The Organic and the Inner World

Ronald Doctor, Richard Lucas, Ronald Doctor, Richard Lucas

• Publisher: Routledge
• Year: 2020
• eBook ISBN:
  9780429921629
• Topic: Medizin
• Subtopic: Geschichte & Theorie in der Psychologie

This book considers the place for analytic thinking in the world of psychiatry with its emphasis on an organic approach to major psychiatric disorders. It is the result of a conference that was held at the Institute of Psychoanalysis entitled 'The Organic and the Inner World'.

Chapter One

Mind and matter: a psychoanalytic perspective

Ronald Britton

The title suggests this might be a treatise on philosophy’s oldest debates: realism vs. idealism or physicality vs. ideality; and it raises one of philosophy’s unresolved issues: the body–mind problem. I am not a philosopher and I will not be pursuing the argument between materialism and idealism, but trying to locate psychoanalysis and psychiatry on a conceptual axis formed by putting physical and mental at opposite ends of a continuum which as yet does not meet in the middle. The approach to the join has to be from one or the other end. At the present time, the neurosciences are approaching from one end and we in psychoanalysis from the other: somewhere between 1895 and 1900 Freud changed ends. In 1895 he wrote that he was totally involved in his “Psychology for neurologists”, a project for a scientific psychology (Freud, 1895). It was a brilliant speculative attempt that was never finalized or published. By 1900 and his publication of the Interpretation of Dreams (1900a), he was, and would remain, at the other end of my imputed axis. At his new starting point it was not neurones but ideas that were the atoms of his inquiry, and information about them came from dreams, the psychopathology of everyday life, self-analysis, literature, mythology, and clinical experience with neurotic patients. Another version of this axis has subjectivity at one end and objectivity at the other.

Ever since Freud changed ends we have occupied the subjective position. However, we should be facing towards the other end, not turning our backs on it. The temptation at either end of this axis is to turn one’s back on the other. This has been so at times in psychiatry, where so-called organic psychiatry is at one end and dynamic psychiatry at the other, and the temptation is for each to turn its back on the other. As our patients live in the middle, this would seem to me to be unfortunate.

I am speaking as a practising analyst, not a philosopher, but, as William Massicote, who is a philosopher, says in a paper entitled “The surprising philosophical complexity of psychoanalysis (belatedly acknowledged)”, “Psychoanalysis encounters virtually every philosophical problem” (Massicote, 1995). Psychoanalysis has, like other professional disciplines, established its own way of proceeding and a discourse proper to itself inside which it can conduct its inquiries and arguments in its own terms. You could say the same about quantum mechanics: once under way it has pursued its own mathematical equations in its own way without having to reconcile its quantum logic with anything outside its realm of sub-atomic particle physics. However, just as quantum mechanics has to meet up with large body physics and cosmology at some point, so we in psychoanalysis have to meet up with psychiatry. When we do meet, I think we need to be clear about the unarticulated philosophical position we adopt as we approach questions about the relationship of brain to mind, or between psychoanalysis and organic psychiatry.

Everyone approaches these fundamental questions from some personal direction, so let me state my professional background and my theoretical position at the outset. My principal interests from school onwards have been in biology and literature. I started out in general medicine and I was fortunate in gaining some specialist knowledge of neurology working as a junior doctor at Queen’s Square before I trained in adult and child psychiatry. From psychiatry, I moved eventually to full time psychoanalytic practice. My past experience, therefore, includes physical and mental disorders, but for the past thirty years it has been psychoanalytic.

My own theoretical position on the body–mind question is that I believe in psychogenesis: that is, that ideas can produce effects. I also believe in somato-psychic phenomena: that is, that bodily processes can give rise to mental states. This probably sounds obvious, but actually not everyone believes both of these propositions.

Epiphenomenalism, a term invented by Darwin’s most enthusiastic follower, T. H. Huxley, asserts that mental phenomena are only the accompanying experience of physical events; that ideas, beliefs, etc., do not cause anything in themselves. I think some psychiatric schools base themselves on that thoroughgoing physicalism, and regard mental states as simply experiential accompaniments to physical events, rather like the bang of thunder and the flash of lightning are the perceptual accompaniments of electrical discharge. We also find others who intellectually inhabit the other end of the body–mind axis and see the physical world as just a mental construction. Thoroughgoing philosophical “idealism” holds that reality is in its nature mental or spiritual. Blake, for example, claimed, “Mental things alone are real”. “Science”, he said, “is the tree of death”. The eye is an organ for projection not perception:

This Life’s dim Windows of the Soul Distorts the Heavens from Pole to Pole And leads you to believe a Lie When you see with, not thro’ the Eye

[Keynes, 1959, p. 753]

