The Physical Basis of Mental Illness

Ronald Chase

• Publisher: Taylor & Francis
• Year: 2017
• Print ISBN: 9781412842648
• eBook ISBN: 9781351477390
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This accessible volume sets an ambitious goal: to help people better understand the nature of mental illness. The term itself is a problem for most who believe, consciously or not, that individuals have both a mind and a body. Ronald Chase is interested in the roots of this thinking about mental illness, and finds it in philosophical dualism, famously promoted by Rene Descartes in the seventeenth century. Chase believes this perspective contributes to the stigma associated with mental illness, and argues for a different conceptual understanding. He describes and evaluates several alternatives, including behaviorism, physicalism, and functionalism. He also explores whether mental states can be reduced to brain states, and whether mental events cause things to happen. His provocative answers suggest mind-body dualism is outdated and misleading, and some version of physicalism is more likely to help us understand mental illness. Chase presents a concise outline of the science of mental illness, with a focus on schizophrenia, noting that faulty brain development is the fundamental cause of major mental illness. Using detailed, but non-technical language, Chase describes how genes combine with environmental influences to produce changes in brain structures and functions. Chase insists on the need to understand mental illness as a biological phenomenon, yet accepts that people use mental terms and concepts in everyday discourse. This scientifically sound challenge to major assumptions currently in vogue with respect to mental illness will initiate a new dialogue on the subject. It will be important to academics, psychiatric professionals, and those affected by mental illness-victims, family members, and caregivers.

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1

Three Historical Vignettes

 

 

 

Athens, 470 BC

Three young men are walking down the road from Athens to the Academia.¹ Menexenus, the son of Socrates, is a student at the Academia, and he is eagerly anticipating another day of thoughtful discourse with his teacher, Plato. Jason and Niko are friends of Menexenus; they have come along because they want to harvest olives in the groves surrounding the Academia. After having walked about a half mile from the Dipylon Gates of Athens, all three men suddenly turn their eyes to observe a bony, bearded man crouching naked among the gravestones at the side of the road. At first glance, it appears that he is bending an arrow toward a target in the trees, but then the travelers note that the old man is holding nothing in his hands. “The furies! The furies!” he shouts, as he thrashes about and points his imaginary arrow first here, then there. He is wild-eyed, filthy, and foaming at the mouth. The three friends immediately realize that the old man is mad, so they approach him to learn more. “Dionysus told me to slaughter my mother and remove her eyes, and I have done so,” says the old man. “Everywhere now, these furies pursue me to avenge my mother’s death. It is because of this that I neither eat nor drink. I fear being poisoned, and I go sleepless lest the furies strike me in bed. Even here, where lies the remains of my mother, the furies torment me, and so I shoot my arrows.”

“Clearly,” says Niko, “this man is being punished for murdering his mother. Perhaps he is also the victim of a family curse. Whatever is at the root of it, the god Dionysus has now entered into his being so that he and Dionysus are like one. Together, they are pursued by the furies whose special interest, as you know, is avenging the wrongs done to parents and ancestors. Only Apollo or another powerful god can bring relief, but I do not expect that they will do that.”

Without directly contradicting anything said by Niko, Jason suggests a practical course of action. “We could help the man,” he says, “by bringing him to a follower of Hippocrates. This wise man has taught us that thoughts and actions come from the brain, while intelligence and feelings come from the air, through breathing. The mad man’s brain has become dry and cold, and that is why he behaves the way he does. No doubt the liver has released a great amount of black bile, which has produced these changes in the brain. We could help this unfortunate man by giving him white hellebore to eat. Hippocrates gave hellebore to his friend Democritus when he too was mad, and it seemed to help. The bitterness of this herb makes one vomit, but it also relieves madness.”

The mad man grabs hold of a young olive tree and shakes it violently as if to dislodge spirits hiding in its canopy. Meanwhile, Menexenus, who has so far remained silent, can no longer hold his tongue. “My dear friends,” says Menexenus, “I don’t disagree with anything that you have said, but your accounts of this man’s difficulties make no mention of his soul. Can’t you see that his soul is in turmoil? It is the sickness of his soul that is responsible for these actions that we behold. By sickness I mean, of course, that the three parts of the soul—reason, passion, and appetite—have become disordered. Justice and good health dictate that reason must rule because reason is divine and immortal, whereas the irrational elements of the soul are merely material. When appetite gains control, people act in bizarre ways. It is the same with the soul as it is with our political state: all parts must work in perfect harmony. You should read Plato’s dialogues, The Republic and Phaedrus, to learn how to maintain harmony within the soul, for in this way you can prevent madness.”

Strasbourg, AD 1585

Manfred, troubled by his sister’s behavior, takes her to see the parish priest, Father Johannes.² The priest’s home is cold and dark, lit only by a fire burning in the hearth. “My dear Marta,” says Father Johannes, “why do you wail with discontent? I remember you as a sweet child chasing butterflies in the fields, but now your brother tells me that you refuse to leave your house and that you act strangely. You shout out peoples’ names, and you knock your head against the wall until blood flows down your cheeks. What is the matter?” Marta wipes away some tears and begins to tell her story.

