“Mind the Gap”

“I just found God where he always was”
The Waterboys – Glastonbury Song (HQ)

The medical model is an approach to pathology or the study of diseased tissue and through it to a study of mental illness or “psychopathology”. Formulations that have existed as far back as the early 1800’s used rudimentary scientific principle to tabulate and diagnose disorder. Heil says it is more correct to form the “cognate sciences and those sciences have strictly limited categorizations.”

Scientific methods are tabulation, observation, measurement and repeatability of empirical tests. “A scientist looks at the how of a phenomenon.” (Singh &Singh 2009).

 The medical model defines health as the absence of disease and secondly that medical science will endeavor to find cures for those diseases. Medical definitions are formulated from “sign”; or some behavior or characteristic of disease that may be discovered during a physical examination of the person, usually measurable. “Symptom” is a subjective departure from normal functioning noticed by the patient.

R.D. Laing (1971) defines the process as…“complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment and prognosis.”

Disorder could be construed as anything that is abnormal or deviant. Psychiatry at a pragmatic, minimum level could be said to have “… narrowed its focus to mental disorders addressed with psychotropic drugs”. Browning (2008) Browning makes the point that since the 1980s American psychiatry has shifted from “mind and psyche to body and brain.

“Cognitive neuro-science continues to encroach upon issues traditionally addressed within philosophy including the nature of consciousness, action, knowledge and morality” (Denys 2003)

 This may be because of new technologies but the spread of this zeitgeist is also due in part to English as a dominant scientific language, power of the DSM formulations as short hand labels, cultural dominance of American theoretical output and secularization of culture.

” As is the case with the other secular professions of law and education, psychiatry in the U.S. has had enormous culture-making power (Browning 2008).

Psychopathology in its definition supposes an entity called “psyche” or soul. In the original Greek, sources this was Aristotelian” psuche “the breath of life, the essence or what “it is to be” [something]” or alternatively a mortal of great beauty who fell in love with Eros the good of love. This psyche is translated to the modern formulation through a process of narrative depiction. In one version of events the myth of Psyche is an allegorical model for the soul or divine part of man. The translation of psyche to the prefix “psycho” is because we have translated; “of the soul” to mean “of the mind.”

Early theories of mind ascribe divine functions to the soul, mind/ essence and deviant mental characteristics or behavior to the opposite end of this mental scale as demonic, beastly or ungodly. The process of defining mind in this period was through metaphysical and supernatural causation.

Pathology is the study and diagnosis of disease through examination; psychopathology is the branch of treatment dealing with mental disorders. Psychopathology implies a number of ideas, first that proper functioning of the human mind is examinable or that there are aspects of the immaterial that can be examined and possibly altered. This logic would then group medical interventions into areas where medicine could objectively observe mental functioning. Commitment to a bio-medical explanation for behavior /illness is key to the medical model. By definition to be mentally “ill” is to fall within the definitions of the medical profession on illness.”

 In this psychiatric context, theorists have argued that causal attributions vary along two main dimensions: controllability and stability” (Corrigan et al., 2000; Weiner, Perry, & Magnusson, 1988).(Quoted by Levi and Haslam 2005)

The categorizations of deviant mind states are the province of the medical profession because medicine (through its interest in anatomy and physiology) had assumed the social mantle of judge (and jailor) on mental capacity.

Doctors label “psychosis” or serious cases where delusion and mental disorder causes a state where contact with reality is lost. “Neurosis” is when the situation is less intense and has the possibility of a return to “normal” functioning. Some “patients” may be chronically mentally unwell and live “in the community,” with various legal and social conditions applied.

To change functioning requires some consciousness that something in ones thinking is “wrong” or disturbed. Courts do not want to define a condition as” madness” and thereby prejudice their ability to judge.

“It would certainly be a mistake to try and discover what could have been said of madness at a particular time by interrogating the being of madness itself…” (Foucault p32 1972)

Doctors become mental health experts by sublimation of responsibility, not through expertise.

