Just as the American Psychiatric Association’s (APA) long-delayed DSM5 was about to launch, the director of NIMH, Dr Thomas Insel, provoked a flurry of acrimony when he mentioned in his blog that his organisation intended to move away from the ideas behind DSM: “Patients with mental disorders deserve better… NIMH will be re-orienting its research away from DSM categories… we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system”1. It now seems Insel’s comments had more to do with NIMH funding needs than points of principle. After a bit of scuffling behind the scenes, NIMH and APA settled their differences2 and the DSM party went ahead. However, the affair raises a critically important issue in psychiatry
Over the past few years, NIMH has undertaken a carefully directed campaign to garner support for its new Research Domain Criteria project (RDoC). This consists of a determined effort to cast the whole of mental disorder as a problem of brain pathology: “First, the RDoC framework conceptualizes mental illnesses as brain disorders… Second, (it) assumes that the dysfunction in neural circuits can be identified with the tools of clinical neuroscience…. Third, (it) assumes that data from genetics and clinical neuroscience will yield biosignatures that will augment clinical symptoms and signs for clinical management.”3. The whole project is very long term and even initial results are not expected in under a decade but the authors were convinced of its direction: “Our expectation, based on experience in cancer, heart disease, and infectious diseases, is that identifying syndromes based on pathophysiology will eventually be able to improve outcomes.” Clearly, the validity of these three base assumptions is critical to the success of the RDoC program.
As outlined in this and a considerable number of other papers in a wide variety of journals, the RDoC program will consume the majority of NIMH budgets for many years to come. It will dominate research in mental disorder, shifting efforts away from matters of psychology to fundamental brain processes. One would therefore expect that the theoretical orientation underlying such a massive expenditure of public money, not to mention the lives of the mentally-troubled and the careers of a generation of professionals, would have been charted in very precise detail.
However, in checking a list of these papers, something became very obvious. The papers were written by a group of the most senior officers of NIMH, supported by the APA and WHO. They were also placed in a broad range of non-psychiatric journals, including Nature and the abstruse Journal of Clinical Investigations, as though aimed at the broadest possible medical/biological audience. The most remarkable feature, though, was the complete absence of anything that would amount to a justification of the (many) authors’ fundamental claim, that a full understanding of the brain will give a full understanding of mental disorder, with no questions unanswered. These papers give the strong impression that they were designed to sway opinion by appeals to authority rather than to convince by weight of evidence from the literature. This, of course, is the exact antithesis of the scientific method.
For any field that claims to be scientific, there are certain fundamental and inviolate rules to follow. They tell us where we can look, what counts as evidence, what procedures are acceptable, and so on. And one of the most important rules of all is this: In science, there is no such thing as a final authority. Where there is uncertainty, we can say that the weight of scientific opinion favours this or that conclusion but the unwavering basis of empirical science is that any opinion can be overturned by further evidence. That’s what empirical means. So in such an important matter, the future direction of the next thirty or forty years of psychiatric research, one would expect that nothing would be left to chance. Every effort should be made to ensure that, given our present state of knowledge, the validity of the chosen path is beyond question. Unfortunately, that is not the case.
My preliminary survey showed that not one of the many authors (e.g.; reference [3] has nine) cited anything that would amount to a justification of the basic, biological claim. This struck me as bizarre, so I rechecked the dozen or so NIMH papers, then followed each author back through the literature for about ten years, but still there was nothing. It seems that, among our ‘key opinion leaders’, the question of the ultimate nature of mental disorder is regarded as settled: it is biological, and the ordinary “…tools of clinical neuroscience, including electrophysiology, functional neuroimaging, and … data from genetics…” will tell us everything we need to know. But where is the proof?