Although this is no longer fashionable in full fig, as it was in some nineteenth century metaphysics, it underlies some modern styles of thought such as existentialism and hermeneutics, various post-modern, holistic, neo-platonic ideas, and the wilder shores of alternative medicine. Psychoanalysis finds itself straddling physicalism and mentalism, or, as I prefer to put it, occupying the middle ground between them. This ground has been vacated by natural science at one end and by analytical philosophy at the other. Both of them, in search of rigour and precision, have excluded anything outside their own confined area of inquiry, thus leaving unoccupied the intellectual territory in between. They have made great strides by doing this, and produced intellectually impressive results. However, one could say that, although it is conceptually unsatisfactory, this untidy middle ground is where we actually live. When we are not at work in the laboratory, in our seminars, or at our desks, we lead personal lives. Whatever deterministic physicalist formulation or reality-dissolving idealism we espouse at work, once we are at home we attribute to ourselves and to others psychological motives and we react to what we believe to be facts; and, even in those demarcated areas of intellectual inquiry, the laboratory or the lecture room, the personal all too often intrudes, bringing with it a rich mixture of body and mind.

It was pointed out by John Stuart Mill that the split between realism and idealism is as old as philosophy itself. He wrote of an eternal dispute between those who look to innate ideas as the source of knowledge and those who assert that

sensation and experience are the sole materials of our knowledge … Sensualism is the common term of abuse for the one philosophy, mysticism for the other. The one doctrine is accused of making men beasts, the other lunatics. [Leavis, 1950, p. 111]

Plato represents the same conflict as the

Battle of the gods and the giants—one side drags everything down from heaven and the unseen to earth … those who battle against them [contend] that true existence consists in certain incorporeal forms which are the objects of the mind. [Flew, 1979, p. 36]

For Plato the “Forms”, that is, innate ideas, preceded experience. They were “changeless eternal non-sensible objects” that inform our sensuous experience, which gives us only a dim view of them. He expressed it in the myth of the cave as a metaphorical description of human enlightenment.

The prisoners in the Cave are at first chained to face the back wall where all they can see are shadows, cast by a fire which is behind them, of themselves and of objects which are carried between them and the fire. Later they manage to turn round and they see the fire and the objects which cast the shadows. Later still they escape from the Cave, see the outside world in the light of the sun, and finally the sun itself. The sun represents the Forms of the Good in whose light the truth is seen; it reveals the world, hitherto invisible, and is also the source of life. [Murdoch, 1977, p. 4]

I am sure you can recognize countless offspring from Plato’s idealistic philosophy even within our own sphere; one could say that Jung was much more Platonic than Freud, and currently there is an argument amongst devotees of Bion between those who prefer his early writings and those who espouse his later work, where he is a more thoroughgoing Platonist.

The separation of physical and mental, or, as it might have been put then, material and spiritual, crystallized in the seventeenth century in Descartes’s dualism. “Cogito ergo sum”, familiar to all as, “I think therefore I am”, and “sum res cogitans”, “I am a being whose nature is to think and whose being requires no place and depends on no material thing”. These two independent worlds, one of spirit and the other body, were, Descartes thought, possibly connected through that unlikely organ, the pineal gland. Cartesian thinking is regarded as misguided in this country and, in the 1940s, Gilbert Ryle did a much acclaimed demolition job on Descartes with his description of the “ghost in the machine” and his linguistic analysis that affirmed that Descartes made a “category mistake” by regarding mind as a different member of the same class of things as body (Ryle, 1949). Mental life, Ryle asserts, has no counterpart to physical space, so to use the language of space is a category mistake. Also, for Ryle, mental activity is not antecedent to the effects it brings about, but is the sum of its manifestations. Mind, in other words, is what it does. It does not cause things to happen. Cause and effect, derived from the study of physical machines, he said, is another category mistake. I think he threw the baby out with the bathwater, but his ideas had a big influence on the reductionist tendency of British psychiatry and provided an intellectual background to cognitive–behavioural therapy. I can see why that title has wide appeal in our psycho-phobic, objectively obsessed country, but, to my subjectivist mind, “cognitive–behavioural” sounds like an oxymoron.

Personally, I follow Bion in regarding thoughts as anterior to thinking; thinking, he asserts, has developed to deal with thoughts. These thoughts are generated from sense impressions, biologically derived phantasies, pre-conceptions, and memories.

Ryle distinguished between knowledge and belief. However, when doing so, he limited knowledge to “knowing how” and dismissed “knowing that” to the realm of “belief”. “Roughly”, he says, “believe [sic] is of the same family as motive words, where ‘know’ is of the same family as skill words.” “So we ask”, he says, “how a person knows this, but only why a person believes that, as we ask how a person ties a clove hitch, but why he wants to tie a clove-hitch”. I will return to the subject of belief later, as I take the view, like Ryle, that all we have is belief in this world, but I would add that our sense of security depends on our innate capacity to treat it as knowledge. However, to return to Ryle, his attitude of subtle contempt for anything subjective, which he shares with some parts of British psychiatry, is best conveyed with a quotation:

Overt intelligent performances are not clues to the workings of minds; they are those workings. Boswell described Johnson’s mind when he described how he wrote, talked, ate, fidgeted and fumed. His description was, of course, incomplete, since there were notoriously some thoughts which Johnson kept carefully to himself and there must have been many dreams, daydreams, and silent babblings which only Johnson could have recorded and only a James Joyce would have wished him to have recorded. [Ryle, 1949, p. 57, my italics]

As well as disposing of the relevance of the subjective, that certainly puts Joyce in his place, and, of course, Freud, though Ryle pays homage to Freud elsewhere. He hails him as “psychology’s one man of genius”, only to use that to assert that he belongs in a “medical category” and that psychology as a counterpart to physiology does not really exist (ibid., p. 305).

