A little while ago I came across an article in CCHR International, in which several psychiatrists were describing a very sorry state of affairs within their field. Understanding how psychiatry got in such a mess, will ultimately take you on a 400 year journey back to medicine's philosophical roots. It begins with Thomas Szasz, a leading critic of the practice of psychiatry.
Thomas Szasz, himself a psychiatrist, had a long history of criticising psychiatric practice. He published the Myth of Mental Illness in 1961, and he explains his ideas in more detail during an interview on psychotherapy.net.
And the quote that caused my shock,
No behavior or misbehavior is a disease or can be a disease. That’s not what diseases are. Diseases are malfunctions of the human body, of the heart, the liver, the kidney, the brain. Typhoid fever is a disease. Spring fever is not a disease; it is a figure of speech, a metaphoric disease. All mental diseases are metaphoric diseases, misrepresented as real diseases and mistaken for real diseases.
source Thomas Szasz in CCHR International, [emphasis added]
A personal reaction
In my early twenties I suffered a relationship break down, and lost my job. About a year later I experienced something my family and I called a 'nervous breakdown'. A doctor would have diagnosed me as being depressed.
This state lasted for around 12 months, and was accompanied by occasional minor psychotic episodes, of which I have no memory. It took me around 7 years to feel fully recovered.
I was very definitely unwell. Whatever was wrong with me was most certainly not 'metaphorical', it was very real.
All diseases are metaphors
I am not saying that mental or physical illnesses aren't real, what I am saying is that all disease is understood through the use of metaphor.
Medicine is a product of the culture in which it exists, and the way disease is understood and treated is intimately linked to these cultural descriptions.
If you saw an ancient Egyption doctor, your disease would be attributed to "droughts" or "floods" of blood and humours being carried through the body, akin to the droughts and floods of the Nile. Greek physicians saw disease as an imbalance of the four humours, a theory that persisted throughout the medieval period. (1)
Modern medicine likens the body to a machine, which operates independently of the mind, like a wrist watch which ticks independently of its wearer.
Medicine thinks bodies are like clocks?
This isn't as stupid as it sounds. To understand what clocks and medicine have to do with one another, we have to go back 400 years to a man described as the founder of modern philosophy, Rene Descartes.
Descartes is of course famous for his maxim "I think therefore I am," however it is to his other ideas that we owe the separation of mind and body, in what became known as mind-body dualism.
Descartes believed that the bodies of both animals and man were machines governed by purely physical laws. Animals he believed were purely automata - machines driven by internal clock work mechanisms. Men were different because they had souls, which he believed was located in the pineal gland, where it was infused with the 'vital spirits' and interacted with the body.
The discovery of the conservation of momentum kicked into touch the idea that the mind could influence the motion of the 'vital spirits'. The Cartesian school which grew up in response to Descartes' ideas held that mind and matter could not interact at all.
Descartes' soul was evicted from its home in the pineal gland, and instead thinkers who came later, such as Malebranche and Spinoza, replaced this idea with something altogether more bizarre.
The Cartesian school's separation of mind and matter had a problem. If mind matter can not interact, then how come when I think "move my arm ", my arm moves in response?
What they proposed was the idea of two synchronised clocks, one ticking just before the other. So if the clock in my mind ticks just before the one in my body, then it will seem that my thought "move my arm " happens just before my arm moves. For the Cartesian's it was God who synchronised these clocks. (2)
What's so special about clocks?
In the 17th Century, clock making was on the absolute leading edge of technology. Clock makers also made precision scientific instruments. Clocks were special, and it is no wonder that the clock was used as a metaphor to try to get round the Cartesian's thorny problem.
The idea of the 'clockwork universe' was behind much of the thinking that propelled Newton's work on gravity. Newton's ideas exerted a powerful influence not only on medicine, but also other fields such as philosophy and economics.
Although physicists largely abandoned Newton's clockwork universe in the early 20th Century, medicine still treats the body as though it were a piece of automata. It's just that it has replaced 17th Century precision cut metal gears with organic biochemical versions. footnote #1
Medicine uses a 'clockwork' metaphor, so what?
