The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness

2 What There Is: Of Mind and Brain

C H A P T E R 2 What There Is Of Mind and Brain 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? —DANIEL DENNETT, 1991 1. A common view in modern analytic philosophy is that the purpose of philosophy is the logical analysis of conceptual arguments. This perspective has little in common with other versions of the goals of philosophy, such as building metaphysical systems of thought (Hegel), seeking epistemological certainty (Descartes), or providing support for ethical (Kant) or religious (Aquinas) systems. Understood this way, we can make sense of Karl Jaspers’s statement that the study of psychiatry requires an understanding of philosophy (Jaspers [1913] 1997). This is so because otherwise psychiatry, like any other scientific discipline, would operate with uninvestigated assumptions and logically immature arguments. Psychiatry in particular runs this risk because its subject matter, the mind, is culturally imbued with many assumptions and beliefs, some of which may be false. For instance, many persons believe mental phenomena are separate from the body, and they thus might be inclined toward psychotherapy, as opposed to biological, treatments for various conditions. Such persons might in fact deny that psychiatric illnesses are medical diseases. Others, who believe that the brain is sufficient to explain all mental phenomena, hold opposite views. These differing perspectives are based on varied philosophies of mind and dissimilar assumptions about the nature of the mind, rather than on either reasoned discourse about that subject or careful investigation of the nature of the mind. If this is the reason why any student of the mind should have an awareness of philosophy, is there anything useful to be learned for psychiatry in the work of philosophers who specialize in the subject area of philosophy of mind? 2. One of the first things that strikes a psychiatrist, used to interviewing patients and faced with the concrete anxieties and moods of the clinical treatment setting, is an initial sense of a certain lack of relevance in some current philosophical controversies. However, these controversies do have useful connections to our clinical experiences. For instance, one of the main topics of controversy in philosophy of mind has been the dilemma of color (Jackson 1982).1 The prototypical problem is this: Suppose Mary is a color scientist, and she knows everything there is to know about color (its physical basis, an understanding of light and the spectrum of color, knowledge of brain pathways of color vision and the neurobiology underlying them), but she has one problem . She is in a black and white room. She has never left it, and she has never actually seen anything with color in it. The question is, Would she know what it is like to see color? There are variations on this theme. Do we know what pain is if we understand everything about the neurobiology of pain but never experience it? Is the neurobiology of pain the same thing as the pain itself? If not, what is there that is added to neurobiology to account for the phenomenon of pain (Flanagan 1991)?2 Another version reminds us that bats do not see; they navigate by their sense of hearing and by using electromagnetic waves. Do we, as humans , have any idea what it is like to be a bat? We can understand everything about the bat’s physiology, but will that allow us to understand what it is to be a bat (Nagel 1974)? These questions all share one essential core: is there something different about experiencing a thing (color, pain, being a bat) above and beyond our scienti fic understanding of the mechanisms of that thing (the neurobiology of color, pain, being a bat)? In other words, returning to older philosophical language , is there something subjective about mental experiences that is different from the objective bases of those experiences? And is this subjective aspect ineffable ? That is, is it by definition nonunderstandable in an objective scientific manner? Or is there some version of subjective knowledge to which it is amenable? Of Mind and Brain 25 3. These issues hopefully give the reader a flavor for certain issues in contemporary philosophy of mind. The reader might note that we have here a series...