Perhaps we should just accept this and go with the flow, as they say, but I had experience of something similar in the past. In 1998, I published a paper which showed that George Engel’s so-called ‘biopsychosocial model,’ beloved of British, Canadian and Australian psychiatrists, didn’t exist. Alerted by the way everybody used the term but nobody ever provided proper references, I trolled through practically everything Engel had ever written, plus dozens of papers that cited him, to find that he had never written the model at all. It is an urban myth so, as a justification for what psychiatrists do, it has all the authority of a fond dream. Perhaps the claims of biological psychiatrists were of the same order, a self-reinforcing belief that had simply become part of the wallpaper in the world of psychiatry, handed from generation to generation just as we hand on our notion of what is the best football team. I decided to search the literature methodically to see if anybody had ever provided anything to justify the NIMH stance.
A PubMed search yielded nothing of interest, so I searched the contents of the major English language journals for the eleven years January 2001 to December 2011, looking for papers that could possibly provide a formal justification of the claims of biological psychiatry. The task of systematically searching every paper published in that period is beyond an individual, and would constitute a serious drain on the resources of even a hundred people. I started with thirteen journals but dispensed with two of them straight away (the Canadian and Australasian journals) as I know they do not publish this kind of material. Full details of the remaining eleven journals are given in the paper4. Through a friend, I was able to obtain copies of anything interesting that was not in those journals so my coverage, while not entirely systematic, was exhaustive – and exhausting. By the end, I was doing little more than staring glassy-eyed at the thousands of pages of basic biological research.
In eleven years, these journals published some 19,234 original research papers, reviews, surveys, editorials, opinions and commentaries, filling something like 154,000 pages of 1465 issues. This did not include correspondence, historical or other topics as they seemed unlikely to be the bearers of monumental news. And be in no doubt: a proof of the claim that biology is all in mental disorder would be monumental, on a par with any major scientific discovery in the past few centuries. Trouble is, I found nothing in this extensive search of the literature that could be taken as a justification of the notion that mental disorder is fundamentally biological in nature. As of 2013, the whole edifice of orthodox or mainstream psychiatry rests on a mantra, something that has the form of a scientific statement but is factually empty, devoid of content. Instead of Insel’s claim that mental disorder can be seen as a form of brain pathology, only this fact has been established: There is nothing in the recent psychiatric literature that amounts to a formal, articulated, publically available, tested and proven biological model of mental disorder.
I concluded that the notion of biological psychiatry is no more than an ideology, supported by people who believe fervently in its truth but who cannot prove their beliefs: “As they stand, these papers represent firmly-held, highly partisan opinions with no convincing basis. They use rhetorical language to present an excessively simplified and one-sided view of a complex question in such a manner as to induce people to think that the matter has been resolved when, in fact, it has not. That is, while failing the criteria for scientific literature, they satisfy the definition of propaganda”4. Essentially, biological psychiatry is an urban myth.
Where does this leave us? Throughout the world, hundreds of millions of people are being “treated” according to a model of mental disorder that doesn’t exist. Moreover, the psychiatric establishment that controls the flow of research money has decided to commit it to a direction that lacks anything like a scientific warrant. We can be sure that junior researchers will dance to their tune on the basis that anything so important as the nature of mental disorder will surely have been sorted out by their elders and betters. They may point to the opinions of, say, the neurophysiologist, Eric Kandel5 but nothing could be further from the truth.6
The burden of proof of the claims of biological psychiatry rests with those who make them. In the absence of proof, we can say that mainstream psychiatry has failed its most basic scientific duty. I seriously doubt that there has ever been anything quite like it in the history of western science.
References:
1 Insel TR, 2013. NIMH Director’s Blog: Transforming Diagnosis. April 29, 2013. At .
2 Lieberman J, 2013. DSM5: Setting the Record Straight. Medscape, May 2013. (online by subscription).
3 Insel TR et al, 2010. Research Domain Criteria (RDoC): Toward a New Classification Framework for Research on Mental Disorders. Amer J Psychiat 167: 748-751
4 McLaren N, 2013 Psychiatry as Ideology. Ethical Human Psychol Psychiat 15: 1-11.
5 Kandel ER, 2005. Psychiatry, psychoanalysis and the new biology of mind. Washington: APA Publishing.
6 McLaren N, 2008. Kandel’s ‘New Science of Mind’ for Psychiatry and the limits to biological reductionism: a critical review. Ethical Human Psychol Psychiat; 10: 109-121. Expanded version: Defining limits to biological psychiatry. Ch. 1. of McLaren N, 2009. Humanizing Psychiatry: The Biocognitive Model. Ann Arbor, Mi.: Future Psychiatry Press.