If you are using it to understand how muscles, hearts, lungs, and kidneys work, then you don't have to worry too much if your metaphor excludes the mind. Minds don't have much influence on them.
However, when you move to psychiatry, then mind is very definitely involved. The clue is even in the name. The word psyche, which is contained in the word, psychiatry, comes from the Greek, psukhē, and means breath, life, or soul. It later came to mean mind, and indeed for Descartes mind and soul were pretty much the same thing.
The upshot of all this thinking has been a twenty year quest to find the biochemical cog in the wheel that drives depression, with the chemical imbalance theory of depression. And the result of this quest?
[There has been] no shortage of alleged biochemical explanations for psychiatric conditions…not one has been proven. Quite the contrary. In every instance where such an imbalance was thought to have been found, it was later proven false.
source Dr. Joseph Glenmullen in CCHR International
Contrary to Thomas Szasz's assertion, there never was a division between 'real' and metaphorical diseases, there was only ever a division between a 'clockwork' body and a mind.
All that has happened is that medicine's metaphor for understanding disease has reached a limitation. It's not a new problem. It also happened in physics, and how they went about solving their own clockwork problem, I believe offers an answer to medicine's own problem with psychiatry.
So how did physicists solve their 'clockwork' problem?
In the early 20th Century, physicists believed in universal time, as though a single clock kept time for the entire Universe.
Albert Einstein's theory of relativity became a hammer which smashed this 'clock' to pieces. What he uncovered was rather than there being a universal clock, each part of the Universe kept its own time. Even the billion upon billions of atoms which make up your body do not all keep the same time.
Things got worse. When physicists started to peer inside those atoms, an even stranger world emerged. The things that made up atoms not only behaved like the billiard balls of Newton's classical theory, they also behaved like waves. The Universe was not only filled with unsynchronised clocks, each of these clocks were also singing their own song.
Physicists responded by abandoning the old metaphor of 'mechanisms' and introduced a new one. They started to talk about 'interactions between particles'
You can put "interaction" into Google image search, and see what kind of metaphor this is.
What you get are two broad kinds of representation, a conversation between people, or an interconnected network. Physicists moved away from thinking about one thing acting on another, like one cog turning another, and started to understand the Universe as a system of two-way, three-way, four or more way exchanges between things.
Towards a new metaphor
Psychiatry needs to put the mind back in the body where it belongs. It then needs to put that mind-body back in the environment from which it has been dislocated
It needs to stop seeing disease as a mechanism and start seeing disease as an interaction between mind and body, and also between this mind-body and it's environment, which is composed mostly of other mind-bodies.
When I became unwell, I did not become unwell, because my 'clockwork' body started to tell the wrong time. I became unwell because the conversation between my mind, body and environment broke down.
I became well again when the discordant songs being played out between these different parts, started to sing in harmony once more. The song they began to sing together was different than it was before, but no less beautiful.
The material in this article is intended solely as a talking point about the role of psychiatry in mental health. It should not form the basis of a decision to stop or reduce medication. You should only do so under the guidance of a suitably qualified professional, such as your GP or psychiatrist. Sudden withdrawal of medication can cause serious harm.
Footnote #1 How enduring is the 'clockwork' mechanism metaphor?
Some ideas can be surprisingly enduring, and the idea of understanding the body as though it were a 'clockwork mechanism' is still very prevalent within biomedical science. But don't take my word for it, let's do an experiment. Try searching for "mechanism of action" in Google Scholar
I was presented with page after page of biomedical research papers, and curiously nothing else from any of the other sciences. "mechanism of action" is an entirely medical term. You could instead try searching for "mechanism" in Google Scholar, and you will get a smattering of papers from other sciences, particularly engineering and chemistry.
And you might be thinking that while you get the idea that "mechanism" makes sense for a machine metaphor, it might not have anything to do with clocks, until you enter "mechanism" into Google image search. Even I was surprised, by what I saw. Your task is not to find clock mechanism images, rather your task here is to find an image which isn't one.
(1) Samual Osheron & Lorna AmaraSingham in Social contexts of health, illness, & patient care (1981)
(2) Bertrand Russell, A history of western philosophy (1979)
Title image by Dave Tuepah