Читать книгу Phobias: Fighting the Fear - Helen Saul - Страница 13

Born into a rich and noble family at the end of the sixteenth century, Descartes studied languages, literature and philosophy at one of the top French schools of the period. But even as a young man he became disillusioned with the limited nature of the teaching and quit his studies to lead a life of pleasure in Paris.

Boredom eventually set in and he joined the army in Holland, where he learned about mathematics and the natural sciences. Then later on, he joined the Bavarian imperial army in the Thirty Years War, which allowed him to travel through Germany, Austria, Hungary, Switzerland and Italy. He was constantly observing, contemplating reality, and working on his own philosophical method.

He moved back to Paris for a few years, eventually leaving again for a life of near-seclusion in Holland. His interests included mathematics, optics, astronomy, chemistry and botany and out of this unlikely mix came key ideas in the history of psychology.

His views on early learning, for example, are still vividly contemporary. In 1649, shortly before his death, he wrote that learning can start before birth.

It is easy to conceive that the strange aversion of some, who cannot endure the smell of roses, the sight of a cat, or the like, come only from hence, that when they were but newly alive they were displeased with some such objects, or else had a fellow-feeling of their mother’s resentment who was so distasted when she was with child; for it is certain there is an affinity between the motions of the mother and the child in her womb, so that whatsoever is displeasing to one offends the other; and the smell of roses may have caused some great headache in the child when it was in the cradle; or a cat may have affrighted it and none took notice of it, nor the child so much as remembered it; though the idea of that aversion he then had to roses or a cat remain imprinted in his brain to his life’s end.

Descartes’ major contribution applies to the whole of psychiatry, not just to phobias and anxiety. However, the respect in which he was held rather unfortunately cast in stone the mind-body split still so relevant to the treatment of phobias.

Descartes set out to question all accepted wisdom and build up his own philosophy from scratch. He was a firm believer in reason and thought all experience was fallible for he could never be completely sure that he had not been dreaming, or even tricked by a malicious demon. Bodily experiences were unreliable, he said, and the only thing he could be absolutely sure of was that he was thinking. His first principle of philosophy was, famously, ‘Cogito, ergo sum’, ‘I think, therefore I am’, and he came to regard the mind or soul as totally separate from the body. They are simply two different entities, he said: the mind is not a physical thing and therefore it can never truly merge with the body.

Descartes was searching for absolute truths and was not attempting to pit future psychiatrist against future psychiatrist. However, his reasoning led to Cartesian dualism, which has translated into medical circles as the great divide between mind and body. Does the cause of a psychological problem such as a phobia lie in the thinking mind or in the physical brain? The question has never been answered and professionals line up on opposite sides of this divide. Geneticists, molecular biologists and neurophysiologists, looking ever more closely into the physical and mechanistic workings of the brain, represent the ‘body’ side of the argument. Their remit is to explore the parts of the brain that can make us susceptible to phobias, anxiety and panic, somehow change its delicate chemistry and reduce our fear. On the ‘mind’ side, psychologists and psychotherapists examine past experiences or current beliefs and aim to challenge and change our thinking patterns to dispel our phobias.

Descartes believed that mind and body were closely linked and he would not have supported this interpretation of his work. In The Passions of the Soul he wrote: ‘There is such a tie between our soul and body that when we once have joined any corporal action with any thought, one of them never presents itself without the other.’ It is ironic that a philosopher who gave himself the widest possible brief is best remembered for naming the rift between some of the most polarised views in medicine and psychiatry.

He even named the meeting place between mind and body as the pineal gland. We now know that the pineal is sensitive to light and one of the hormones produced there, melatonin, regulates our sleep-wake cycle. Scientists researching jet lag and shift-work patterns have long been interested in the pineal but their work apparently had little relevance to phobias. However, some researchers now believe that certain light frequencies, acting via the pineal, may influence our susceptibility to both anxiety and phobias (discussed further in chapter 9).

Descartes’ belief in the central nature of thinking and reason makes him, like the Stoics before him, a rationalist. Cognitive therapists say that our beliefs fuel our fear, almost ‘I think, therefore I am frightened.’ Chapter 6, on cognition, examines at this in depth and it is quite possible that Descartes would have agreed with some of the main ideas.

Immanuel Kant, more than a hundred years after Descartes, was another rationalist, and his ideas fit equally well with cognitive therapy. Again, he stressed the importance of reason. He said, ‘The understanding cannot see. The senses cannot think. Only by their union can knowledge be produced.’

Kant believed that our ideas shape our view of the world. It is as if our ideas are spectacles that distort what we see. They determine what we focus on and how appealing it looks. We do not see an event itself, but only its appearance through these unreliable glasses. Put simply, there are alternative ways of looking at any event. Cognitive therapists today would agree. They aim to change people’s interpretation of events, just like adjusting their spectacles to change the focus or the tint.