Neuroscience has been a late addition to medical training and machines to scan electrical energy in the brain later still, coming to the mainstreamin the 1980s, following earlier Russian studies in the 1960s. Knowledge of chemical and biological processes makes treatment of aberrant behavior through drugs and physical intervention.

“… the belief that psychopathology cannot do without philosophical reflection, so obvious the last 150 years has recently vanished …the focus in training is in scientific knowledge, such as clinical neuroscience, behavioral and social sciences.” (Denys 2007)

Seeing medicine as secular and empirical and religious structures of thinking as fatalistic and anti-exploratory does a disservice to religion and its function. Bruno Bettelheim observed in his concentration camp experience Jehovah’s witnesses and other strong ideologically driven identities served as a mental buffer from the loss of motivation and desire for life, {conditions evoked in many/most “normal” prisoners}.

Dawkins asks is religion a placebo that prolongs life by reducing stress. Freud, coming from a neurological background, thought that religion is the “opium” of the masses. Contextualy those ideas are very similar.Dawkins concludes that religion is a byproduct of something else… suggesting the irrationality of love, hope and optimism as factors that provide grounds for evolutionary success. Quoting Frazier’s anthropological survey … “Once entrenched in a culture [memes] they persist and evolve in a manner reminiscent of biological evolution” (Dawkins p219 2007)

This digression invokes the notion that simply looking at material function for brain ordering and conception forming is a limiting strategy which focuses all problems into a particular solution that is both culturally mandated and devoid of meaning, value and subjective cognition. It also begins identifying a human focus on conformity and “constructive irrationality” (Dawkins p218 2007) evinced by Asch’s conformity test or Stanley Milligrams seminal work. What religion does show us is the power of ideas, archetype and narrative as supervening authority in our lives. Any formal examination of human social order must contain an acknowledgement of immaterial factors, an argument that would lend credence to Searle’s monist belief that brain creates mind.

Making meaning or cognition is a fundamentally different place to begin than the medical model with its emphasis on biological causation and subjective/objective tabulation. If looked at as internal and external frames of reference, the difference in the meaning made by the insane or mad patient is seen as socially unacceptable {defined by the professional mind reader}. “One way of interpreting the meaning of an action is in terms of the reason for doing it. Davidson argues that reasons are causes and that reasoning or rationalization is a species of causal explanation.”(Crichton 2004)

If we examine mind (as an “internal”{- a value laden concept supposing that mind is singular, in one body and one cohesive entity} impression of an external world) we can propose that mind can be likened to a cognition- meaning interface. This comprehension may only have reference for the observer (the “me”) which involves a series of kaleidoscopic reflections on self, rationality and reality. The question on whether the human entity is a cohesive whole with a defined rationality is more a philosophical position rather than a medical one.

In the medical model the human is observed from a neurological viewpoint (and possibly a reductive materialist one also. The brain is seen as a modular organ with long term memory and spatial navigation situated in the hippocampus, reason and logic situated in the later evolving, prefrontal cortex and motor and nerve functions located throughout the cerebellum, “all influences on human behavior, environmentally as well as hereditary, are mediated biologically.” (Wright p 249 1994)

If we look at the reasons for needing a holistic illusion of wholeness (based on our own “boundedness”) then it seems that a disjointed organism with various sensory drives is possible, but one with a supervening decision making functioning is more practical in Darwinian terms, thus implying a fundamental reason for “self” or “me” cognition. This supervening function can be logically wrong as in Dawkins example of the moth the flying into a flame, (Dawkins 2006 p201 202), not as mistake of reason but as mistake of fact (confusing one light source for another). Mental malfunction can be mistake of meaning, value, fact or truth depending on the situation but the medical model in applying a problem focused, labeling, approach may disregard the context of meaning. Pinker gets close to the scientific dilemma by asking; by allowing for choice are we just allowing a ghost back into the machine? (Pinker 2003 p166)

“Why do secular thinkers fear that biology drains life of meaning? It is because biology seems to deflate the values we most cherish. ….they have mixed up ultimate causation (why something evolved by natural selection) with proximate causation.” (Pinker p191 2003) One way of interpreting the meaning of an action is in terms of the reasons for doing it or its functionality. Davidson argues that reasons are causes and that reason giving, or rationalization, is a species of causal explanation [narrative models].

