Читать книгу Leaving Psychiatry - J. R. Ó’Braonáin. M.D. - Страница 6

“Human beings are complex biological systems, with mind as an emergent property. For this reason there are inherent uncertainties regarding diagnostic formulation and optimal care. It is anticipated that this guideline will assist clinicians to better navigate complex and challenging clinical scenarios. Tailoring care to the individual in the context of an effective working relationship is the foundation upon which the proper application of this guideline relies.”

The above quote was taken from the elsewhere mentioned Guidelines into the management of mood disorders published by the Australian and New Zealand guild of psychiatrists. The amphibology is almost impenetrable, as the text gives us no clue to the relation of the parts. Are the “inherent uncertainties” in the process of minds alleged emergence from matter (matter as material and efficient cause?) or in there being the mind per se after having emerged? Or is the challenge in the human being a complex biological system, where being can otherwise imply an experience of being as noun or as verb, as much as denoting this or that member of the species homo sapiens? Or is the complexity in the irreconcilable combination of the two elements of mind and matter as I will claim, or the human qua a human person and not a scientistically formulated “biological system”? And what on Earth has this ontology have to do with profane issues of psychiatric diagnoses? I will argue it matters greatly, this being the subject of the present chapter. Such is the matter of mind.

There is no inherent uncertainty in diagnosing a heart attack when this diagnosis is properly made, this despite the heart attack being in the minutia of its pathophysiology a complex biological event in a complex biological system, with the attack certainly emergent in the sense that it had not occurred a day before, yet not emergent as anything outside its own physicality and temporality. And so we have to ask, as later we will, what is meant by the word “emergence”? In any case this guild, as do others, nail their colours to the wall in acknowledging that to know the maladies of mind requires a knowledge of the mind itself, this being the solid ground upon which they need stand when diagnosing and treating. This is not a controversial expectation. How can pathological anatomy be possibly understood without a knowledge of the normal? What is mental illness without a knowledge of mind in general, either as noun or verb? This being so, the mind nonetheless renders psychiatry “inherently” different to other specialties which might make a claim to be medical. And so with that acknowledgement made, let us not dishonour what they have seen to be the case and state the matter simply; psychiatry cannot know itself or the patient either, unless it first knows the mind. I would argue its predicament is direr still, as the psychiatrist cannot know either itself or the patient without looking itself square in the eye as a participant in a social and political transaction, this also in part defining the patient to whom they might relate and who in turn relates to others. What was missing in the bio (complex biological), psycho (mind) formulation was the greater collective (socio) component of this greater complexity, which has also been called, in toto, a biopsychosocial model. And yet whether bipartite or tripartite, the latter so called biopsychosocial model is nothing more than a collection of considerations that can be placed under three differentially listed columns and so is not any model of the person at all, where model implies an explanation of where and why the boundaries between the categories and what are the interactions between these and their elements so as to produce the final product. A model is an explanation of precisely how components statically and dynamically fit together, not merely a three columned list of spare parts sitting on the shop floor.

To all this the reader may counter, with a pragmatic refrain, that the psychiatrist does not need to know or even conjecture on what the mind is in order for its praxis to be meaningful. All that matters is if treatment and diagnostic formulation “works” (I have included diagnosis as something that “works”, as diagnosis has as much utility as treatment in the psychiatric ritual, it is a shared fantasy that “treats” the psychiatrists and the patients anxiety not knowing what illness they “have”). The psychiatric pragmatist may state that in times past all physicians may have administered a perfectly suitable remedy without any knowledge at the time of what it chemically was and how it physiologically worked, and the patient none the worse for it. They might cite the example in our own day of general anaesthesia, where it remains only dimly known of how it works (where dim is a charitable overestimate). And fair enough. If one wishes to be rendered unconscious and insensate to avoid what would otherwise be agony at the surgeon’s blade, then who cares how this is to be achieved, and who cares how the sevoflurane or propofol interrupts the mystery of consciousness. This theoretical question is only of interest to the philosopher, and not at all when the philosopher is prepped for surgery. Such an analogy between general anaesthesia and psychiatry would be misplaced however, as general anaesthesia has no claim or calling to be anything other than a wholly self contained pragmatic exercise. It entirely explains itself by its success to bring the patient to deaths door and back again, and does not attempt couch itself in any greater narrative of the human condition.