I agree. It’s the biggest example of doublespeak, scamming, smoke and mirrors, and out and out lying in the past 500 years. Biopsychiatry and the drug companies have done a great job of pulling the wool over peoples’ eyes. It’s accepted without question everywhere in the world. The big question is how do we go about exposing it for the lie that it really is?
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Yes, please, the million-dollar question……..
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Dr. McLaren,
We have a psychiatrist in the U.S. who shares your sentiments. His name is Dr. Peter Breggin, aka ‘the conscience of psychiatry’.
In short, you’re not alone. In fact, you’re in the very best of company.
Duane
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Sentiments was the wrong term.
Strong feelings – based upon factual, *very realistic* concerns. Thanks for being part of MIA!
Duane
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Oh yes, AMEN.
The fervent believers in biological psychiatry as THE answer to the problems of mental illness need to sidestep the serious issues of how one learns to think in ways that are productive, or more likely to be correct, or more salubrious in terms of overall physical health and good social relationships, because questions of this nature are intrinsically thorny, hedged about with value judgments, and inherently subject to controversy.
By pretending that we’re dealing with a machine that’s either born out of whack, or got that way, and simply needs some tinkering to fix’er’up, they evade the tough problems – even while seeking to hog all the funding available in the mental health system.
… no matter how well the brain itself is functioning, even if one views it as just an extraordinarily complex machine, you’ve got the problem that bedevils us all:
“Garbage In, Garbage Out”
In a world overflowing with data, how can one cull out the junk? And that’s an issue even with an overly simplified model of what’s going on in human consciousness…
It’s sad. It’s blatantly obvious that none of the folks pushing this view have ever studied philosophy of science, much less contemplated the challenges of formulating a scientifically-sound epistemology; all they seem to care about is improving “physical treatments for mental illness”, which is the wrong problem.
http://gravatar.com/bonzeblayk
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Philosophy of Science????? These people wouldn’t recognize any school of Philosophy if it walked up and bit them in the behind! For spending so many years in school, for which they feel they need to charge us outrageous fees to pay for, doctors of all specialties are the most poorly educated of all professionals. For the most part their education has been narrowed to science, and when it comes to the so-called specialty of “psychiatry” even this is suspect. I suspect that they couldn’t fight their way out of a wet paper bag when it comes to analyzing anything critically from a broad spectrum of disciplines. They lack education in Humanities and the Arts. Their education is too narrow in all respects.
Most psychiatrists today can’t even do the most basic knid of talk therapy since they’ve never been exposed to it. All they get is how to prescribe drugs to people, taught to them from textbooks produced by the drug companies.
So, it doesn’t surprise me that they’re so willing to accept anything that drug reps feed them about the toxic drugs. They’re not critical thinkers and are not broadly educated enough to do anything else.
Add to this the problem that people who go to doctors don’t critically analyze anything that the doctors want to do. “If the doctor says I need to do this then I must because she/he is the doctor and must know best!” People blindly follow anywhere that medical professionals want to lead them, without asking any questions.
By the way, I really like being able to edit my posts. Thanks for making this available.
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A- to the -men.
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I think action is required here. Firstly for us to continue to ask Dr Thomas Insel for his scientific evidence for such an ideology. Also to show the pseudo-scientific nature of biological psychiatry to all reputable scientific/medical journals etc. It is not enough just to comment on sympathetic sites such as here. It is necessary to counter this insidious ideology by continual questioning of the persons and organisations that promote these false myths. Who will adopt the mantle of the late Dr Thomas Szasz?
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Quite agree, quite agree.
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I think what this man is written is very important. It’s the closest thing one could find debunking the “brain disease” BS. But how do we translate this into something we can get the general public to listen to?
In any case, I think the research this man has done is something we should add to our tools for making change.
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Mr Chabasinski;
“But how do we translate this into something we can get the general public to listen to?”
