In the medical field and the scientific world in general we are moving away from the idea of a mind separate from our body or brain. In general there are some real benefits to this conceptualization. For example, take the thorny issue of addiction. Traditionally medicine has defined truly addictive drugs as those that cause physical illness and dysfunction when they are stopped, making you chemically dependent on them. However, other drugs clearly cause havoc in people’s lives because they feel they must have them, even if stopping them doesn’t cause physical illness. Many have labeled this psychological addiction. As our understanding of neuroscience progresses the distinction between psychological vs. physical addiction can develop less meaning. Addictive neural pathways are real and physically represented by identifiable neuronal circuits. Psychological problems are not well respected in our society and carry a stigma. They are all too often seen as a failure of character. By making the psychological biological by unlocking a physical mechanism for it, there seems to no longer need be any stigma, as addiction is wired in by chemical reactions in the brain.
This is an interesting argument, that collapsing psychology to the brain mechanisms can erase stigma by medicalizing it and making it a matter of physical function. In addiction it makes quite a bit of sense. We know what part of the brain is being stimulated, that dopamine reward pathways are building and feeding the habit. The derogatory statement, “It’s all in your head,” remains technically true, but loses its bite when you can explain it in such a physical and tangible way.
Psychology is moving more and more in this direction these days, drawing upon our burgeoning knowledge of neuroscience and the brain. There has always been an obvious biological underpinning in conditions like bipolar disorder or schizophrenia, which clearly have an inherited physical component. The truth is that we can find a biological component in any mental illness.
Clearly any process that physically effects the brain also effects the mind and behavior. The two are irrefutably tied together. Steven Peck, a biology professor at BYU, once wrote of a vivid personal example of this when he became delusional from a viral encephalitis.
There are some problems with this viewpoint, however. For example, psychopaths lack a measurable empathy response in their brains on brain scans. Does this mean they aren’t liable for their crimes? Did their brains make them do it? If everything that happens in the brain is physical, are we ever responsible for anything we do, ever? If all our choices and behaviors can be reduced to a chemical reaction in the neurons in the brain, do we really ever even really make choices?
The exact point where biology ends and consciousness and agency begin remains a mystery to me, but I know that point has to exist. I don’t think simply knowing a mechanism seals our fate. This determinism is faulty and lazy thinking. However, knowing about how biology affects the mind makes me exceedingly glad that I don’t have to be the ultimate judge of others. In the end, understanding biology can make forgiveness easier.
More curious to me is this. Why does our lack of understanding the mechanisms of addiction or mental illness lead to stigma in the first place. Addicts clearly are not acting in their own rational self interest. Their lives are blown apart by the object of their addiction. Why isn’t it more clear in the first place that some powerful reality is causing this maladaptive behavior. What difference does it make if we know the neurotransmitters and circuits?
Why are we so quick to judge the minds and hearts of another, and assume we know what is going on and who is responsible in cases of Depression, anxiety, post traumatic stress or even violence? Furthermore, why does knowing the physical mechanisms of our mind mean we know all that there is? Case in point, physical stimulus of the brain in certain regions has been shown to trigger spiritual feelings. This means that artificial religious experiences can be manmade, but does this mean there can be no legitimate external stimuli causing the same spiritual feelings?
Do we have to doubt everything we see because an artificial stimulus can cause a hallucination? Do we throw out everything we hear if a magnet can stimulate our auditory cortex and cause us to hear a voice? Should we pluck out our eyes because a magnet can trigger visual hallucinations? If a seizure causes a false smell, is every smell we get henceforth and forever simply “all in the head?” Clearly our senses aren’t perfect but if we throw them out, what do we have left to navigate what is going on in the world. What is there beyond our brain to help us learn the truth.
While we have abundant evidence that physical malfunction of the brain causes malfunction in the mind, we also have an abundance of evidence in the reverse direction, that the mind also controls reactions in the brain and body. Most famous among these is the placebo response. Our beliefs alone physically change the expression of a disease to such a degree it has to be accounted for in every clinical medication trial.
There are also numerous studies on how personal or group prayer (unblinded), community, human contact, and pets all lead to better health as well. These things change our thoughts which then literally change the physical function of our bodies. On the negative side, anxiety, fear, worry, depression, poor self worth all lead to tangible negative effects in blood pressure, energy levels and all around health.
Doctors are often the worst of discriminators when it comes to psychology. We want very much to focus on the physical and explainable. We spend years and years learning physiology and mechanisms of disease. We learn solutions. When a patient comes in, we diagnose problem and then we fix it. It feels good and gives you a rush. It is simple and beautiful. We feel secure in our usefulness and all is well with the world. Broken bone, I can fix that. Strep throat, piece of cake. A broken mind, on the other hand… well, that just complicates everything.
Dealing with the anxiety, illogical or maladaptive behaviors in patients, (or their parents,) does cause doctors much frustration. Even more frustrating can be physical ailments that appear to be a reaction to environmental and psychological stresses. We refer to them as conversion disorders. So many headaches or abdominal pain have a cause beyond the biology of the immediate vicinity of that area of the body. These patient’s defy quick and easy solutions. Furthermore, because we have stigmatized the psychological ailments, patient’s don’t want to hear the problem is psychological. Nobody wants to be the hypochondriac. I believe a desperate need to avoid the psychological problem or label is a big reason that the symptoms convert physically in the first place. Conversion disorders challenge the beguiling picture so may of us have of our job as purely a combination detective and biochemical mechanic of the body. Thus many throw around the phrase “It’s all in your head” as if the problem is solved. Illness has specific meanings to many people and physicians can end up spinning their wheels if they don’t understand those meanings. Wellness can be a state of mind or the spirit as much as anything.
You could say that all this frustration stems from mind-body dualism. Would it be less frustrating to say all conversion disorders, anxiety and illogical or different health beliefs all occur because the brain is programmed that way. It is ironic that as physicians don’t want to deal with the psychosomatic. So many of us want the body to be all that is left in this mind-body dualism. Yet these wonderful neuroscientists want to solve the problem by extending the definition of the physical to swallow up our concept of the mind. Perhaps we can do this successfully in many cases, but I believe this is often just a backwards way of doing what is truly needed. Sometimes we need to talk things out, make an emotional connection and let people feel validated to help them get better. Sometimes we need to deal with the mind and put biology on the back burner. Dualism is only harmful when we isolate one part and ignore the other. Stigma for addiction and mental illness only come as we privilege biology at the expense of our minds.
A true healer really needs to take into account everything that makes this patient a person, and address issues from all sides. When illness is a complex life altering problem, we have to realize we won’t be able to fix it in an office visit. The key to being a true healer is to understand the whole person in order to make them whole again. This is how I imagine the great physician, our savior, to work in our lives. We may not be able to do it in a lifetime, but we can stop and enjoy the journey. It can make for one magnificent ride. These life lessons go beyond just doctoring. When it comes to solving whatever problem we may face, or just living life, what I think we all really need is to pay attention to the mental, the spiritual, and the physical. I stand firm in the belief that we are much more than just machines.