Psychiatry on the other hand necessarily asks grander questions and pretends to have grander answers into mind and its maladies. In its pretences it tells people who they are in their symptoms and the relation between normal and abnormal, and in its omissions cannot avoid the charge of assuming what the patient is not (as spiritual beings for instance, the cohort of believers run roughshod over in the above quoted guideline elsewhere purporting to have sought and respected submissions from a broad audience with broad values and beliefs). It really does matter if the patient asks what mood is, and is told mood relies upon a harmony of certain neurotransmitters and that indeed good mood is an epiphenomena of the operations of these neurotransmitters. Or alternatively is depression inwardly directed anger or the outcome of laziness or not living up to expectations? It really does matter if the patient is told their addiction is a “highjacked” reward pathway or alternatively more a moral matter or distraction against life's meaninglessness with neuroscience having little of substance to offer to the question. It really does matter if we posit the unconscious to exist at all, let alone it being the warzone from which bursts forth our anxieties. It is only in begging the question towards a philosophical pragmatism (see chapter to follow) that these and countless other questions do not matter.

The current chapter, perhaps to be the shortest in the book, hardly addresses a survey of what the mind is or is not. Nor is it a survey of C.D, Broads taxonomy of mind as consciousness or an answer to Chalmers “hard question” of the same (i.e. the explanation for consciousness itself as the ground upon which all mental operations must stand and be experienced as mind in either noun or verb). Nonetheless I’ll take a stab at a defence of a radical agnosticism with respect to mind. Should I be correct, it will make of psychiatry forever a speculation longing to become the place it can never arrive. And if that is the case, psychiatry sits upon a level playing field with the pastor or wise grandmother as to what maketh the man (or woman).

Brain and Mind

Take a garden variety neuron. One neuron is first excited into activity by another, and so do we begin with the second or the first? But the first is also excited by another, and so on ad infinitum back to some embryological point where somewhere some first neuronal pair was excited to act. Thus our entry point into the brain is arbitrary. And so we are back to the garden variety neuron at an arbitrary space and time in the adult brain. A starting point of excitation for neuron 2 might be, in the simple case, a neurotransmitter floating around in the fluid space between neuron 1 and neuron 2. And the neurotransmitter might form a loose chemical bond with a protein in the seething semi fluid membranous coating that wraps around the neuron and is its cellular “skin”, this membrane being the place within which this protein “receptor” is to be located. This loose chemical bond results in a changing of the receptors structure, the change in structure being entirely explained on first principles to be a physical event, much as a door is explained by where the hinges are located and from where the force is applied when the wind slams it shut or swings it open. For the moment we are imagining neither a mind forcing its will upon the neuron or a hand forcing a will upon the door. This is a change in receptor structure that might, once again in the simple case, result in the receptor becoming a channel or loch through which flows positively charged sodium ions. Why do they flow in and not out? Actually they flow both ways, yet the nett flow is in one direction, this the result of random movement of a physical thing and an initial imbalance in concentration either side of the membrane. The original state of separation of charge and concentration imbalance across the membrane of various ions is driven in large part by other subcellular machinery whose operations can also be explained on the basis of one chemical bobbing up against another, changing the shape of it and so on, the principle chemical unit in this case being a little molecular machine that pumps sodium out and potassium in, in a ratio the resultant of which is more electrical negativity on the inside of the membrane at rest. The events of neuronal activation are similarly entirely explained by basic physical and statistical principles at play. The fact that the positively charged sodium ion is not at a temperature of absolute zero permits motion. The differential concentration either side of the membrane predicts the statistics of bulk nett flow (from high to low concentration). The second law of thermodynamics explains the same (the increase in disorder if energy is not applied to increase order, in dissipating a concentration gradient) and so on. The state of affairs can collectively be readily explained by calculations of both the Nernst and Goldman Hodgkin Katz constant field equations. Should enough sodium enter into the cell to alter the electrical state of the neuron to the requisite threshold, there will be another species of sodium channels responsive to changes in the electrical milieu whose shape will also change, so called voltage gated channels. These will conform into an open state and more sodium will float on in, this sodium diffusing sideways within the neuron, the resultant being more electrical change and more sodium influx propagated along with length of the nerve (so called depolarization and propagation). At the terminus of the nerve the voltage change will activate yet another species of little intramembranous proteins bobbing around like icebergs in the semi fluid sea that is the cellular membrane. These admit calcium ions which in turn come to activate a chain of events that allow for a change in shape of an internal scaffolding within the neurons terminus such that vesicles (little bubble like structures) containing neurotransmitter fuse with the membrane of the neuron itself, releasing the transmitter into the space between neurons to float on over to interact with neuron 3. To imagine vesicular release, imagine a lava lamp where the bubble within the tube is hollow, contains a chemical transmitter substance, and releases it to the outside world if allowed to partially fuse with the glass of the tube, in this case with the outside of the tube composed of the same substance of the bubble and not the glass of the tube in our analogy. The released transmitter will float around between neuron 2 and neuron 3, perhaps resulting in activating the latter when enough quanta of transmitter arrives at its destination. There also will be subsequent processes returning the neurons 1 and 2 to the state of rest and excitability, returning initial charge separation and vesicular separation from the membrane, and refilling the vesicle with transmitter.