Bio-Psychiatry relies on the old College Debating maxim that the first person to call his opponent crazy, wins.
Nowhere have I seen better exemplified the actual function of Govt. than the NIMH.
Govt. has but One duty, and that is to Fail as hard as it can while remaining within the strictures of plausible deniability.
If Any Govt Agency actually solved the problem it was created to solve, that Agency would have no grounds to continue existing and a gazillion other Govt Agencies would be clamoring for the successful Agency’s funding.
Govt. Agencies expand and their bureaucrats move up the ladder to become bosses by Failing so that they can then go before Congress with the excuse that Whatever it is they’re doing is not succeeding Only because they are simply Under Funded.
“Our program is sound, we just need more money.”
Dr. McLaren;
Thank You So much for the heavy lifting you’ve done here.
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I am very pleased that Dr. Niall McLaren has joined this web site. I have been reading his articles and watching his videos for quite some time to validate my reality against biopsychiatry’s/NIMH’s evil, fraudulent LIES in bed with BIG PHARMA/BUSINESS to push bogus, life destroying stigmas and lethal drugs, ECT and other useless but deadly torture treatments and rights violations on a brain washed public!!
Dr. McLaren has exposed that main stream biopsychiatry cannot afford to hear or acknowledge critics because if they did, their whole bogus house of cards falls apart!
Dr. Thomas Insel’s latest evil eugenics agenda is all too clear in that he has continued to announce the supposed brain research results before the research is supposedly done. This shows that he is dealing in the typical biopsychiatry/BIG PHARMA industrial cartel along with other corrupt government hacks in Congress, the FDA and other agencies by promoting the usual fascist ideology to blame and stigmatize the victims of the power elite corporate cronyism that has hijacked the planet in the guise of mental health, medicine and faulty brain wiring used as the latest fraud fad of biopsychiaty. Psychiatry is not about health in any way, shape or form, but rather, it is about fascist social control used in so called democracies just as it has been used in Stalinist Russia to silence, discredit, abduct, torture, brain damage and destroy any critics or whistle blowers with Snowden and Bradley recent examples. See Dr. Joanna Moncrieff’s “Psychiatric Imperialism” article exposing this totalitarian agenda of THE THERAPEUTIC STATE fought against by the noble Dr. Thomas Szasz debunking biological psychiatry and its forced torture treatments. Dr. Szasz pointed out that when a thug hits someone in the head with a sledgehammer he is seen for the thug he is, but when biopsychiatry hits someone with the sledgehammer of a bogus, life destroying stigma to call into play predetermined torture treatments like forced brain damaging drugs, ECT and other barbaric tortures along with forced, prolonged commitment until the brainwashed victim admits to having the bogus “mental illness,” or making them bend down for the abuse and rights violations, the biopsychiatrist is not recognized for the same thug he/she is!
Dr. Insel has a long sordid history with the infamous paid drug company shill, Dr. Charles Nemeroff, exposed by Senator Grassley for his hidden millions he made while creating bogus, junk science drug studies causing great harm. Both Insel and Nemeroff have been poster boys of old boy network cronyism by covering up for each other and helping each other to get lucrative academic and NIMH jobs and government grants from the NIMH.
I would like to see Dr. McLaren share his great research about the fraud of the DSM and biopsychiatry here.
Thank you for sharing with us. No surprise Dr. Insel is trying to woo BIG PHARMA back to the fold with the latest “boy who cried wolf” ploys wearing the “emperor’s new bogus brain claims and new drugs” as is typical of this fraudulent profession professing nothing but lies and fraud to aid and abet their fellow user abusers in power.
Anyone who has had the most basic science course can see that Dr. Insel is not even pretending to use real science to back up the next fraud he has just announced now that the fraud of the junk science DSM is so well exposed. The fact that Dr. Insel has declared the DSM to be INVALID and that it still will be used says it all about human rights in the United Stalinist States of America! This makes it clear we are living in a totalitarian dictatorship run by psychopaths who aren’t even trying to cover up their latest human holocaust agenda of stigmatizing the whole planet with bogus “mental illnesses.”
