On Thursday March 27th, I will be giving a talk to a hospital in Perth by MS Teams titled: “Can there be a biological psychiatry?” This will be 12.30pm Perth time (GMT+8). Either email me for the link (jockmclaren@gmail.com) or use these codes:
Meeting ID: 470 923 061 230
Passcode: xQ3Zr2Ds
*****
After moving to the city, a 42yo woman with a long psychiatric history was referred by her new general practitioner for assessment of her antidepressants. Over about 20 years, she had been treated with dozens of different drugs in large doses, plus ECT, but nothing worked. She complained of feeling sad and miserable all the time. As per routine, she was asked what she thought was causing it: “Do you know why you’re feeling sad?”
“Oh yes,” she replied, “it’s my depression. It always does it.”
As she gave her story, it became clear that the primary problem was a severe anxiety state which went back to her ghastly childhood. She had about half a dozen panic attacks a day from a list of about fifty specific fears, plus the general fear that the world is a dangerous and unpredictable place and humans will only hurt her (cats were fine, though). At the end of the interview, she was shown her long lists of anxiety symptoms and her fears. “Now you see why antidepressants don’t work,” she was told. “The primary problem, going right back to your early family life, is anxiety.”
“Anxiety?” she exclaimed, jumping back in her chair. “Oh no, that’s terrifying.”
Actually, yes, anxiety is indeed terrifying. It’s been said, and I’m sure it’s true, that a full-blown panic attack is the worst sensation a human can experience and still survive. And it has to be. The role of anxiety is to save your bacon, it has to force you to get away from the danger, so it has to be strong. It has to override all other emotions, attractions, arousals, tiredness, hunger, pain, the lot, to make you run for safety. Unlike other emotions, which wear off, anxiety reinforces itself, building up and up until you give in and get away.
Trouble is, psychiatry doesn’t take it seriously. The file of letters and discharge summaries she brought showed that people had known all along about her anxiety but it was considered trivial, “co-morbid,” or just her being pathetic. Psychiatry is obsessed with depression and simply doesn’t understand the role of anxiety in precipitating depression, but the point here is her belief about her own anxiety state. She firmly believed the normal emotion of anxiety was a time bomb inside her ready to go off at any second and turn her into a twitching, dribbling mess. She believed her anxiety had only two settings, full off and full on, and she had no control over it apart from avoiding everything that could wreck her day. And because she believed it, that’s what it did. So what’s this thing called belief?
Four years ago, we watched (in some degree of disbelief, actually) as thousands of people stormed through the US Capitol Building, driven, they said, by the belief that the 2020 US election was “stolen” and they had to sort it out. But how could they believe that when the facts were plain for all to see? What does it mean to say “I hear what you’re saying but I believe something else”? This raises the question of the nature of belief, which has always been a central topic in philosophy, known as epistemology, “the theory of knowledge, especially with regard to its methods, validity, and scope, and the distinction between justified belief and opinion.” However, the notion of believing is far too important to leave to philosophers: beliefs, and clashes of beliefs, are pushing us closer and closer to the literal end of the world as we know it.
What we believe counts, but when it comes to working out what it means to say “Well, I believe that …” we run into the sand. Philosophers tend to start with beliefs as a real thing and go forward, trying to sort out the consequences of beliefs and how we reconcile them with the real world. Some go back to their origin, trying to discover how we acquire beliefs and then sort them into stacks. Now there’s another field, given the ugly neologism “creditions” to remind everybody that this is a different approach. A couple of years ago, there was a conference held in Hannover at the rebuilt Herrenhausen Palace, now published with the sparkling title: Credition - an interdisciplinary approach to the nature of beliefs and believing [1]. Its 42 chapters cover all sorts of fascinating topics arranged around their definition:
…creditions, is an umbrella term that signifies the neural subfunctions that constitute the category of processes of believing, as are similarly present in the categories of emotions, perceptions, and actions (p7).