“It started one day in early summer when Aunt Freda told me that I must go upstairs. As soon as I entered the bedroom, I saw fifteen men wearing the knights’ green clothing. Fifteen men! She said that I must choose one of these men to take as my husband. At first I refused, and I was beaten until I bled. When I could no longer resist, I pointed to the smallest of the men. I lost my flower in the hours that followed. After that, Aunt Freda often transported me, at night, over vast distances. One night she took me from Strasbourg to Cologne.”

Although feigning surprise at Marta’s tale, Father Johannes anticipates something of the sort, for he is aware that Marta’s Aunt Freda has already been burned as a witch. Thus, he knows that Marta is possessed by a devil. He knows, too, that only those who have forsaken the faith can succumb to a witch’s inducements and become possessed. So Father Johannes is torn between sympathy and duty. He recognizes her pain, but he is also aware of his responsibility to keep the parish free of all types of evil, principally the evil inherent in devils, witches, sorcerers, succubae, incubi, and werewolves.

Father Johannes has additional troubling thoughts that he cannot share with anyone. Like his contemporary, the French essayist Montaigne, he questions the powers attributed to witches. How is it possible, for example, that a witch can transport Marta overnight from Strasbourg to Cologne? No horse can gallop so fast. Also, how can he reconcile his readings that speak of excessive black bile as the cause of crazy behaviors with the church’s position that black bile is simply the proximate cause of madness, while the devil is the ultimate cause. What, exactly, does all of this mean?

His thoughts turn to the text, Antipalus Maleficiorum (The Enemy of Witchcraft, 1508), from the pen of Johannes Trithemius. This other Johannes was a Benedictine abbot, greatly admired for his wisdom and gentleness. Father Johannes picks up the document and reads, “There is no part in our body that the witches would not injure. Most of the time they make human beings possessed and thus they are left to the devils to be tortured with unheard-of pains. They even get into carnal relations with them. Unfortunately, the number of such witches is very great in every province.... Yet Inquisitors and judges who could avenge these offenses against God and nature are few and far between.... Many suffer constantly from the most severe diseases and are not even aware that they are bewitched.”

With all of this bubbling in his mind, Father Johannes faces a difficult, practical decision. Should he excuse Marta by administering a holy unction, or should he allow her to be prosecuted and punished? In the end, a passage recalled from Pope Innocent VIII’s bull, Summis desiderantes affectibus (Desiring with Supreme Ardor, 1484) settles the matter. In this declaration, the pope had proclaimed, “All heretical depravity should be driven far from the frontiers and bournes of the Faithful.” And so, Father Johannes takes Marta to the local prosecutor.

Some weeks later, Marta is brought before the judge. Her body has been shaved from head to feet, so that no devil can conceal himself within the hair, and her nakedness reveals many marks of torture. As a further precaution, she is made to walk backward into the court so that she cannot bewitch the judge by gazing upon him with her evil eyes. Peter, the judge, is a no nonsense kind of guy. He obediently looks to the Malleus Maleficarum (the Witches’ Hammer, ca. 1488) for inspiration, interpretation, and instruction. It is obvious to him that Marta is possessed by the devil. Furthermore, it matters not that she may have imagined certain events like the overnight transport from Strasbourg to Cologne, for this very possibility is dealt with in the Malleus Maleficarum, “The art of riding abroad may be merely illusory, since the devil has extraordinary power over the minds of those who have given themselves up to him, so that what they do in pure imagination, they believe they have actually and really done in the body.” In other words, the devil produces not only the witch’s evil acts, but also her deluded thoughts of evil acts. Finally, as also stated in the Malleus Malefi carum, anyone who succumbs to the devil’s influence is guilty of having a weak will and has thereby sinned by voluntarily allowing the devil to take control over his or her soul. The only way to free the soul is to burn the body. Judge Peter agrees with all of this, so his decision comes quickly. He declares Marta a witch, and he condemns her to death by auto-da-fé.

Los Angeles, AD 1960

We are driving on the Golden State Freeway heading north toward Los Angeles city center, and beyond that, home. Or rather, my dad is driving; Mom is seated next to him, and I am in the backseat. The summer air is hot, dry, and smoggy. We are returning from a visit to the Metropolitan State Hospital, Norwalk, where my brother Jim is a patient. Jim is twenty-six years old, tall, thin, and schizophrenic; I am seven years younger. Two years ago, while studying for a graduate degree in English literature at UCLA, Jim phoned Mom to say that he had a gun and he intended to kill himself. Now, only a few weeks later, he has already been in three hospitals. Before he dies, he will know thirteen different hospitals and at least nine psychiatric residences. His symptoms include many of those that are typically associated with schizophrenia, namely paranoia, auditory hallucinations, depression, and anger. Jim and I have traveled together, played ping-pong, basketball, and chess, joked, and argued.

