Friday, January 05, 2018

Mental illness is, in the first instance, a disturbance of the mind (and thus not the brain)


“It has in recent years become fashionable to conceive of ourselves as the helpless products of our genes; free will and responsibility are commonly thought an illusion, to be displaced by genetic and neural determinism; and the theory of evolution in invoked to explain morality and altruism in terms of natural selection. Our affinity with other hominidae has become a subject of extensive research, often aimed at cutting us down to size. The prowess of the great apes is exaggerated, often in order to narrow the perceived gap between animals and us. This development in the Zeitgeist is sadly understandable, but unwarranted [Lest somebody is tempted to draw the wrong inference: this is not, however, the principal motivation of animal ethicists or those hoping to widen and extend our sense of care and concern for our animal brothers and sisters … or cousins. There need be no necessary connection between the extension of our moral compass to embrace nonhuman animals (which may include highlighting aspects of our animal nature we hold in common: like consciousness, the capacity for suffering, proto- and basic emotions, etc.) and the project of diminishing or failing to distinguish the distinctive features, attributes, and powers of human beings or persons.]. We are, to be sure, hominidae—but the only language using ones. No other creature has eaten of the fruit of the Tree of Knowledge of Good and Evil. We are animals, but the only animals who can aspire to live under the rule of law [or simply, and especially, moral norms], and who can achieve happiness [or eudaimonia, flourishing, or self-fulfillment as defined by philosophers and sages] (as opposed to mere contentment). It is well that we should bear in mind our rational nature and what is distinctive about us—what makes us ‘darkly wise and rudely great,’ ‘a pendulum between smile and tear,’ ‘the glory and the shame of the universe.’ … [In distinguishing and comparing man and beast we must bring to the fore] the applicability and reasons for the applicability of many cognitive and cogitative concepts to human beings, and to all other animals that are neither blessed with, nor cursed by possession of, the powers of reason, thought and understanding.”—P.M.S. Hacker, from the Introduction to The Intellectual Powers: A Study of Human Nature (Wiley Blackwell, 2013)

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And now a snippet from Olivia Goldhill’s brilliant essay, “In the Dark: 30 years after Prozac arrived, we still buy the lie that chemical imbalances cause depression,” Quartz, December 29, 2017

“ … [T]he idea of chemical imbalances has remained stubbornly embedded in the public understanding of depression.

Prozac, approved by the US Food and Drug Administration 30 years ago today, on Dec. 29, 1987, marked the first in a wave of widely prescribed antidepressants that built on and capitalized off this theory. No wonder: Taking a drug to tweak the biological chemical imbalances in the brain makes intuitive sense. But depression isn’t caused by a chemical imbalance, we don’t know how Prozac works, and we don’t even know for sure if it’s an effective treatment for the majority of people with depression.

One reason the theory of chemical imbalances won’t die is that it fits in with psychiatry’s attempt, over the past half century, to portray depression as a disease of the brain, instead of an illness of the mind. This narrative, which depicts depression as a biological condition that afflicts the material substance of the body, much like cancer, divorces depression from the self. It also casts aside the social factors that contribute to depression, such as isolation, poverty, or tragic events, as secondary concerns. Non-pharmaceutical treatments, such as therapy and exercise, often play second fiddle to drugs.

In the three decades since Prozac went on the market, antidepressants have propagated, which has further fed into the myths and false narratives we tell about mental illnesses. In that time, these trends have shifted not just our understanding, but our actual experiences of depression.”

The complete essay, which is, as we say, spot-on, is here.  

Update: I’ve just learned of a recent piece in the Guardian that provides us with a similar, albeit more personal argument that nicely complements Goldhill’s article: “Is everything you think you know about depression wrong?

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One of the underlying problems (or presuppositions, essential assumptions, animating premises) here is the failure to conceptually—and properly—distinguish the mind from the brain and, correlatively, to understand what it means to be a human animal and/or person (the latter in a metaphysical sense; thus one might advocate for a conception of legal personhood by way of  granting a small cluster of legal and perhaps moral rights to—some class of—nonhuman animals, while denying that these animals are persons in a metaphysical sense, or in the terms of a philosophical anthropology, which is based on a concept of a distinctively human nature). Furthermore, what Raymond Tallis describes as “Neuromania” (an uncritical and philosophically indefensible understanding of the various neurosciences) and “Darwinitis” (e.g., in the form of evolutionary psychology) has contributed to and exacerbated this failure. What follows are titles that help us understand why we should adamantly refuse to conflate the mind with, or reduce it to, the brain, or to believe that the mind simply arises or emerges from the brain (it might rather be understood as a necessary yet not sufficient condition of mind).

