As I have been reading psychiatry blogs, I have noticed that the idea of biological psychiatry is often the target of strong negative feelings. This may be due to past bad experiences with psychiatrists who seemed to rely too heavily on the biological model. It may be due to a simply philosophical difference between the commenter and the biological psychiatry community. There may be any number of additional reasons not to like biological psychiatry. Still, biological psychiatry is a science and is based on a sound philosophical basis.
As part of my blog, from time to time I would like to post some ideas that show that biological psychiatry has value. My goal is NOT to show that it has all the answers or even all the most interesting questions. My goal is also NOT to defend every assumption or assertion made by every biological psychiatrist. I would simply like to discuss the ideas underlying the field and how they are used to address the ideas of mental illness and what it means to be human.First, the fields of biological psychiatry and biological psychology, go back to the arguments for and against mind-body duality. I will not re-hash all of these arguments here, but suffice it to say that there were philosophers who believe that our mind and our bodies were made out of different stuff (the dualists) and others who thought that our mind and body were made of the same stuff (the monists). Among the monists, there were those that thought that the single stuff was “mind stuff” (the mentalists), that the single stuff was “material stuff” (the materialists), or that mental processes and brain processes were the same thing simply described from different points of view (the identity position).
Over time, the monists seemed to gain the upper hand in this philosophical debate, and the materialists and those holding the identity position became the most influential monists. The dualism popularized by Descartes, fell into disrepute (by many but not all); and scientists of the mind increasingly became studiers of the brain. This was not a random choice, however. Throughout history, people had observed that those with head injuries often had alterations in their mental abilities. Injuries to the back of the head often resulted in blindness. Injuries to the front of the brain led to impulsive behaviors. Strokes in the left hemisphere led to inability to understand or produce speech depending on where the stroke was. Neuroscience began to reveal specialized areas of the brain and physiological processes capable to storing memories. The more we knew, the more we became convinced that the mind is a function of the brain.
This explosion of information about the brain and how it produced sensations, movements, memories, physiological control of our bodies, and innumerable complex behaviors, led to immediate improvements in the field of neurology. Neurologists quickly became adept and localizing lesions within the nervous system and predicting the likely effects of nervous pathology. But still, there were behavioral problems that did not seem to correspond to any known brain lesion. What were scientists to make of that?
The answer depended upon your philosophical views. The scientific materialist saw such behaviors as signs of a malfunctioning brain. Various metaphors were used to illustrate it such as clocks and computers. Freud, however, developed theories based on a dynamic unconscious and explained at least some of these behaviors as extreme types of “normal” interactions among conflicting unconscious wishes, desires, beliefs, drives, anxieties, etc. He developed a method to reveal these dynamics and improve the mind’s ability to manage such conflict. This led to the development of a variety of “talking cures” for mental illnesses. This view of mental illness could still be claimed by the scientific materialist since “unconscious wishes, desires, beliefs, drives, anxiety, etc.” are nothing other than functions of the brain. Thus, even in this case, if these brain functions do not work together to enable a person to live a tolerable life, it can be addressed by fixing the brain. Easy, huh??
The debate between the relative values of biological and psychological approaches to mental illness (a false dichotomy, IMHO) teetered back and forth for many decades. Early triumphs of biological approaches include the discovery that General Paresis of the Insane was caused by syphilis and that complex behavioral changes could be caused by deficiencies in vitamin B-12. The obvious behavioral changes caused by alcohol, opiates, hallucinogens, and stimulants showed that behavior could be pharmacologically manipulated. More recent discoveries that some cases of obsessive-compulsive disorder are caused by Streptococcus infections and that depressive syndrome can be caused by hypothyroidism, lend further credence to the idea that our mental state rests on a foundation of biological processes.
Thus, it seems that biological approaches to mental health are here to stay. There is a great deal of controversy over how this information may be used and what price we pay for relying on it. Some believe that its benefits outweigh the risks. Some believe that the risks of using this information is too great. Regardless, the ideas behind biological psychiatry and psychology have grown to be foundational ideas in our society. Even many of those who think they reject biological approaches to mental health unwittingly endorse it (e.g. “Don’t take those drugs; take my vitamins.”) These beliefs are so prominent that they have practically become invisible. I believe that these ideas are also very powerful and are worth careful consideration and serious critique.