’ question: if there is a mind, how does it interact with the body, or can we dispense with it and pretend we’re all zombies? When studying physical changes associated with mental disorder, does the physical change cause the mental disorder or is it the other way around? Invariably, mainstream psychiatry assumes that the physical disturbance is primary and the mental effect secondary: the body governs the mind, and nothing else is possible. That’s what biological psychiatry means but, as Insel admitted, it hasn’t worked. Don’t worry, they say, it’s sure to come good, just send more money.

Biological psychiatry is an ideology, that much is clear [1, Chap. 2], and the defining feature of ideologues is that they are never wrong. They’re incapable of admitting their fundamental stance is misconceived, and definitely unable to apologise for wasting everybody’s time – and lives. Always it’s “We’re making huge strides in understanding mental disorder, on the verge of great discoveries.” When, as always happens, that “great stride forward,” such as the atrocity known as psychosurgery, loses its gloss, rapidly advancing technology provides another. All too often, it’s simply the same old same old recycled, as is now happening with hormones, but psychiatry is the only medical discipline without a past, only a glorious but ever-receding future.

A hormone is a chemical secreted in one part of the body which has its effect in a distal part, mostly carried to its target organ by the blood stream. In the old days, it was assumed that each hormone had one job to do but it’s now clear this isn’t true. They can have dozens of effects, and it all depends on the specific receptors and where they are in the body. Testosterone, for example, was originally assumed to have only sexual effects but it is now known to have a huge range of effects, starting at about the fourth week of gestation and continuing throughout life. Naturally enough, it affects the gonads but it also affects the brain, skin, muscle, bone and ligaments etc. As soon as reliable tests were available, psychiatrists wanted to know whether excessive testosterone “caused” male aggression. No, it doesn’t. In fact, primary disease states causing excessive testosterone are rare; high levels are essentially determined by psychological factors, which brings us back to the mind-body problem: how can thinking cause a rise in testosterone? Well, as every teenager soon realises, it sure can, and usually at the worst possible moment.

The problem for biological psychiatrists is that they can’t explain this, which forces them into a corner where anything undesirable is deemed a “disease.” For every disease, there then has to be a primary biological cause because nothing else is conceivable. We see this in a couple of articles published in Psychiatric Times. One looks at the relationships between sexual hormones and eating disorders. They want to show that binge eating is somehow related to the effects of testosterone on the brain, because testosterone is the male hormone and males are more impulsive than females so when they see food, they can’t switch off the urge to reach for it. Or something, it’s all lost in the jargon about aromatase (an enzyme) and the brain’s immeasurably complex “hypothalamic and arousal circuits.” Undeterred, they conclude:

(This research) can help us understand a broad range of psychopathology where impulsivity or a difficulty responding to cues from the environment leads to less than optimal functioning or impairment in some cases.

The person interviewed for the article is a psychologist. Normally, psychologists don’t study neurophysiology, neuroanatomy, endocrinology, and so on. Instead, and channelling their inner JB Watson, they all have sublime faith in their methodology. He is saying: “OK, we don’t have any results but send more money and we’ll see what we can find.” Where critical thinking fails, methodology will deliver.

The other paper is potentially a bit more helpful as it looks at a well-known side effect of what are called antipsychotic drugs: wrecking the patient’s sex life. All these drugs are dopamine (DA) blockers, which means they release the inhibitory effect of DA on prolactin, causing high levels. This important hormone has a huge range of effects, both physical and psychological, so for people compelled to take the drugs, excessive prolactin is very troubling: loss of libido, menstrual dysfunction, lactation, gynaecomastia, impotence, infertility, osteoporosis, pimples and so on. Predictably, the authors conclude with the suggestion that to counter the sexual side-effects of psychiatric drugs, sufferers could be given more drugs. As it happens, prolactin is also a “stress hormone,” meaning it is released in response to a variety of stressors, both physical and psychological. People with early mental disorders often show high prolactin levels, indicating they are feeling distressed. The article ends by lamely suggesting this may be used as a “biomarker,” i.e. as a test to decide who is heading for a mental breakdown. They could also ask people if they’re feeling upset but that won’t happen, because the ideology of biological psychiatry says minds are irrelevant.

The question facing mainstream psychiatry is clear: can we talk of the mind with the same level of reliability as we talk about neurons and rocks? The answer is a qualified yes, but first we need to deal with the ancient problem of trying to join two incompatible substances. The way to do this is to get rid of the idea of “the mind as a substance.” The biocognitive model [3] says that if we conceive of mind as an emergent informational state and not as a separate “substance,” then plugging it into the body’s well-known, neural-based informational system is conceptually quite simple: all we need to join mind and body is the correct three pin plug. I don’t mean in the sense that philosopher David Chalmers uses in his latest book, Reality + [4]. Chalmers has written some serious philosophy but this book isn’t part of it. It’s part daydream and part mischief, wrapped up with some non-serious idealism (my critique is at [1, Chap. 10]). However, he had previously clarified two issues in philosophy of mind, which he called the “easy problem of consciouness” and the “hard problem.” The easy bit is how we make decisions. He suggests that’s all mechanical, it is very fast and silent in that we can’t access it. I see this as the basis for Freud’s “system unconscious,” but that’s not essential. The mental process of making a decision is essentially mechanical; our personal contribution is simply to change the weighting of the various factors in each decision: “Hmm, looks like rain. I don’t like getting wet so I won’t go for a walk just now.”