The above is the most basic model, explained in the most basic terms faithful to the physicality of the system. Nowhere in all these happenings is anything like that which we know to be the case in our being aware, in feeling and thinking and in directing our intentionality inwards and outwards. Where in all this is the spontaneous emergence of the language of consciousness and mind and persons, let alone the raw beingness of consciousness and mind?

The reader may make the obvious objection. They might say that two or three neurons does not a brain make, and that consciousness and mind is the “emergent” product of complexity.

And yet how can this be the case? There are no convincing analogies of emergence the likes of which we are asked to believe happens in the relationship between brain and mind. One could say that the wetness of water is an emergent property from the combination of billions of water molecules. Yet this is a nonsense. Wetness is the subjective sense of a person with a mind who “feels” water. Wetness needs mind. The fluidity of water on the other hand results from the properties of the water molecules themselves and their arrangement at a given temperature and pressure. Fluidity can be understood with a language already contained within a semantics of physical chemistry. Are we to propose that from placing the straws on the camels back, that somehow emerges this alien state of crushing the camel, like a giant phantom hand has appeared in the midst of the straw or come down from on high. And yet the potentiality of the crushing was contained within the mass of each straw, this pitted against the physical carrying capacity of the camel. Something happened for sure yet nothing alien emerged. Or it is like a revolutionary society, which in its emergence is more than the conversation. And yet what is so alien here? Is not the revolution of the same properties of the conversation in the café or the first call to arms? But where in the brain can we find mind, even in its proto or partial emergence?