I’m always wary of anything that includes the word ‘interdisciplinary’ as it’s likely to be an excuse for everybody to waffle on aimlessly and, ranging from neurophysiology to religion, this weighty volume didn’t disappoint. It didn’t get off to a good start as the 60 or so contributors appear to have no concept of information and how it is implemented in the brain. What counts is the notion that, after nearly a hundred years in the wilderness, beliefs count as a matter of scientific enquiry.
Regular readers will recall that I make a lot of the influence of the philosophical doctrine of positivism on the nature of science, on medicine and thus on psychiatry. In one blunt sentence, positivism says: “If it can’t be measured, it isn’t science.” Beliefs can’t be measured, therefore beliefs aren’t science. QED. Apart from psychiatry’s dalliance with Freud’s psychoanalytic theory of the mind, which was almost entirely about emotions anyway, the past hundred years of psychiatry and psychology have more or less been driven by the challenge, delivered in 1913, of the American behaviorist psychologist, John B Watson:
I do not wish unduly to criticise psychology. It has failed signally, I believe, during the fifty-odd years of its existence as an experimental discipline to make its place in the world as an undisputed natural science ... We have become so enmeshed in speculative questions concerning the elements of mind, the nature of conscious content that I, as an experimental student, feel that something is wrong with our premises and the types of problems which develop from them ... 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 [2, p163,166].
That was challenging. He was telling his colleagues: “It’s too difficult. All this talk of beliefs and perceptions and emotions just goes around in circles so we should stick to what we can see and measure.” Given what they knew at the time, that was fair enough but we’ve moved a long way since then. At the time, beliefs, especially religious, meant “spiritual” and spiritual meant supernatural, which was what the positivist movement was designed to expel. However, although we have politicians who impress as not thinking, we now have machines that put up a good impression of thinking. Moreover, we have the fundamentals of a theory of information that allows us to talk meaningfully of unseen things such as beliefs and perceptions and emotions without going in circles [3]. This is very important because while psychologists and psychiatrists have spent the time since then trying to be more objective than thou, people’s beliefs keep dragging us to the edges of destruction, as in:
Our race is superior to yours so we’re going to clear you out, or
God gave us this land so we’re going to clear you out, or
We’ve got more money than you so we’re entitled to clear you out, or
We don’t like your religion/politics/face so get out before we clear you out.
What we believe about ourselves and each other counts. If we’re going to talk about beliefs, the one topic we can’t avoid is the very one psychiatry has carefully avoided, religion. Unfortunately, the conference in Hannover devoted only four rather vague and inoffensive papers to religion. I’d say the reason is that they don’t have a theory of mind that allows them to distinguish between the mechanisms of belief (neuronal, cognitive etc) and the contents of those beliefs. The only mentions of terms such as ‘spirit’ or ‘spirituality’ were quotes (as in “Their belief in spirits…”) rather than a direct attempt to answer the questions:
What is it about the human experience that leads to beliefs in the supernatural?
How do these beliefs influence human behaviour?
Can we talk meaningfully about these things?
The first question is fairly straightforward: we all have the experience of having experiences. We have immediate access to a private world of brilliant colour, sounds, smells and feels, of memories and hopes and fears and miseries. Our inner experience says there’s something non-physical but, despite the best efforts of Watson’s behaviorists, that also applies to animals. They have the same biological mechanisms as we do, so the default position is that animals experience just as acutely as we do. Animal lovers don’t have to prove they do, the other side have to prove they don’t, which is impossible, and stupid.
The totality of the inner world amounts to mental life, or mentality, which we can understand as an informational state. Just as we can’t avoid our inner reality, we also can’t avoid the fact that it isn’t like anything else in the physical world. That’s one side of our traditional supernatural beliefs, the other side is the mystery of the universe itself. How did it get here, how do things work? We need to know, answers aren’t obvious so we make them up. As for mentality, we have an informational theory of how it arises from computational action in the brain. There can be no such thing as disembodied information so, when the brain stops functioning at death, the whole of mental life will cease forever and cannot be recovered in this world. If people want to believe it will continue to exist in some other realm, that’s fine but that’s faith as there’s no proof. We also have some idea of how belief systems interact with perceptions, leading to both physical and emotional/physiological responses, i.e. a theoretical resolution of the ancient mind-body problem that bothered Watson and his colleagues so much. As long as we see the mind as an informational state, then it is valid to say that the informational content of a belief can effect bodily changes.