Two days ago, Jim was given electroconvulsive shock. Earlier, at the Edgemont Hospital in Hollywood, he was given insulin-induced shock. These are supposed to be therapies, and both procedures seemed to help, but only temporarily. Each time, his unpredictable, uncontrollable behavior returned after a few days.

Traveling home after the visit, the dismal atmosphere of the hospital still fills our car. We recall how the hospital staff had made us wait for more than an hour outside a heavily secured glass door before Jim was let out, and then we were obliged to speak with him inside a small public area that held only basic physical comforts. To make matters worse, Jim said little today. Not that he is very talkative at the best of times, but today he was both silent and sullen. Recalling all of this as we speed along the freeway, none of us is feeling optimistic.

I lean forward to ask my mother in the front seat, “How does electroconvulsive shock therapy work, anyway?”

She turns her head around to reply, “Dr. Held told me that it clears the mind.”

“Clears the mind of what? And, what’s left in the mind afterward? I don’t understand this shock therapy.”

“It’s very complicated, Ron, and I’m only beginning to understand these things myself, thanks to Sigmund Freud. Freud is a rare genius, he and Albert Einstein. You’ve read some of Freud’s books, so maybe you know that there are three parts to the mind: the ego, the id, and the superego. The ego is essentially our conscious self. It makes decisions and dictates our actions. The id represents our basic biological needs like hunger and sex. These instincts exert powerful, but unconscious, influences on the ego. The superego is also an unconscious part of the mind. It acts like a counterweight to the id because it represents religious and moral values. Do you know about psychodynamic conflict? The id may urge the ego to do one thing, while the superego tells it not do that very same thing. These conflicts can take over the mind and cause schizophrenia. This is why Jim has been seeing Dr. Held for the past several years, to uncover his unconscious conflicts. Anyway, whatever is the nature of his conflicts, the electrical shocks are supposed to get rid of them. Once that happens, he’ll be free of those pent up energies that make him so withdrawn and irritable.”

After a pause, my mother continues, “There is something else that is important for you to understand. You are mature enough so that I do not have to hide any of this from you. Conflicts also come from within the family—like in our family. You know how difficult it is sometimes at the dinner table. The tension, it can be unbearable.”

“Mom, you do not have to tell me about tensions in the family!”

Dad keeps his eyes on the road. He does not join in the conversation. He has no interest in psychology.

Mom continues, “Sure, Ron, I know that you suffer from this situation as much any of us. Still, we should try to understand what Freud says. I’m sure you have heard of the Oedipus complex, where the boy loves his mother and is jealous of his father. Who knows, maybe Jim has this. And, let me tell you, I have heard that some analysts blame the mothers of schizophrenics for causing conflicts in their children. I don’t buy it. In fact, I really do not know how any of this applies to us. I’ve always loved Jim, and I think he loves me. To tell you the truth, I trust Freud, but I just don’t understand how sex explains Jim’s condition. Maybe his sexual conflicts are buried too deeply for us to see them.

“Deep inside of what?” I said, “Where is the mind, anyway? And, what about the brain? Are they shocking Jim’s brain or his mind? I mean, I just cannot figure how shocking the brain is going to resolve a conflict between the id and the superego. Nor for that matter do I understand what, exactly, is the id and the superego. The ego is more or less familiar, but since the other things are not part of our consciousness, how do we know that they actually exist? I really wish I knew how the brain works.”

Dad is finally ready to state his position. “I don’t know about any of this sex stuff or any supposedly unconscious conflicts. All I know is that Jim had some bad experiences over there at UCLA. He’s an intelligent boy, and he’ll get over it.”

Notes

1. The portrayal of the mad man in the fourth-century BC Greek narrative is loosely based on the tragic plays Orestes and Bacchae, both by Euripides. The interpretations of bizarre behavior are based on Zilboorg, 1941, Simon, 1978, and Roccatagliata, 1986.

2. Marta’s narrative from sixteenth-century Stausbourg is based on material found in Zilboorg, 1941, and Roccatagliata, 1986. The quotations from Antipalus Maleficiorum, Summis desiderantes affectibus, and Malleus Maleficarum are taken from Zilboorg, 1941.

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2

The Search for Understanding

Mental illness is easy to recognize, but difficult to explain. When a family member spends hours at a time alone in his or her room mumbling incoherently to himself or herself or when our child is consistently indifferent to our loving attentions, we suspect that the person is mentally ill. Likewise, if a friend says that he is Jesus Christ and he will heal us of an ailment, or a neighbor cuts his lawn every day and meticulously removes every tiny bit of debris, in these cases, too, we think of mental illness. By contrast, we recogni...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• 1. Three Historical Vignettes
• 2. The Search for Understanding
• 3. Descartes’ Dualism
• 4. Dualism Supports Stigmatization and Other Unhelpful Attitudes
• 5. Philosophical Alternatives to Cartesian Dualism
• 6. Mental Illnesses are Brain Illnesses
• 7. Toward a Reconciliation of Philosophy and Science in Psychiatry
• Bibliography
• Index