That having been said, let’s entertain the nonsense anyway, and pit it against our intuitions. Let’s scale up the complexity. Where there were three neurons and two synapses, we now have billions. And so what? From heaping lead upon lead upon lead do we see emerge an ounce of gold? Billions of more of the same is greater mass without effecting an alchemical transmutation of what that mass is composed of. Now it’s in the arrangement they might say, the spatial complexity is the wellspring of emergence. Fair enough. Let us put one train upon a track, then multiply the tracks into an elaborate system of a national railway, with thousands of miles of tracks and hundreds of trains coming and going in extension and recursive loops. And yet we still have nothing more than trains and tracks. Nowhere in all this does the great train God emerge to know itself as something beyond its material and efficient self. Or at least the train God has not acquired a communicative apparatus to communicate its existence to us, and so we have exercised the option to hypothesize its non-existence. Those of a pan-psychic persuasion think every material thing is conscious. Even a grain of rice has a tiny packet of proto consciousness. How a consciousness not conscious of itself can be a meaningful consciousness is for them to say before the proof in the rice is found. Digressions aside, we might say it is not in the spatial complexity so much as the complexity of elements that mind emerges, of there being a potpourri of different neurotransmitters and different types of neurons and glia, along with a bewildering complexity of intracellular machinery. Yet once again so what? In an age when we have many who literally believe that oxytocin is love, that dopamine is hedonism and reward, that serotonin or GABA is calm, that anandamide is bliss, in even dismissing these scientistic horrors, how does the immaterial property “emerge” from the complex co-existence and operations of all these neurotransmitters in the same brain. Does consciousness emerge in there being a half dozen herbs in the chemical soup, or is it less, or is it more? How does the complexity in neurotransmitters interact with that of glia and neuronal shape and size to create mind? And where might the threshold be found between zombie and person? And once again we are appealing to an alchemical argument in the emergence of one from the other. Now they might say it is not in the complexity of the spatial properties, or the number of arrangements, but in the temporal complexity. Once again so what? And once again we can return to the train analogy. How might we conceive it to be possible for the train God to emerge from the fact of some trains always running in perpetuity down the tracks, others released at a given frequency from their stations, some traveling under contingent modal schedules of supply and demand of special occasion etcetera. Music also depends greatly upon temporality of physical events and yet the instruments and sound waves can neither compose the music nor listen to themselves. Or we might imagine it possible for us to build a computer in the imago of the brain, building up the elements of the circuits within circuits one by one, testing dynamic frequencies of substructural components until somehow what emerges is the conscious computer that we have taken as an article of faith to have passed the test to convince us has a mind like our own (and contra Turing, this will always necessarily involve an article of faith). After all, what is so special about proteins, fats and fluids when these might simply be material realizations of on/off functions and spatial arrangements which might be achieved by other non-biological material means, or even the abstractions of a model that, like mind in mind, be the idea of a model. One day they might say “aha, a circuitry of a billion neuronal switches arranged like a spiral within a spiral here running at 70Hz, and a 5 billion unit helix shaped circuit there running at 10 Hz, with each node in the helix connected to fixed points in the spiral, this is the basic model from which consciousness emerges and a mind comes to say ‘cogito ergo sum’ when we attach up to some communicative output”. If the spiral is to appear similar to that of the galaxy or if the helices to resemble DNA there would be those to ponder the spatial correspondences. The esoterica in the shared symbology would be the stuff of many new age books. Is the universe then conscious they would ask? Is DNA? As above, so below. But regardless of what spatio-temporal correlate to consciousness is the threshold of its apparent emergence, what would they have really found if they think they found it? What have they explained, except to open the door to mystery all over again.

The fact that the above is a gross simplification of the brain is acknowledged. Yet I would submit to the reader that when one takes a partial Cartesian turn and comes to dwell within their own mind for a reflective moment and seeing it as the you who you are, and then takes an honest look at brain as the material thing it is, that they can only be left with the conclusion that words such as property and substance dualism and emergence are stand ins for others better fitting the occasion, those being supra-material alchemy or, better yet, a miracle. Now an alchemy implies an alchemist I’ll grant you, just as a miracle implies a miracle worker. And so what? Let us not yet launch into that question or recoil from the implications of the same, foreclosing on what ought to be the moment of being caught suspended in confrontation with the miraculous. My contention is that mind and brain are metaphysical categories so radically different as to be radically irreconcilable. Just to restate, I am not proposing this to be a devilish problem for which we have yet to arrive at a solution, like an understanding of what caused the plague in the days before microbiology in its current form. I am proposing that the metaphysical gulf between brain and mind is so great as to not allow for the possibility of a solution. The horizon of an answer in the distance that the neuroscientist sees is simply a projection of their own wish, a faith in their own scientistic eschatology. And I am willing to wager in particular that what Chalmers calls the hard problem, i.e. the explanation for consciousness as the ground upon which all mental operations must stand, can and will never be solved to the satisfaction of an honest neuroscientist. Any awaiting of a new science or paradigm shift is as much an article of faith as the belief in a miracle.

