Natural Dualism and Mental Disorder

The Biocognitive Model for Psychiatry

Niall McLaren

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9781032025308
• eBook ISBN: 9781000457230
• Edition: 1
• Topic: Medicine
• Subtopic: Mental Health in Psychology

This book presents an integrative, dualist model of mental disorder for psychiatry, as a counter to the so-called "biomedical" approach that dominates the field today. Starting with the humanist concept that mental disorder is real, it uses a computational approach to build a genuinely bio-psycho-social model. This shows that mental disorder is primarily psychological in nature, not biological.

The historical background extends as far as Descartes, and proceeds via some of the revolutionary thinkers who have shaped modern society. In particular, it builds on the work of George Boole, Alan Turing and Claude Shannon to construct a radically new concept of the mind as a real, informational space which, for better off for worse, can malfunction. It extends this idea to build models of personality, of personality disorder, and then of mental disorder. Finally, the concepts are tested against a variety of themes from other fields to show its generality.

Based in the philosophy of science and of mind, this work represents a radical departure from anything in the history of psychiatry. Its purpose is to provide a formal, articulated model of mental disorder to fill the theoretical void at the core of modern psychiatry. This book is written for medical students and recent graduates, for psychiatrists, psychologists, social workers and, broadly, anybody with an interest in human affairs, such as philosophy, politics and other related fields.

Part I Basic principles

1 Setting the scene for natural dualism

DOI: 10.4324/9781003183792-1

You never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.

Richard Buckminster Fuller (1895–1983)

The most that can be expected from any model is that it can supply a useful approximation to reality: All models are wrong; some models are useful.

George Box (1919–2013)

1.1 The psychiatric view. Monism and reductionism

In talking about mental disorder, we have to talk about mentality. These days, everybody accepts that there is a mind and that there are mental events which occur within that mental life. The only dispute relates to how to give a rational account of the mind: What is its nature? How does it come about? How does it interact with the body?

The simplest approach is monism, the idea that the universe is of a single or unitary nature. The most common view is that there is no more to the universe than the material realm of time and space, matter and energy, all governed by the laws of physics as we usually understand them. This means that ultimately, the mind is also physical in nature, that it is no different in principle from all other things that we can see, touch and measure. This concept is known as materialist monism or, more precisely, as physicalism. The other type of monism is that the universe is entirely mental in nature, better known as idealism. There is a further niche in the middle, neutral monism, which says that mind and material matter are both manifestations of a single substance which we haven’t yet discovered. There are very few modern philosophers who would take either of the latter two views seriously so it seems physicalism wins by default but… there are serious problems with this option.

In a material universe, big things are built from smaller things, so the best way to understand the behaviour or properties of bigger things is to take them apart. As a form of explanation, reductionism says that the behaviour or properties of higher order entities are fully explained as functions of the behaviour or properties of the lower order entities of which they are composed. The whole of modern western science is built upon this concept and, so far, it has served us very well.

Biological reductionism says that the appearance and behaviour of all life forms is fully explained by the actions of the chemicals that comprise the living organism. However, when this principle is applied to humans, it has to include the mind. Reductionism says that the whole of the human mental life, including properties of mind and all mental events without exception, can be fully explained as properties of the physical matter of the brain. It is an attempt to account for the phenomena of mind in physical terms, not least because any other option immediately bogs down in contradictions.

For a reductionist, a full account of the anatomy, physiology and genetics of the human brain will yield a full account of the mind in all its aspects, with no questions left unanswered. Biological psychiatry relies on materialist monism or physicalism for its theoretical basis. It says that all questions of mental disorder can be answered in their entirety by a full knowledge of brain pathology. In logical terms, knowledge of the brain is necessary and sufficient to explain mental disorder: there is nothing else that needs explaining, and there is nothing else that could be explanatory. This is how the experts see it:

• Psychiatric disorders are brain disorders… Psychiatric disorders are medical disorders [1] (David Kupfer, b. 1941, chairman of DSM5 Committee; emphasis in the original).
• First, the RDoC framework conceptualises mental illnesses as brain disorders… Second, (it) assumes that the dysfunction in neural circuits can be identified with the tools of (ordinary) neuroscience… [2] (Thomas Insel, b. 1951, former director of US NIMH, which disburses the great bulk of psychiatric research money in the US, ca. $1.5bln each year).

