Psychiatry is caught up in a number of philosophical errors. One is reductionism, as psychiatry tends to seek underlying biological causes for mental disorders. The other is dualism, as it thinks of mental disorders as either caused by our brains or caused by our minds. Both these errors are a result of seeing the world as made up of a hierarchy of things. Instead, if psychiatry saw the world as fundamentally made up of processes, dynamically interacting with each other, a much more nuanced understanding of mental disorders would become available to it, argues Elly Vintiadis.Elly Vintiadis, “Reality and mental disorder: Psychiatry has a philosophy problem” at IAI News (September 19, 2022)
From her essay at IAI News:
Beyond the problematic search for essences and ultimate levels of reduction, another problem in psychiatry that often goes unacknowledged is dualism: we still tend to see psychiatric illnesses either as brain-based or mind-based. This dualism can also be seen in our attributions of responsibility and blame; the more a disorder is seen as psychological or environmental/social causes, the more the patient is considered blameworthy and responsible for it. While if the disorder is seen as biological it is the other way around: it is typically thought of beyond a person’s control. In addition to this, dualistic thinking underpins the conventional dichotomies of nature vs. nurture and biology vs. culture that try to establish which of the two in each dichotomy is more fundamental, often giving secondary importance to anything relating to the larger social context.
These three problems of essentialism, reductionism and dualism, do not necessarily go hand in hand with a non-processual metaphysics, but they are only possible within such frameworks. By adopting process metaphysics, we can explain why questions such as whether a disorder has biological or social causes or what a disorder really is, are ill-posed while providing a context in which such questions do not arise. Because mental disorders are complex phenomena that manifest in different ways, operate at different timescales and emerge through diverse causal pathways they are better understood as processes, made up of a collection of processes that interact in non-linear ways.Elly Vintiadis, “Reality and mental disorder: Psychiatry has a philosophy problem” at IAI News (September 19, 2022)
Trainee psychiatrist Umar Nasser thinks about replacing “states” or “entities” with “processes” and reflects,
Surely process metaphysics has just produced a new reductionism – everything is “process”?
Also, the idea of a process doesn’t seem to make much sense to me unless you’re talking of a process in relation to an object which goes from one state and into another state. The idea of a process seems to therefore depend on the idea of an underlying stable element. It can’t be ‘process all the way down,’ can it?
Lastly, we have pretty stable kinds in the chemical and biological worlds, like the elements of the periodic table and species in biology. Whether or not ‘all is process’, these stable kinds exist. If so, I don’t see why mental disorders can’t be equivalent natural kinds in the psychiatric landscape.
Hark! Some of us hear William Shakespeare warbling in the background.
MacBeth, in the play named after him, is asking a physician to help Lady MacBeth who is losing her mind in the stress of dire events precipitated by her husband’s encounter with three (count ‘em) witches:
MACBETH: Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain
And with some sweet oblivious antidote
Cleanse the stuff’d bosom of that perilous stuff
Which weighs upon the heart?
Therein the patient
Must minister to himself.
Throw physic to the dogs; I’ll none of it.
Ah yes, that is always the temptation. Throw out the discipline altogether or make radical changes. But it’s not clear in which direction Vintiadis wishes to throw it…
Understanding the human mind is necessarily complex because it is both what we are trying to perceive and the tool by which we hope to perceive it.