Part of the problem lay in the language. Neuroscientists speak of the “reward circuitry” of the brain without there being a silicon chip or electrical wire in sight, and in full knowledge that so many loops of connection are found in the brain as to make the analogy of “circuit” trivial. And computer scientists program what they call “neural networks” without a single neuron to be found anywhere outside of their heads and on the desktop in front of them. Psychologists increasingly talk of the nature/nurture problem as being a hardware/software problem (in so doing an insidious move from nature and family towards computer science), and cognitive scientists talk of the mind of a person as a processing unit of packages of information, and of the on/off state of neurons in terms of the binary “language” of the computer. Military engineers develop “smart” bombs and we talk of computers “solving a problem”, the smart phone app “suggesting” we buy something or the satnav in the car “telling” us the way. We live in an age when the computer is described in terms of mind and mind (and brain) in terms of computer, just as every age has chosen the apex technology of the day as an analogue for both mind and brain. And so with the lubricant applied to this psycholinguistic crime, we might be incredulous to hearing the fact that no computer, even an “artificial intelligence” (which dare I add has no consciousness), has ever calculated anything at all, any more than it would be true to say an umbrella protects us from the rain. We protect ourselves from the rain using the umbrella as a prosthetic. We build clocks that have a mechanism, the output of which is what we call the time. Yet a clock does not “work out” the time. It does not “tell us” the time. And an artificial intelligence might propagate and elaborate an output that might be fruitful, even unto novel fruit and better than we can imagine with our feeble minds. Yet so does a tree yield its own fruit. An artificial intelligence does not invent, innovate, compete or win at anything as there is no winner there within it, no internal witness to innovation. Likewise, there is no binary language, no ones and zeroes within the computer, and in its complexity we do not have calculation qua mental activity. We do not have intentionality between self and objects both internal and external with preferences driven by emotion, desire and telos. We simply have statics and dynamics of matter and energy, complex machines that we anthropomorphise into being like us. Similarly, no book communicates things to us. We read meaning into it or extract meaning from it that the authors mind is communicating to us through words on the page. But without two minds this is just ink and paper. As a test of the degree to which we have allowed these semantic conflations between man and machine cloud our judgment, try and explain the operations of any complex technology or machine used by a human without use of any terms that might be more properly descriptive of a person with a mind, of feeling and thought, of intentionality and teleology. And try and explain the operations of the mind without recourse to the language of technology. It is harder than you think, and more difficult than I wager would have been the case were we not indoctrinated in a philosophically malignant overreach of analogy and metaphor.

Returning to emergence

One way out of these troubles is to imagine that the “emergence” is not some kind of immaterial ghost from the brain (a substance dualism). Rather there is no immaterial mind at all and emergence is some kind of stand in term for a focus on a heretofore unacknowledged physical property no more special than any other (property or semantic dualism). And so the second dimension of a drawing emerges from the first and the third emerges from the second. If the 3 dimensional object is materialistic then heat emerges from it, mass and gravity emerges in interaction with other masses and mind emerges in a way consubstantial with its own materiality. Or it could be said that a brain qua supercomputer is doing its super mechanical thing and the mechanism has certain functions that require a partitioned “language”, functions of “modelling” itself in relation to other computers or modelling future outcomes so as to optimize future outputs in accord with a programmed equilibrium state and so on. This language being distinct from others in the machine includes terms like as “I”, “me”, “you”, “feeling” and so on. And that is what mind is, semantically emergent yet materially (and metaphysically) non-existent. Or so some might say.

I have sometimes been tempted to walk some way down this line in an objection to Descarte. When Descarte thinks he can step outside of the perceptions given him that he doubts the authenticity of, and instead rationalizes his own existence as a mental actor, he is using language that is not his own, language he acquired from a source that he has already considered suspect and unknown. He remembers once having been a child and learning a language. But was he and did he? His is a conversation that he has been thrown into with a game which is not his own. It is impossible for him to extricate himself and start anew, even if he imagines himself as come into being a second ago with false memories given him by the demon. Every way he might know himself, in its language dependency, is suspect. And so he cannot say “cogito ergo sum” (I think therefore I am), yet rather “cogito ergo cogito” (there are thoughts, therefore there are thoughts), or “sum ergo sum” (or I am therefore I am), both statements empty of meaning. What is left of the person when void of language used to communicate self to self? There would be raw consciousness and qualia, with little else besides. In a primitive sense there would be mind without the one with the mind, this leading to contradiction.