For psychiatrists, whose medical training is directly in the tradition of western materialist science, biological reductionism holds a powerful attraction as it appears to mesh neatly with the rest of biology, with no discontinuity. Absent reductionism, we would be forced to grapple with the idea of mental disorder being caused by errors in some sort of ghostly “thing” in the head, which definitely doesn’t mesh with western science.¹

1 Reductionism has an additional appeal in that it allows people to embrace the concept of mental disorder while holding firm fundamentalist religious views. In that case, mental disorder is seen as nothing more than the body going wrong; the soul remains perfect, as when it was created.

Unfortunately for its supporters, no psychiatrist has ever offered a proof of biological reductionism, as McHugh and Slavney glumly observed:

… in contrast to cardiologists, psychiatrists cannot go directly from knowing the elements of the brain (neurons and synapses) to explaining the conscious experiences that are the essence of mental life. At the frontier of brain and mind, wherever that may be, the words we use change from tangibles (neurons and synapses) to intangibles (thoughts, moods, and perceptions) … Unlike cardiologists, psychiatrists are unable to go directly from the molecular structure of a bodily organ to the functional results of that organ’s action [3, p. 30].

There is indeed no such proof anywhere in the specialist literature of any field [4], meaning biological reductionism is wholly an ideological claim, divorced from scientific reality. The history of why it has become so influential is another story (see [5] for a very readable account of the history of biological psychiatry) but the narrative of a biological psychiatry has now become immune to, and, all too often, vehemently protected from, criticism, as philosopher Daniel Stoljar (b. 1967) noted:

The first thing to say when considering the truth of physicalism is that we live in an overwhelmingly physicalist or materialist intellectual culture. The result is that, as things currently stand, the standards of argumentation required to persuade someone of the truth of physicalism are much lower than the standards required to persuade someone of its negation [6].

Essentially, and not least because the alternatives seem so vague and uncertain, people want to believe that physicalism is the way to go, so they have never bothered too much about the details.

In a careful analysis of the concept, Stoljar considered three basic questions. If we say that everything is physical, firstly, what are we actually saying? Second, is it true? Third, what are the consequences of making this claim? He determined that physicalism is more an attitude than a consistent explanatory thesis. So, if we hear a noise from the roof at night, we assume it’s amorous possums and not demons. If a friend ails, we don’t automatically think of spells or possession states. And if his malady is depression, we assign it to the class of brain dysfunctions as a ‘chemical imbalance of the brain.’

Guided by physicalism, we assume this because it sounds real, objective and amenable to intervention. As good rationalists, we don’t want to resort to psychologism, i.e. to think of his depression as some indefinable hangover from childhood or, equally repellant, as a moral failure. We want to avoid both invoking irrefutable mental constructs and casting moral aspersions at the sufferer, just because that path (psychologism) is wide open to abuse. A physicalist approach, or ontology, seems to be objective, rational, non-judgemental and progressive - you could almost say ‘modern’. Who could ask for more? Well, here we run into a problem, as Stoljar’s almost forensic dissection concluded:

… there is no version of physicalism that is (a) true and (b) deserves the name… the very considerable influence of physicalism on contemporary philosophy is largely without foundation.

Unfortunately, biological reductionism, the basis of modern biological psychiatry, is very much one of those unfounded versions. Even though it isn’t the theme of this book, we will return to this point.