The hard problem is how the brain generates the experience of being alive, the realm of senses, emotions and so on. In the biocognitive model, experience (or qualia) just is the result of layered, recursive processing of the sensory input in the informational space generated by the brain. Emotions are the internal equivalent of sensations, triggered by specific signals from the computational or decision-making part acting on specialised, deeper centres: “I see a snake. Snakes are dangerous.” That part is silent and near-instantaneous; it has to be, otherwise we’d step on the snake. The act of recognising a threat immediately triggers the threat response, commonly known as anxiety, which has its mental effect of feeling bad, plus the physical components getting us ready for action – racing heart, rapid breathing, sweating, tremor, etc. All animals have a threat response of one sort or another (the “flight or fight” reaction).

Crucially, there is no discontinuity between perception and action, no point at which information has to jump from one “substance” to another. Regardless of their location or their function, all neurons conduct their information in the same impulses. Impulses generated in a receptor organ, such as the eye or touch receptors in the skin, are passively conducted to the computational neurons of the brain where they are manipulated to produce two outcomes, action (the easy problem) and sensation (hard problem). Once a decision is made, instructions are sent to the different muscles or secretory organs. The mind-body junction then becomes the point at which a computational neuron touches (synapses on) a neuron conducting instructions to the body. These can be motor neurons, activating different muscles systems, or endocrine, activating different secretory glands. Assuming all computational neurons are alike, the difference is the terminal point of a conducting neuron. There is not just one “mind-body junction,” there are billions, but they add up to a single, smoothly functioning system (technically, this raises the question of epiphenomenalism; another day).

The mind as we know it is an informational space generated by the brain’s computational capacity. It seems likely that we will never learn the exact codes used in this process but that’s not essential. For psychiatry, what counts is that there is a single functional path from receptor organ to effector organ, transmitting messages by the same mechanism throughout; all that changes is the significance of the messages, depending on where they are and how they are manipulated. This offers the reliability we need to talk meaningfully about the mind. We use the patients’ reports of their mental state combined with what we see of their behaviour to work out what factors must have been involved in their making just that decision. That is, we assume their computational processes are rational, which means we can work out what they must have believed in order to make that decsion. The brain is working fine, it’s just that their beliefs are scrambled or contradictory. Trump, for example, believes he has to be seen as the winner in any encounter with a human being. If anything goes wrong, he blames the other person. He would deny this because it’s obviously silly but we ignore his denials and conclude he has no self-esteem and his entire life (Reich’s “character defence”) is geared toward concealing just this point. However, the picture is now complicated by his rapidly advancing dementia.

Similarly, the biological approach to anorexia nervosa is to search for a biological “cause” for wasting away. Nothing has ever been found. The alternative is that, regardless of what they say, anorexics have made a decision to lose weight. It is conscious, it is not a disease state but is based in wrong beliefs, mostly related to self-esteem. Anxious people will commonly deny they’re anxious as they see it as a moral failing. However, the fact of being anxious says they have perceived a threat; the practitioner’s job is to work out just what the threat was. In fact, it is recursive: the panicky person is scared of being anxious. However, fearing your own anxiety state automatically brings it on. Nothing wrong with their brains, they just fear stammering and looking stupid [5]. Similarly, a depressed person has experienced a loss. Perhaps it’s recognising that a marriage is no good but leaving seems impossible; or that being anxious is intolerable but nobody seems able to help, so there’s no hope for life. This also works for psychosis. There is a good example in Mad in America this week. The father was diagnosed with paranoid schizophrenia and poisoned by drugs. In fact, he had a secret fear of angering men in authority dating from childhood. This fear drove him to imagine what may go wrong, and eventually to believe it had gone wrong. Nothing wrong with his brain.

The brain is a computational organ. That’s what it is, that’s what it does. If the output state, including emotions and behaviour, are “disordered,” then don’t waste time checking the machinery of computation (the brain itself), just look at the beliefs governing the computations. Some of these are obvious, but the damaging ones are usually well-hidden, even non-verbal because they go back so far, as Freud explained.

If we conceptualise the mind as a “substance,” then it necessarily has magical properties and can’t be included in a science of human behaviour. If we reconceive it as an emergent informational state, we get rid of that problem. This formulation fits neatly with our understanding of how the nervous system works, and is consistent with the current model of data processing. That model wasn’t available to Descartes so he did the best he could. Seeing “me, my self,” as nothing more than whispy informational states is a bit of a wrench but if you rely on a mobile phone to do your banking, you’re already familiar with it. This is why artificial intelligence is potentially very dangerous: the money-hungry clowns running it are likely to take short cuts and develop a model that has no inner restrictions. A bit like some politicians we could mention.

References:

1. McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon.

2. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.

3. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.

4. Chalmers DJ (2022). Reality+: Virtual worlds and the problems of philosophy. London: Allen Lane.

5. McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

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My critical works are best approached in this order:

The case against mainstream psychiatry:

McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon (this also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).

Development and justification of the biocognitive model:

McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.

Clinical application of the biocognitive model:

McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

Testing the biocognitive model in an unrelated field:

McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

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