And yet here we are confronted with a reality of our own consciousness that is neither rationally a priori or axiomatically true, yet simply proven a phenomenological fact in our being. And thank heavens we have our own personal consciousness as it is our only strong proof we exist at all as mental beings. Clearly our mind is not a material thing. Contra hard materialism, to argue anything successfully is partly an analytical exercise and partly an identification with the argument. A mind/brain material monism with emergence as merely property or operation of a biological computer (to not, in a stronger sense, exist), demands an almost mystical nihilism to successfully argue, let alone identify with it as an idea that is comfortable like hand in glove. In its radical self-denial, it is more Zen than science and yet neither at the same time. I am not proposing that mind brain monism is not true. I am arguing simply that to my mind it has not been adequately argued and I doubt it ever can be. It denies the undeniable. It is a hypothesis with which I cannot (as opposed to choose not) to identify, where non-identification is not trivial.

The brain won’t go away

One might say that we can philosophize until the cows come home, yet the mind is undeniably dependent on the brain. In its rather severe dependency we might have the proof of emergence at of least a ghost contingent on the brain for its ethereal existence (a substance dualism contingent on the brain), or the proof that mind is the workings of the brain (in which we return to a property dualism). I’m so frequently encountering people who argue these positions to have been the recent findings of post enlightenment neuroscience, though we can be reminded that Hippocrates (or someone claiming to be Hippocrates) stated over two millennia ago

“Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant, in some cases using custom as a test, in others perceiving them from their utility. It is the same thing which makes us mad or delirious, inspires us with dread or fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absent-mindedness, and acts that are contrary to habit. These things that we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist, or dry, or suffers any other unnatural affection to which it was not accustomed. Madness comes from its moistness.”

Now Hippocrates was perhaps, nay was, working on false premises. He would have seen the changes in perfusion and colour to the body and face in various states of disease and might have made inferences as to corresponding humoral imbalances in the brain. In all likelihood he never even witnessed a brain dissection, if for no other reason that the brain turns to mush unless pickled. Not until the age of Thomas Willis was this problem overcome. But what I think would have been driving the mind equals brain hypothesis in ancient Greece might have been a common knowledge of many in antiquity. When, for example, a Greek strikes a Persian with a weapon or a Persian strikes a Greek, there are different outcomes following a central chest injury vs a blow to the shoulder or the leg. And all these might result in different outcomes, very different outcomes, to that of an acquired brain injury from a blow to the head. Most preliterate persons might well have well known that a knock on the head can profoundly change a person, if not kill them. And so it is not only the premise of Hippocrates observation, yet his place in the intelligentsia also as the one with licence to discover, both as further questioning the scientific metanarrative we have made for ourselves. In any case, the Greeks did not deny the embodied lifeforce that is the psyche or soul.

Now we can say that we have moved beyond Hippocrates and Neuroscience texts such a Kandel and Schwartz “Principles of Neural Science” include the above quote as a throwback to the time when natural philosophers (i.e. scientists) were interested and conversant in history and the liberal arts, a projecting of persona to being the gentleman scientist. It's quaint isn’t it. In any case we have moved beyond Hippocrates. We now know the parts of the brain correlating with vision, olfaction, muscle movement and so on. If a part of the brain dies, there can be a more or less predictable range of outcomes such as loss of speech, vision, smooth sequential movement and so on. With respect to vision for example, we can even locate the place in the brain correlating with the perception of objects with certain orientation and movement. The teasing out of these modular brain regions and also more distributed so called circuits are what Chalmers calls the easy problems. Nevertheless, like shining a light in a furnished room containing an infinitely deep well at its centre, all we have simultaneously done is to resolve the even greater darkness of the hard problem, consciousness itself. Its edges are illuminated, this leading the neuroscientist to think they are closer to the solution when they are further away than ever. And so what have we gained from saying, for example, that vision is dependent on the unexplored whole brain to now say it depends on this particular part of the brain into which we have journeyed? Neither tells us what seeing is, let alone what it is when “I see”. And have we answered the question if mind drives brain as a necessary instrument, or brain drives mind, the latter as its secretion?