1.2 Dualism, supernatural dualism and its problems. Natural dualism

In contrast to monism, dualism states that the universe is of a two-fold nature. The human mind is seen as irreducibly mental in nature, i.e. it has properties which can never be explained by reference to the physical or material universe. Dualism says that, in addition to the material realm of time and space, matter and energy, all governed by the laws of physics (especially the laws of thermodynamics), humans have a mind or mental realm, which is emphatically not governed by any physical laws. It has its own laws (we presume there are laws, otherwise the concept of mind is chaotic) which are distinct from those of physics, with no contact at any point: the laws of the physical universe and any mentalist laws constitute separate realms of discourse.

However, because a non-material mind isn’t amenable to investigation by the methods and principles of our very successful materialist science, dualism doesn’t get a good press. The well-known philosopher, Daniel Dennett (b. 1942), summarised the problem as he saw it:

My first year in college, I read Descartes’ Meditations and was hooked on the mind-body problem. Now here was a mystery. How on earth could my thoughts and feelings fit in the same world with the nerve cells and molecules that made up my brain [7, preface].

Right at the beginning of his education, Dennett concluded they can’t. He has spent the rest of his allotted span trying to formulate an alternative, with what would charitably be called limited success. Despite his initial impressions, the fact remains: Yes, we surely have blood and brains and all that physical stuff in our heads but… equally powerful is the belief that there is more to us than mere nerve cells and molecules. We do indeed have “thoughts and feelings,” the problem is to give a proper account of them. Philosopher David Oderberg (b. 1963) has long complained not just that dualism is not taken seriously, but that it’s actually seen as a joke:

Dualism… (is) more the object of ridicule than of serious rational engagement. It is held by the vast majority of philosophers to be anything from (and not mutually exclusively) false, mysterious, and bizarre, to obscurantist, unintelligible, and/or dangerous to morals. Its adherents are assumed to be biased, scientifically ill-informed, motivated by prior theological dogma, cursed by metaphysical anachronism, and/or to have taken leave of their senses [8].

Or, as Dennett would say, all of the above. He believes the criticism is justified, and more. Dualism, he says, is crude and infantile magical thinking, the epitome of non-science, a “… hopelessly contradiction-riddled myth…” [7, p 430] that violates the fundamental laws of the universe, creating endless logical problems without solving any:

Dualism, the idea that a brain cannot be a thinking thing so a thinking thing cannot be a brain … accepting dualism is giving up… I wiggle my finger by … what, wiggling my soul?… (mind stuff is) ectoplasm, Wonder Tissue… There is the lurking suspicion that the most attractive feature of mind stuff is its promise of being so mysterious that it keeps science at bay forever … if dualism is the best we can do, then we can’t understand human consciousness [7, p. 37-9].

That more or less sums up Dennett’s attitude, but his antagonism is misplaced. The word ‘dual’ means two-fold. There is nothing in the definition of dualism that implies magic. To paraphrase Richard Watson:

The crux of dualism is an apparently unbridgeable gap between two incommensurable orders of being that must be reconciled if we wish to justify our assumption that the universe is comprehensible [9, emphasis added].

Mind-body dualism says only that there is an apparently unbridgeable gap between the two incommensurable orders of our being, mind and body. The task for any dualist theory is therefore to give a rational account of the apparently immaterial mind in non-material terms. That is, it must explain its nature, its origin and how it interacts with the body without relying on physicalist concepts. However, and this is the difficult bit, we have to do so within the modern ontology, meaning without breaching the laws of thermodynamics. That sets an exceedingly high bar. You can understand why people have decided it’s easier to abandon dualism: it’s just too damned difficult. But to make it worse, I will add a further task: any valid theory of mind must give rise to a formal account of mental disorder. If a theory of mind can’t indicate a potential explanation of mental disorder, then it isn’t worth pursuing.

There are various types of dualism but the oldest and still the most widespread is supernatural dualism. This says that the mind (or soul, or spirit) is not part of the natural, material realm; instead, it bel...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• List of figures
• List of tables
• Preface
• Part I: Basic principles
• Part II: Implementation
• Part III: Conclusions
• Index