It is easy to demolish dualism, perhaps, but not so easy to replace it. Spinoza, the seventeenth century father of pantheism, with God as Nature, took it that there is only one infinite substance and that mind and matter are different attributes: like one man known by two names, not two separate men. Leibniz’s view was that there are an infinite number of substances, monads, all separately maintained by God, to whom they are related, without any interaction between them; an odd image, rather like a large family of only children.

If we discard dualism and theism, we are left with various forms of parallelism in which mental and physical coexist in a non-causal relationship, or some sort of Monism, that is, the belief that only one kind of substance exists. This allows materialists to assert that all is material and idealists that all is mental. “Neutral monism”, espoused by William James, is probably the concept with which we are most comfortable; it suggests that there is one common substance of which matter and mind are phenomenal modifications.

A more modern version might be to take pattern or sequence as non-material features of physical substance. The effect of a code is, after all, independent of the nature of the material carrying the code, but it does need some substance and it does travel through physical space. In a way, this could be said to be true of DNA: it is a code based on sequence, and one that can be reproduced through various chemical transformations. However clever our abstractions, what Braithwaite calls our scientific deductive systems, we are never at ease without an analogical model. Braithwaite warns us of the risks of misconceptions that come from using models, such as mistaking the inherent properties of the model for the logic of the system it is meant to represent and concluding, thereby, that something is self evident which really pertains to the model, not the scientific deductive system (Braithwaite, 1946). Nevertheless, we find comfort and conviction using them, and our familiarity with computers offers us a new model for the old problem. We can now distinguish between hard- and software, a distinction that has already crept into that most reliable lexicon, jargon, where we now speak of faults in the “hard wiring” to distinguish brain deficits from psychic dysfunction.

However much it was scoffed at as a philosophical position, dualism was nevertheless institutionalized by the separation of physical science from the philosophy of mind and the separation of physics from metaphysics in the nineteenth century. Once liberated from each other, they were free to progress within the perimeter of the field they defined for themselves. In effect, I think the professionals have solved their problem by confining their activities to their own zone of rigour and expertise. This tends to result in the big questions being left to amateurs. A hundred years before Freud began to build psychoanalysis, its precursors, the poets and thinkers of the Romantic Movement, tried to deal with the big questions that had been left on one side by the rationality of the eighteenth century “Enlightenment”. Of these, the most outstandingly original thinker was the poet Coleridge. Born in 1752, he formed an intellectual partnership with Wordsworth in 1797 that resulted in the lyrical Ballads, exactly a hundred years before Freud first described the Oedipus complex in a letter to Fleiss. Not only did Coleridge write haunting, memorable poetry, such as “The Ancient Mariner”, “Kubla Khan”, and “Christobel”, but he brought German philosophy to England, particularly that of Kant, to rebut the narrowness of English Utilitarianism. Thanks to some marvellous scholarship by Kathleen Coburn, we now have access to his previously uncollected and unpublished “notebooks”, where he privately jotted down his ideas about everything (Coburn, 1961). He was proto-psychoanalytic: not only did he think of unconscious ideas and motives, attached importance to dreams and to the formative importance of childhood experience, he surprises one with his invention of words such as psychosomatic and pre-conception. For our present purposes, I will quote three short passages.

A passion is a state of emotion having its immediate cause not in Things but in our thoughts of the Things—A passion is a state of emotion which whatever its object or occasion may be, in ourselves or out of ourselves, has its proper and immediate cause not in this but in our Thoughts respecting it … ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• Dedication
• SERIES EDITORS’ FOREWORD
• ABOUT THE EDITORS AND CONTRIBUTORS
• PREFACE
• INTRODUCTION
• CHAPTER ONE Mind and matter: a psychoanalytic perspective
• CHAPTER TWO Discussion of Ronald Britton’s chapter on mind and matter
• CHAPTER THREE Mechanisms of change in mentalization-based treatment of borderline personality disorder
• CHAPTER FOUR Discussion of “Mechanisms of change in mentalization-based treatment of borderline personality disorder” by Peter Fonagy and Anthony Bateman
• CHAPTER FIVE Exploring the inner world in a patient suffering from manic-depression
• CHAPTER SIX Response to the chapter by Trudie Rossouw on manic-depression
• CHAPTER SEVEN Where is the unconscious in dementia?
• CHAPTER EIGHT Discussion of Sandra Evans’ chapter “Where is the unconscious in dementia?”
• INDEX