  • Bennett, M.R. and P.M.S. Hacker. Philosophical Foundations of Neuroscience. Malden, MA: Blackwell, 2003.
  • Bennett, Maxwell, Daniel Dennett, Peter Hacker, John Searle, and Daniel Robinson. Neuroscience and Philosophy: Brain, Mind and Language. New York: Columbia University Press, 2007. (I prefer the arguments of Bennett, Hacker, and Robinson over Dennett and Searle.) 
  • Bilgrami, Akeel. Self-Knowledge and Resentment. Cambridge, MA: Harvard University Press, 2006.
  • Descombes, Vincent (Stephen Adam Schwartz, tr.). The Mind’s Provisions: A Critique of Cognitivism. Princeton, NJ: Princeton University Press, 2001.
  • Finkelstein, David H. Expression and the Inner. Cambridge, MA: Harvard University Press, 2003.
  • Gillett, Grant. Subjectivity and Being Somebody: Human Identity and Neuroethics. Exeter, UK: Imprint Academic, 2008.
  • Gillett, Grant. The Mind and Its Discontents. New York: Oxford University Press, 2nd ed., 2009.
  • Hacker, P.M.S. Human Nature: The Categorial Framework. Malden, MA: Blackwell, 2007.
  • Hacker, P.M.S. The Intellectual Powers: A Study of Human Nature. Malden, MA: Wiley-Blackwell, 2013.
  • Hodgson, David. The Mind Matters: Consciousness and Choice in a Quantum World. New York: Oxford University Press, 1991
  • Horst, Steven. Beyond Reduction: Philosophy of Mind and Post-Reductionist Philosophy of Science. Oxford, UK: Oxford University Press, 2007.
  • Hutto, Daniel D. The Presence of Mind. Amsterdam: John Benjamins, 1999.
  • Hutto, Daniel D. Beyond Physicalism. Amsterdam: John Benjamins, 2000.
  • Hutto, Daniel D. Folk Psychological Narratives: The Sociocultural Basis of Understanding. Cambridge, MA: MIT Press, 2008.
  • Pardo, Michael S. and Dennis Patterson. Minds, Brains, and Law: The Conceptual Foundations of Law and Neuroscience. New York: Oxford University Press, 2013.
  • Patterson, Dennis and Michael S. Pardo, eds. Philosophical Foundations of Law and Neuroscience. New York: Oxford University Press, 2016.
  • Smith, Christian. What Is a Person? Chicago, IL: University of Chicago Press, 2010.
  • Tallis, Raymond. The Explicit Animal: A Defence of Human Consciousness. New York: St. Martin’s Press, 1999 ed.
  • Tallis, Raymond. I Am: An Inquiry into First-Person Being. Edinburgh: Edinburgh University Press, 2004.
  • Tallis, Raymond. The Knowing Animal: A Philosophical Inquiry into Knowledge and Truth. Edinburgh: Edinburgh University Press, 2004.
  • Tallis, Raymond. Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity. Durham, England: Acumen, 2011.
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Finally, I happen to have three bibliographies that are directly relevant to the topics broached in Goldhill’s piece:

Image: Ella Bergmann-Michel (20 October 1896 – 8 August 1971) I don’t know the title or date of this painting.


Blogger Bill Haines said...

Fascinating! Thanks Patrick. And that’s a very illuminating essay you link to.

As always I don’t know the literature, but it seems to me that anyone’s obvious first thought about causes of depression should be that in many or most cases it arises when what the mind has to deal with overloads the brain, causing the brain to be stuck because of side-effects of its representational mechanisms – like a computer that overheats from a complex problem (I imagine there was a time when that could happen). And insofar as one takes such a picture seriously as a possibility, (a) one is going to be unhappy with the simplicity of the term “the cause” of depression, even for a single case (as one should be anyway on general principle) and (b) one is going to be interested in the questions when and how far the stuckness is a side-effect or a proper effect of (representation by) the representational mechanisms: a question about (among other things) the cognitive import of feeling and of dispositions to act (or not act), and hence the moral authority of such things. And one important sign of whether the stuckness is a side-effect or a representation might be the kind of personal experience or social event that causes it. I suppose there might be a sense that medics should not be involved in such questions as whether one’s feeling that one ought not to live is reasonable.

1/15/2018 9:29 AM  
Blogger Patrick S. O'Donnell said...

Thanks for commenting Bill (I often wonder if anyone reads this stuff!): it's a pleasure to hear from you! I should note that I'm rather skeptical about the concept of "representational mechanisms" (as well as the value of computer analogies and metaphors: hence the short list of titles I included here) and I suspect only the most severe forms of depression are somehow tied to problems with our brains.

1/15/2018 5:46 PM  

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