With an informational theory of mind, the vexed question of free will quickly resolves: Yes, we have free will in that we can mentally create a range of future options, then choose one, put it into effect then abruptly change it, all without breaching laws of thermodynamics. We can say: “We believe God gave us this land so you’ve got to go,” or we can say: “We believe God gave us this land but we also believe we shouldn’t kill our neighbours or covet their house or donkey, so let’s live peaceably together.” There is a choice, but choosing is wholly a mental event. However, when we use the term ‘mentality’ in relation to morality or indeterminate matters, such as what happens after death, we usually swap to another word, spirituality. But it’s exactly the same thing, the properties of a mind just are the properties of a “spirit.” The mechanisms are the same, the only difference is the way we use the words.
Can we therefore talk meaningfully about a person’s set of beliefs? We can, as long as we remember we are simply talking about lumps of information that have to be reconciled. I don’t have to believe that your religion is true in order to point out contradictions in your beliefs that will cause conflict or distress. It gets a bit more difficult when we deal with people who want to believe in the supernatural, they’re desperate to convince everybody that disembodied spirits visit them or knock things over at night. They have the choice of saying “It’s true, spirits come to me at night” or “Looks as though I was mistaken, let’s take the dog for a walk.” They won’t say that, they like the idea of being special but that’s their choice.
Psychiatry has spent the last hundred years trying to fit itself into the Procrustean bed of positivist philosophy. If positivism didn’t approve of things like hopes and plans, it ignored them. If it had no place for emotions, it translated them into biological data (“You feel sad? OK, that says your serotonin levels are low. Take these and come back in a month”). If a belief didn’t mesh with the conventional view, it didn’t bother asking how it came about, drugs suppressed it. The end result is a psychiatry that’s going nowhere, that has nothing to show for untold billions of dollars spent on research apart from lives wrecked in mental hospitals and people given addictive drugs that shorten their lives.
The conference on beliefs was important (although I wish they’d come up with a better term than “creditions”). It says the human sciences have to expand to include mentality/spirituality, to stop pretending to be “objective” and see ourselves as sentient beings. Without mentality, the “science of mental disorder” is about as effective as a bike with no front wheel – you can pedal as fast as you like but you aren’t going anywhere. To indicate the shift from an artificial objectivity, psychiatrists need to ask specifically about what ordinary people call “spiritual matters." That means they need some understanding of what’s involved in each of the major religions, if only to be able to say: “Looks as though you need to talk to somebody more qualified than I am, can we organise that?”
Are beliefs powerful? They certainly are. People start wars over them. For the anxious lady, her belief that her own anxiety was so severe that it controlled her was a truly terrifying thought. Every time she saw something, however small, that might make her anxious, she started to become anxious in case she became anxious; at the first sign of anxiety, she panicked, thereby closing the vicious circle. With half a dozen attacks a day of up to an hour each, she felt she couldn’t live like that, death would be preferable. The psychiatrists, who didn’t believe that beliefs could play any part in mental life, didn’t ask about that and simply rearranged her drugs, or booked her for ECT. That’s how strong their beliefs were. However, she did well. She was stabilised on beta blockers to control her agitation but it took her three years to get off all the nasty drugs.
References:
1. Selz RJ, Angel HF, Paloutzian R, Taves A (2023). Credition - an interdisciplinary approach to the nature of beliefs and believing. Lausanne: Frontiers Media SA. doi: 10.3389/978-2-8325-2993-5
2. Watson JB (1913). Psychology as the behaviorist views it. Psychological Review, 20:158-177.
3. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge.
The parents of the 6yo Texas child who died of measles are still opposed to immunisation.
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Jock, where is the talk. please? I am in Perth. Doug.