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Well said that man, and thank you for all the hours of searching and getting sore eyes to expose this Myth. How this gets translated into the public domain and a wider audience I do not know. have you published this as a paper in another form somewhere else e.g. medical journal? because you should.
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This paper was published in “Ethical Human Psychology and Psychiatry” in June this year. It should now be available through medical and other libraries.
The goal of this work is to hedge the spurious biopsychiatry industry in using its own methods. They say they want fully indexed, reliable scientific work only? OK, let’s see if they meet their own standards. In fact, as we have all known for decades, they don’t. DSM is a scientific farce and cannot ever be rectified. Drug trials are profoundly dishonest (see the irreplaceable Erick Turner’s latest paper, Publication bias in psychiatry: causes and solutions, CNS Drugs (2013) 27:457–468 DOI 10.1007/s40263-013-0067-9, May 22, 2013), ECT is truly medieval in concept and effect, and so on. I have found the same problems in a variety of other areas of biopsychiatry; the good news is that the rising generation of residents (trainees) and medical students are becoming heartily sick of being told everything is a chemical imbalance of the brain. We need to be able to break through the wall of propaganda emitted by NIMH-Big Pharma-Big Academia and show it for what it is. That requires grassroots activity.
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Dr. McLaren,
Thank you for your response. As I said I am very happy and grateful you have joined MIA and I hope you will share your other great contributions debunking biopsychiatry’s bogus DSM stigmas, lethal drugs, the barbaric ECT you acknowledge to be “medieval” and their many other human rights abuses as agents of fascist social control and certainly nothing medical, helpful or healthy for the most part.
I hope the trainees of psychiatry have enough empathy not to continue in the deliberately brain damaging/disabling so called “treatments” of biopsychiatry. What do you think?
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Yes. So excited about this article. But how do we get people to care?
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“But how do we get people to care?”
How many commentators here blog?
As opposed to how many pages of Industrial Strength Bio-BS are clogging web search results?
Blogs are free, you just have to expend the time and energy to post.
Search Engines will find them, right along with the Industrial disinformation.
If you don’t blog, get started. As terrific a resource as MIA is, not everyone is going to find it and read it. Learn how to write eye catching post titles to drag new readers to your page even if you’re only reposting Govt. reports, or to help spread what you read here and elsewhere.
It’s got to be a full court press to get through the hundreds of billions of dollars spent by the drug makers, their junk medical sales force, and their ‘Public Advocacy Group’ marketing depts, like NAMI.
I wish MIA alone Could do all the work but that’s not enough, and Everyone here needs to help.
Blog and Post often.
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I applaud McLaren’s critique of Insel’s new monster, RDoC, except I am puzzled by his comments that George Engel never wrote about the biopsychosocial model and it “doesn’t exist” (“Alerted by the way everybody used the term but nobody ever provided proper references, I trolled through practically everything Engel had ever written, plus dozens of papers that cited him, to find that he had never written the model at all”). Well, it might not exist any more, having been snuffed out by the pseudobiological juggernaut, but for a while it was an inspiration to many young bloods entering the field. Engel wrote at least 3 influential papers between 1977 and 1980, two of which have the term in the title and the other which discusses it in the text, and all of which were decisive in my eventual decision to leave the profession:
1977 The need for a new medical model: A challenge for biomedicine. Science 196:129-136
1979 The biopsychosocial model and the education of health professionals. Annals NY Acad Sci 310: 169-181
1980 The clinical application of the biopsychosocial model. Am. J. Psychiatry 137:535-544
The first of these (in Science) is the most cited (nearly 2000 times). Years later, after I discovered the BPSM in my training, I corresponded with Engel near the end of his life and his words of encouragement had a lot to do with my eventual abandonment of the practice of psychiatry entirely. In some respects I am even more severe in my disdain for the industry of psychiatry than McLaren, whose outspoken stance I admire, so I just want to dispel the impression (perhaps unintended) that maybe Engel was in the same league as Insel or Gottesmann and others that dominate the industry of pseudobiological psychiatry now. Engel, by the way, was at the University of Rochester NY just down the road from his more famous contrarian contemporary, Thomas Szasz, at the NY State University branch in Syracuse. I was unable to find the full text of McLaren’s 1998 article (“A critical review of the biopsychosocial model” Australasian Psychiatry 32(1):86-92) on line so I don’t know what he actually says about Engel and the BPSM. Despite its limitations, the BPSM did restore some humanity and sanity to the profession for a while.