In one essential element Cartesian dualism does disservice to western thinking and that is to separate essence from existence (in contrast to eastern holistic models). The principle that “I” can be mind/soul immaterial remains a strong contender for the essential power of mind but it must be argued that “developing” existence does require sensing apparatus. Conversely it could be argued that, “I think, I am” is only one possible form of logic, I imagine, therefore I may not exist may be a nihilistic argument but it has the merit of denying the material essence in a logical way (the ghost may be antecedent to the machine in the same way that I can will something into being or form a plan of action -“intentionality” which is the solipsist/creationist argument or a computer geek’s avatar forming).

It is a human (materialist) conceit that “real” must have a physical basis.

Me

It is a conceit to imagine that what we call human consciousness is somehow “sufficient,” yet our precarious form of life is built on very small graduations of change in the natural environment and our sense information is rudimentary in comparison with other more specialized animals. An argument echoed in part by Foucault …Is there not a danger that everything that has so far protected the historian…the teleology of the sciences…the long and continuous labor of thought…the awakening and the progress of consciousness…may disappear, leaving for analysis a blank, indifferent space, lacking in both interiority and promise? (Foucault p39 1972)

Renaissance thinkers who followed the principle of scientific method espoused ideas for a doctrinaire treatment of disease or sickness. The enlightenment belief in reason and logic allow for secular causality (Locke, Hume) and changes in perspectives on personal responsibility, freedom and social structure.

…liberty being the most noble faculty of man, it is not degrading ones nature, reducing oneself to the level of brutes who are the slaves of instinct…(Rousseau p43 2004)

The concept of modernity or modern civilization while not being defined as a historical epoch ushered in ways of dealing with medical issues in a greater scale, with the building of universities in large towns followed by hospitals and later mental hospitals. This functional construction of a medical model does not obviate narrative structure, social mores and the changes in living standards. It is true that small changes in sanitation, clean drinking water and the implementation of public healthcare had exponential effects which gave Doctors new power to claim expertise in matters of mind. Conrad 1992 (Quoting Conrad 1975) says that medicalization is defining behavior as a medical problem or illness and mandating or licensing the medical profession to provide some treatment for it.”

. The eastern or Asian model of holistic medicine has evolved through a completely different conceptual process.  I would argue is no less effective for the peoples it serves. This draws us into a debate over the efficacy of different models based not of the effectiveness of outcomes but on the salient factors which induce the practitioner to define a successful outcome. There is a function in western individualist though to keep action fundamentally grounded within an individual, which is conceptually a difficult place to lay blame for societal (nurtured) ills.

What can be ascertained is that proper functioning of mind is suggested by an increasing awareness, consciousness or mindfulness and having more capacity to derive the intentionality or purpose of others and things in the environment. Interestingly these are not the objectives of the psychiatric profession in regard to patients. It could be argued that by objectifying the individual into the patient, that patient becomes not a person but an object of experiment. Mental illness is that which would lead another person to confuse your intentionality…

” we don’t want our free acts to be unmotivated, inexplicable, random lightning bolts without rhyme or reason. We want there to be a reason for them, we want these to be our reasons… (Dennett p124 2003)

Modern neuro-science has assumed a level of expertise on brain function. In materialist terms mind is the operation of brain. I feel if I am to be true to the conceptual analysis I have to make the point that humans examine the concept of mind while at the same time they are using mind to analyze it- so aspects of the evaluation call into question belief and philosophy and not simply an objective, factual examination of inert physical states.

Neurosurgeons test for basic brain function using basic tests of cognition – light in the eyes response to pressure and the ability to see two raised fingers. Using MRI scans it is possible to examine brain function in a modular fashion where stimulation can achieve various physical responses which draws the question – could a person without consciousness be electrically stimulated to the level of “zombieness”?

Could a computer achieve sentience (Turing test) in the opposite way or could a combination (live computer/dead body) of both achieve a new cybernetic form of life – a machine in a ghost?