An answer in favour of materialism might be in the fact of just how profound the changes to mind can be in disease or in states of drug intoxication. A congenitally blind person is likely never to describe a visually vivid dream and never say “I see with my mind’s eye, yet lack the apparatus to see in the world”. Helen Keller "saw" and held memory in her fingers. A demure introvert might experiment with phencyclidine and become a raving homicidal lunatic. The older person with dementia might not simply lose their memory, but their memory of having lost memory, and indeed their whole connectedness with themselves and the world goes with it. These are prima facie devastating blows to a non-materialist account of mind or accounts which place mind on a pedestal as anything more than epi-phenomenon, though their claim to being fatal blow is more a neuro-scientistic mode de jure, than a fact beyond other interpretations.

One such non materialistic objection, and one which has been played out in religion and popular culture (cross culturally) from antiquity, is the notion that the person is primarily a non-physical substance that becomes attached to a material structure into which it grows and comes to identify. To a behaviourist the phenomena is actually a supernatural Pavlovian experiment without extinction being easily achieved. Just imagine it to be possible that there is something which is better described as spirit that comes to be shackled to a brain and grows with it. With time it would forget what it is in the greater sense, and contra Plato might never have known to begin with what it was then to forget. It might only know itself in the phenomena of its conscious awareness and in its intentionality, particularly its intentionality of moral faculties and the like. But this is the bitter joke, for the mind never achieves an emancipation from the attachment to the material brain, and neither ignorance of neuroscience nor a knowledge of its limitations is to any avail. When the brain bleeds the mind reflexively bleeds in its own way, even unto the end of the person as they knew themselves and were known to others. I am not proposing this ontology to be true, much less expecting it to convince the diehard materialist. Yet it is a fair opening gambit to an ontology that could be developed and indeed has been developed by better minds than mine. In its accommodation of both the facts of neuroscience and the miracle of consciousness as per outlined above, it is far from being the least parsimonious formulation either. The fact that it lay partly outside the bounds of what is ordinarily considered science provides no a priori’s to abandon it as a possible (nay plausible) way to see self in world.

The glimpses we have into this supra-material self may be within aesthetics, morality, peak experiences and the givenness of consciousness, along with certain aspects thereof. One of many places to which I was taken to marvel when I was younger was the spatial location and extension of consciousness. And this was a sense of marvel only to be amplified by a knowledge of neuroscience, as its answer to the mystery was as unfulfilling as an answer could possibly be. Take something sharp and jab it into your finger tip. The pain you feel is of course in your finger, not somewhere behind the eyes. Now I could tell you that there is a sensory representation of that same finger in the brain, this homunculus having been resolved with clarity by Wilder Penfield and others nigh on a century ago. Stimulate that finger part of the brain and you may have the very same sensation in your finger as if you dug into the fingertip itself. Ablate that same area in the brain and you might prick your finger a thousand times and feel nothing. We could also do, as nature sometimes does, cross wiring experiments where one physical stimulus leads to a different physical sensation, or where removing a limb results in the sensation that your limb still exists out there where it was and yet now only empty air has come to fill the space (see in the use of the word “wiring” the ease with which the technological metaphor creeps in). Now I, as well as anyone else cognizant of neuroscience, can dismiss the mystery here. I can say that the feeling of the finger as being spatially outside the brain and in the finger is simply the brain performing some strange ventriloquy, like the performer who projects the voice as if coming from the doll in their lap. But this neuro-ventriloquy, if true, is much more profound and cannot be simply believed without pause. For neuroscience would say, and say rightly, that the only the brain itself has the requisite complexity to effect the emergence of the finger consciousness. Certainly the “wiring” in the finger is just the ramifications of a simple nerve. There is no little brain in one’s fingertip sufficient for the complexity argument to hold, and so I am not in my finger they will say. And yet I do not experience things within the head as if to say “I the one behind the eyes feel a pain and know that it is associated with a noxious stimulus to the finger”. If I take upon myself the cap of the materialist neuroscientist I cannot liberate myself from the experience as being in a place (and time) which, so says the dogma, lacks the neurological complexity to be experienced. That is to say I cannot convert the beingness of the finger from spatially within the finger to within the head and somewhere behind the eyes simply in virtue of knowing about the sensory homunculus. Even an assiduous change in language to prohibit “in finger” consciousness cannot alter the basic fact of being out there. And so back we are to dismissing things as a trick of our ventriloquist brain, and the case is closed. The mystery does not go away however, nor does an evolutionary explanation which might pretend to answer the “why” or “how”. How am I, qua nothing but an emergent product of the brains complexity, consciously existing res extensa in the finger, a place of neurological austerity? I would suggest to the materialist that if they admit to the possibility of any ventriloquist act as they apparently must, then why not countenance one of a different kind, i.e. not one where matter automatically in the act of emergence thinks that it is mind (for lack of a better turn of phrase), and not one where the brain qua mind thinks it is spatially located “out there”. If the concept of ventriloquism exists in the world at all and it admitted into argument, then why not allow for the hypothesis that an immaterial mind confuses itself with the walls of its jail and automatically thinks that it is matter?