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The notion that the biopsychosocial model doesn’t exist is quite shocking to people who have long relied on it as a counter to reductionist biopsychiatry (remember that Engel used the term biomedicine).
A model is a series of propositions relating to an hypothesised mechanism which exists one dimension removed from the observations to be explained. The propositions must be in testable form and must be capable of refutation before it qualifies as a scientific model. Engel did not write it. He outlined a case for it but never actually set down the propositions necessary to allow for a model of mind-body interaction. His concept of mind (which he never specified in detail) was essentially Freudian in concept; nobody these days would accept it as valid science.
That paper is in Australian and New Zealand Journal of Psychiatry 1998; if you can’t get a copy, email me and I will send one. A revised version is Chap. 8 in my book from 2007, Humanizing Madness.
The problem for many psychiatrists who endorse Engel’s work is that, without it, what do they have? They use it to fend off the depradations of biopsychiatry but much better models of mind-body interaction are now available, including interaction at the molecular level.
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Dr. McLaren, Keeping the facts straight must require very intense effort in your line of work. Also, thanks for remarking on the connection to the Academy.
I can’t think of anything to do other than what I see people trying here or learn from compatible sites, but your publication ranks as necessary for all the fundamental reasons that touch on concerns all around. The right criticism at the crucial time.
Thanks very much
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Neither Engel nor the many people he inspired had such a technical definition of “model” in mind. It was more like the notion of “framework”. Reminds me of what the statistician George Box said, “All models are wrong, but some are useful.” In this case, all definitions of “model” may be wrong, but some may be more useful, or at least more commonly used, than others.
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In philosophy this is the idea that the mind is brain processes. Brain somehow produces consciousness. Most contemporary philosophers, operating with a certain inferiority complex due to the successes of the hard sciences, tend in to hold this position. Materialists who can not actually define what matter or substance is–that elusive stuff that was once so real and tangible.
You have done an admirable job. Valuable research. Will anyone listen?
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“mental illnesses as brain disorders…” or would it be mental distress causing physiological changes in the body? We have all gotten bad news and felt our stomachs turn over, our gut tighten, our breathing getting shallow. Or good news and an expansive energy-feeling flowing happily through out our bodies. Or gotten the flu and felt lousy. No doubt we have two way traffic. But in any case for thousands of years philosophers have wrestled with this problem without coming up with a completely satisfying solution in the West–though in the East they did. One they accept at least which is that consciousness, mind, is primary.
So the likelihood of someone coming up with the solution at the NIMH is really nil. They have taken a leap of faith in a direction that will bring in money and keep them busy. And please the corporations. Man the automaton. Give it an adjustment. But it is ridiculous theory. A kid is treated terribly and grows up depressed and violent. Oh, just his biology. Tweak here, tweak there . . . now he is normal and fit for life. It really makes life into a joke. It saps all the meaning out of it.
So the mind decides that matter which it only infers from mind’s contents is real; and mind is simply a by-product. Why trust the mind? But there is no direct route to matter, to biology. All the pathways lead through mind. This is a maze then.
Recently I watched Yuna Kim perform at Sochi during the last night Gala. She skated with grace and beauty to John Lennon’s Imagine. Just biology? Just some brain processes in her somehow transmitted to my brain? That kind of thinking would rob life of any reason to live it. I suppose working inside some gov institution one can become desensitized. Lose the common touch. Only laugh at obscure scientific jokes about brain tissue and the like. A kind of morbid enclosed life of obsession. But their pursuit will at best lead only to some even more savage attack on those suffering. Who is going to look at some brain scan and say, ah, there is the diseased neuronal connection. Now we will zap it with our healing machine. Stand back. Oops. Another casualty. On ward and up ward.
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