On a theoretical level it seems the answer is yes on all counts, basing the analogy on “ourselves” as organic computing machines (computational theory of mind), which begs the question, what exactly is consciousness? We can answer that a child of eighteen months is capable of doing a simple test that shows a form of consciousness (spot-mirror test) but a cogent definition is mired in psychological oddities- phantom limb syndrome, coma states, sleeping and dreaming being some of the more obvious. What is extant is that consciousness “is integral to intentional states” Maslin( p 303 1988)such as desires thoughts and beliefs

On a social level the medical profession‘s job is to evaluate a form of social responsibility. That means that the objective is to define the parameters of free will. As Dennett observes true free will would involve no fear of consequence and a commitment to doing exactly what one wants to do (a fairly typical laypersons definition of madness) it is preferential then for the mind to be a machine for evaluating consequences and choosing those consequences that permit the best chance of genetic longevity. Dennett calls this the birth of “evitability “(Dennett p 56 2003)

In a philosophical sense we are leaving a position of hard determinism behind because mind is not constrained by factors of causation (within the hyper real/virtual sphere) and to define brain simply in biological terms does a disservice to those creative functions of mind that we hold in high esteem; spatial awareness, an aesthetic sense and imagination.

Medical models are reductionist- espousing a form of investigation which forms a top down model of behavior related as we already deduced to a social conditioning and explored using trial and error methods. This devolution or reductionism is opposite to mind in terms of evolutionary psychology. It is interesting that a conception of mind in biological terms is couched in behaviorist models when the purpose of mind seems to be to offer an escape from these models in terms of “emergent” properties.

This importance of brain/mind can be analyzed in terms of the amount of energy it takes to power this gigantic information processor. It takes nearly eighteen years to fully grow. A vast amount of circulating blood and air, is centered at the apogee of the organism in a point of vulnerability, an unbalanced five kilos of porridge. These physical factors all delineate a “fitness” for evolutionary purpose.

 I argue that…”any animal is a model or description of its own world, or more precisely the world in which its ancestors genes were selected” (Dawkins p241 1998).

 This would mean that the world that specifies such a brain/mind would be one that “values “the qualities that brain/mind possesses.

In a similar argument the qualities sought by psychiatrists as factors delineating a dysfunctional brain/mind would be those elements most culturally devalued (accepting that culture is not environment or the nature of a being).

We know that there is a time lapse between cognition and consciousness of an event which in turn gives a reasonable basis for an idea that consciousness is preceded by biological and motor responses to events. Deciding between the free will possible in the human animal when science tells us we are caused poses the question of “agency”.

Dennett argues that “you” are the totality of the response and not just elements of it- “You are not an extentionless point” (Dennett p 242) or to paraphrase Locke, the mind needs an “object”. He also argues that communication (p242-257) is the basis for awareness, quoting Wegener that, illusory or not, conscious will is the person‘s guide to his or her own moral responsibility” ( Dennett p252 2003)

Conclusions

Medical models specify causal biological factors for brain illness and treat conditions with drug or physical restraint. Treatment of the “patient” objectifies the person and labels the disease implying the function of psychiatry is investigation of disease rather than restoring mental health.

Subnormal or abnormal brains seem to be those individuals who somehow lack the ability to be conscious of social conventions and rules. Mental issues (e.g. hyperactivity and depression) seem to have contributing factors outside strict biological causation predicated on “disease” and social consequences that fall into states of stigma and isolation not covered by medical expertise.

Philosophy speaks about mind as concept, not just human mind and human brain thereby assuming an exploration that is broader in scope and context than psychiatry and neuroscience. With a focus on logic and reason philosophy is antecedent and complementary to medicine.

Mind (if it exists) probably is born in the social behavior of having an identity, communicating and interacting, areas of investigation which encapsulate all form of “thought in action”. Medical models are a form of social “norming,” meaning that moderating behavior is central. In the same way that the judiciary does not often comment on politics, the medical profession remains aloof from philosophy. It would be my overall contention that pragmatic social conditioning outweighs philosophy within the medical model.

Image courtesy of  Pixabay.com/en/universe-sky-star-space-all-2742113/

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