Both Horns of a Dilemma Are Usually Attached to the Same Bull: A Built-in Impediment to Understanding Psychoses

BRIEF PROPOSAL BOTH HORNS OF A DILEMMA ARE USUALLY ATTACHED TO THE SAME BULL: A BUILT-IN IMPEDIMENT TO UNDERSTANDING PSYCHOSES ROY M. KAHN* It would appear that the existence of disorders in mood or behavior for which no cause was readily visible firstdragooned the seventeenth-century physician into the "mental " business. Priests of miscellaneous religions had grappled ritualistically with the invisible demons of "psychosis" within, but then demons went out ofstyle. The doctors were left as persons who normally dealt with the invisible which is inside of people. They inherited the unknown from the barber-surgeons who trepanned for stones to cure odd ideas, since the populace appeared to have decided that instant reliefwas rather better than eventual salvation. The doctors aren't having much luck either if statistics be true. In the light of recent technological and philosophical developments one must now again question whether the people doing psychological-psychiatric research are best trained to investigateprocess as against state when there have come to exist neurophysiologists , molecular biologists, certain forms of psychologists, biochemists, systems theoreticians , and cyberneticists with computers excellently adapted to study process. For 'psychosis' is process and is not state.1 The traditional psychiatric approach to psychoses has been to separate them into "organic" and "functional" categories. A lot of thinking has been devoted to trying to integrate (or trying to further separate) these two categories. Stanley Cobb [i, 2] has argued brilliantly and forcefully for a meaningful concept of "functional," while others [3, 4] have argued the scientific significance of "organic." Flanders-Dunbar [5] has noted that all disease should be viewed as process, without mentioning psychoses explicitly. There is some question whether psychosis is a "medical" disease at all. Arieti [6], trying to summarize, has pointed out that all psychoses are behaviorally evaluated and possess * Address: Counseling Center, T-5, University ofCalifornia, Berkeley, California 94720. 1 State is a process stopped in midstream—frozen for study, as a biological cross-section or specimen . Process, in contrast, may be considered as all ongoing systems—activity taken as a stream. It would include the effects of the activity stream upon impinging systems (internal and external), plus all feedbacks and systems for feedbacks (active or not). In psychosis, internal process is ongoing neurochemical activity in its integrative as well as individual effects. Condition may be defined for these purposes as any constant (in the mathematical sense) present in either a given state or ongoing process, in an individual or his relevant environment. 633 organ and organ-function components as well as molecular underlays. While this is certainly true, it belies the basic issue by eliding the central concept ofprocess. In reality, any "organic" and "functional" division is based primarily on whether neural or biochemical changes can be shown to have occurred in conjunction with the disordered behavior. Where a fairly consistent demonstration of "organic" changes is accompanied by more or less consistent deviant behavioral concomitants—by gross measure—a causative relationship has been assumed, and the behavior has been labeled an "organic" psychosis. Such psychoses as senile dementia, toxic reactions, etc., fit such a general paradigm. Conversely, when no neurochemical or morphological changes can be demonstrated (as yet, anyway), the (psychotic) behavior has been said to be "functional ." This word "functional" needs defining, but one definition may suffice for now: a misfunction of the interactions of parts rather than causative structural supramolecular changes in them. The division into "organic" and "functional" is essentially artificial, and the reasoning underlying it may be spurious. As far back as 1940 Craik [7] suggested cybernetic models to clarify the dilemma. Consider the following apparently true mutually contradictory propositions involving solipsistic reasoning: (a) any modification in behavior requires some sort of neurochemical activity—and in this sense it is all "organic," even the "functional" kind; (b) the morphological differences in the brains of retardates—for some reason—are not considered to produce organic psychoses, although the behavior is consistently somewhat disordered; (c) when "organic" changes are demonstrable, it is still the integrative functions or processes of the brain which are modified, impeded, or stopped (yielding odd behavior), and in this sense all psychoses are functional—for example, in psychoses "organic" operationally means...