This is probably my last post in this blog, unless something truly important comes up. First of all, I am no longer formally authorized to write about psychiatry, because I don't do it anymore; I withdrew from my residency program and thus relieved myself of any and all responsibility.
Secondly, and most importantly, I realized that psychiatry is not an evil in itself, but only a symptom of the malady that the whole Western society seems to be suffering from. To criticize psychiatry without regard to our society's economy, politics, history or ecology is like treating depression without regard to a person's lifestyle, income, diet or love. Such treatment, and such critique, generates a lot of visible 'action' but is in fact pointless and doesn't help.
Besides, there are people who've said everything long ago and with such clarity that I can never hope to achieve. When's the last time you read Orwell's 1984? This book doesn't even mention psychiatry, but it contains everything that there is to understand about it. If you've read and understood this book, I really have nothing else to say to you; and if you haven't understood it, then no amount of my blogging is going to help you anyway.
And remember: Freedom is when you can say that two by two equals four, even if your Party (or your Doctor) claims otherwise. That's all there is to it, really.
Friday, March 27, 2009
Thursday, February 26, 2009
Myth 4. Psychiatric disorders are diseases of the brain.
It is very frequently told to psychiatric patients that the psychiatric disorders are diseases of the physical matter of the brain. It is in fact one of the cornerstone postulates of psychiatry, which allows it to maintain its position as a medical discipline. It takes root in the materialist philosophy which claims that consciousness is a direct product of matter and is therefore rigidly determined by it. No change in consciousness, it is said, can happen without being caused by the corresponding change in matter. Thus, it follows that the cause to any imaginable change or process in consciousness lies in the physical matter of the brain; by manipulating the brain with certain accuracy we can theoretically bring to life any state of consciousness.
It is important to realize, however, that this is no more than a philosophical concept. It may be a nice concept, but it has never been proved. Yes, there have been numerous cases in the history of psychiatry when some or other mental changes were achieved by manipulating the brain; many behavioral disturbances were successfully treated by biological means. One of the most famous examples of the latter is syphilis of the central nervous system, which can cause personality changes, psychosis or depression; a lot of such patients were cured by the newly discovered antibiotics, which reinforced the belief that one day we may find biological substrate of all psychological problems.
This was a generalization, and it still remains the object of rather abstract philosophical belief. We have not observed any physical brain changes in numerous well-shaped psychiatric syndromes, leave alone psychological states, despite years of frantic efforts to find them. Moreover, what we know about the brain physiology in relation to the content of thought, is rough and approximate. In a famous experiment a neurosurgeon caused a patient to hear music by inserting an electrode in a certain part of his brain. Impressed by this report, we tend to forget that, first, it was an accidental finding in this particular patient that would not necessarily work for all of us, and second, no matter where the surgeon would poke, he could not choose what music the patient was hearing. He would not have the faintest idea where to put his electrodes for the patient to suddenly say that two plus two equals eighteen instead of four, and where to move them so he says seventeen. This is not a technological problem; even theoretically couldn't we imagine, which of the brain parameters must be modified to achieve such an effect.
We may find out one day; but as of now to say that we have established and proved a direct causal connection between the brain matter and the consciousness is a grave exaggeration.
Actually, it is quite uncertain that such definite connection exists at all. Perhaps a famous computer analogy will be of use here. What we see on a computer screen depends to some extent on its hardware (processor, memory, monitor, and all kinds of colorful wires), but is not really determined by it. The hardware only provides the possibilities, the general scope of possible actions, but the actions themselves depend on the software as well. The software, on the other hand, is not something "material" in the usual sense of the word. We cannot take a snapshot, a picture, of the software. The code, of course, can be written down on a piece of paper, but in this form it will not work; for it to work, it must dynamically interact with the appropriate hardware in real time. No hardware by itself can determine, for example, what type of images appear on my screen - only whether or not the screen is capable of displaying images in general.
If the computer doesn't work properly, the problem may be either in the hardware, or in the software. Hardware problems must be dealt with by hardware means, whereas software problems by software means. By maintaining, essentially, that all problems are hardware-based, psychiatrists put themselves in an unenviable position of a person reaching for a screwdriver every time his keyboard language is wrong.
It is important to realize, however, that this is no more than a philosophical concept. It may be a nice concept, but it has never been proved. Yes, there have been numerous cases in the history of psychiatry when some or other mental changes were achieved by manipulating the brain; many behavioral disturbances were successfully treated by biological means. One of the most famous examples of the latter is syphilis of the central nervous system, which can cause personality changes, psychosis or depression; a lot of such patients were cured by the newly discovered antibiotics, which reinforced the belief that one day we may find biological substrate of all psychological problems.
This was a generalization, and it still remains the object of rather abstract philosophical belief. We have not observed any physical brain changes in numerous well-shaped psychiatric syndromes, leave alone psychological states, despite years of frantic efforts to find them. Moreover, what we know about the brain physiology in relation to the content of thought, is rough and approximate. In a famous experiment a neurosurgeon caused a patient to hear music by inserting an electrode in a certain part of his brain. Impressed by this report, we tend to forget that, first, it was an accidental finding in this particular patient that would not necessarily work for all of us, and second, no matter where the surgeon would poke, he could not choose what music the patient was hearing. He would not have the faintest idea where to put his electrodes for the patient to suddenly say that two plus two equals eighteen instead of four, and where to move them so he says seventeen. This is not a technological problem; even theoretically couldn't we imagine, which of the brain parameters must be modified to achieve such an effect.
We may find out one day; but as of now to say that we have established and proved a direct causal connection between the brain matter and the consciousness is a grave exaggeration.
Actually, it is quite uncertain that such definite connection exists at all. Perhaps a famous computer analogy will be of use here. What we see on a computer screen depends to some extent on its hardware (processor, memory, monitor, and all kinds of colorful wires), but is not really determined by it. The hardware only provides the possibilities, the general scope of possible actions, but the actions themselves depend on the software as well. The software, on the other hand, is not something "material" in the usual sense of the word. We cannot take a snapshot, a picture, of the software. The code, of course, can be written down on a piece of paper, but in this form it will not work; for it to work, it must dynamically interact with the appropriate hardware in real time. No hardware by itself can determine, for example, what type of images appear on my screen - only whether or not the screen is capable of displaying images in general.
If the computer doesn't work properly, the problem may be either in the hardware, or in the software. Hardware problems must be dealt with by hardware means, whereas software problems by software means. By maintaining, essentially, that all problems are hardware-based, psychiatrists put themselves in an unenviable position of a person reaching for a screwdriver every time his keyboard language is wrong.
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