Another possibility, terribly unpopular nowadays more for falling out of fashion than plausibility and more a result of the sycophantic want for philosophers to cling on as scientistic appendages as opposed to the philosopher telling the neuroscientist how to think and where they have failed to think, is another kind of mind brain monism. Only in this case the monism is not material but mental and usually, though not necessarily, religiously informed. In such a world view what we think of as brains and rocks and the orbits of planets are thoughts within a greater mind. In their regularity and radical separation from our own little minds, certain of these thoughts are experienced as something solid, separate and “objective”. Our perceptions of this solid world out there are internally valid of course. Yet the solidity of the external world is a category error. For in the greater mind all in creation is weakly consubstantial, with thoughts merely crystalized in various forms in time and over time. Our own mind is a thought made free from the greater mind, with some limited agency to change itself and effect change. And what we cannot easily change is the brute facts of the material world. To disavow the existence of this greater mind is a projection of our own narcissism in defending the limits of what our own can know and do. We might think that if we cannot be more of ourselves, then this greater mind cannot be at all.

As Ronald Knox wrote, when thinking of the immaterial monist Berkley

There was a young man who said "God

Must find it exceedingly odd

To think that the tree

Should continue to be

When there's no one about in the quad."

Reply:

"Dear Sir: Your astonishment's odd;

I am always about in the quad.

And that's why the tree

Will continue to be

Since observed by, Yours faithfully, God."

All of the above is not offered as proof of what is, this being impossible. Rather it is a briefly reasoned defence of what might be. When multiple hypotheses explain the phenomena, we must in dint of reason be agnostic and know what we believe as an article of faith.

My own inclination is that things are of one of three possibilities. The first would be a mind brain material monism which denies the givenness of personal consciousness. This is so profoundly nihilistic as to require something of a paradoxical transcendent or mystical turn to explain mind away. And so for this and other incoherence in the argument besides, it lacks appeal both logically and intuitively. Then there is the (substance dualistic) notion that God has a sense of humour, making mind emergent each moment as a miracle of upmost immanence to us, with the brain being both the tool upon which mind works and the manifold upon which it stands to know itself. And yet in us being half mind and half matter we are not fully anything of either except a reminding of our own mortality, perhaps the one miracle which really can die and stay dead when its time is up. The final possibility is something akin to Berkley, where there is certainly only a monism, but it isn’t matter and any transcendence can only be found in placing a faith in a mind greater than our own to either not forget us or remember us in some hyper-time.

Now what has all this to do with psychiatry? Well we are back to where we started. There is nothing lost to the renal physician thinking the kidney is a glorified filter or the heart a glorified pump (yes they are both endocrine organs too of course). Both subspecies of physician may play about happily in metaphysically smaller ponds. But psychiatry has thrown itself into something deeper without being able to swim, and the village has invested it with the power to be our lifeguard.