Dan Kriegman, Ph.D.
January 30, 2012
Sandra Steingard’s recent post, “Is It All In Your Heads,” has occasioned a spirited discussion—on monism, dualism, and what may be going on when someone hears a voice. In her post, Dr. Steingard reflects on some common criticisms of mainstream psychiatry, and in the process of sorting out her own thoughts, she sets forth a basic belief that I—and almost all psychologists and psychiatrists—share. Our brains are evolved biological structures that clearly function according to the rules of the physical world.
Her piece and the responses stirred up this thought for me: How can one understand the relationship between human psychological experiences and the material world in a manner that doesn’t lead to a medical conclusion that, in mainstream psychiatry today, might be summarized as, “The problem is all in your brain, take your meds!” (I am not saying that Dr. Steingard came to that conclusion; however, that is the conclusion that is instinctively drawn by many in the field when they speak of distress and other psychiatric symptoms arising from the brain.)
To better understand my thinking on this, I should note that I’m a psychologist who has written extensively about evolutionary biology. I don’t think you could find anyone who believes more in the notion that everything is mediated biologically. But I also find myself in accord with Bishop Berkeley who fairly conclusively demonstrated that the only things that can be known to exist exist in minds: There is no physical world that can be known outside of a mental experience of that world.
Furthermore, modern physics has fairly conclusively demonstrated that the physical substrate of the world of our experience is nothing like our experiential world, i.e., relativity, quantum, and string theories point to a fundamental, underlying reality that is utterly unlike the experiences we are referring to when we use words like chairs, cars, dogs, or people. So in a profound way, modern physics has demonstrated that what really is out there — i.e., the “reality” that exists independently of our mental construction — is not the mental construction that exists in our heads.
Consider. The fundamentally relational ground-of-being is fraught with mysteries and paradoxes. It has a mind-boggling dimension as it confronts us with incomprehensible facts. For example, where is the experiencing self that knows? Is it in the bouncing molecular billiard balls of our nervous systems? Your experience of “green” (not to mention such things as “love”) is not merely a pattern of electrical stimulation being passed through some nervous tissue. Clearly there is some relationship between our nervous systems and our experience. But a pattern of nervous excitation is a pattern of nervous excitation, not “the experience of green.”
The preceding statement is one way of describing the mind-body problem that is highly relevant to this whole issue and can be discussed without bringing in any unnecessary dualism. Rather than introduce dualistic notions to this discussion, I will attempt to demonstrate that materialistic monism — which is the dominant philosophical worldview underlying almost all mainstream science, not just psychiatry — leaves us with incomprehensible paradoxes that simply indicate that something must be misleading in such an approach. Let me explain this further.
If we were to look closely through a special microscope that showed every nerve cell glowing brightly as it passed an electrochemical impulse along its shaft to the next cell, and if we were able to watch in very slow motion, we might see a similar pattern occurring each time our subject looks at a green wall. And a different pattern when the person looks at an orange wall. But when we look at the person’s brain tissue and examine the pattern of nervous stimulation, try as we may, no matter how closely we look, we will not see “green” or “orange.” So, where in the monistically conceived world is the experience of green or orange?
Well, we do know that the color sensation/experience is being “known” by an experiencing self. After all, you do exist, and you do have experiences such as “green.” But where is your experiencing self in the spatial dimensions of the physical world? As much as it may be tied up with brain activity, it simply isn’t “in the brain”; again, no matter how carefully we look we will not find the experience/sensation/awareness of green when we examine your brain tissue.
As Henry David Thoreau wrote, “With all your science can you tell how it is, and whence it is, that light comes into the soul?”
This “mind-body problem,” along with numerous other impossible questions/paradoxes, lead us to a fundamental state of awe that need not include any of the dualistic, magical thinking typically associated with words like “soul.” We can remain monists (or better yet, just avoid the monist-dualist dialectic and stick to the paradoxical facts that defy our understanding) without any spooky spirits thrown into the works. We need posit no hidden homunculus in the brain. We know that the experiencing mind, psyche, self “arises out of” — or is “tied to” or “correlated with” — phenomena in the material world. Simultaneously, it does not exist in, cannot be found by examining the material world.
Bishop Berkeley, the British Empiricist, took it one step further: All known features of the material world exist only in minds that cannot be located in that physical world. Minds arising out of a physical world? Or a physical world that exists solely in minds? The incomprehensible, the paradoxical, is real.
Thus, there may be something essentially misleading about the materialistic, simplistic biologizing that has gripped modern psychiatry. Dr. Steingard wrote, “The experience of hearing a voice that no one around you can hear is reflective of a set of brain processes.” And surely it is. As she noted and as I already ceded in my description of the issue above, every mental experience has a relationship to biological brain processes.
There is, however, an implication in such words that something essentially different is happening in the brain of a person who hears a voice that others can’t hear. Given my extensive experience as a practicing clinical psychologist, this is an interesting but questionable conclusion. While I have treated people who have been diagnosed with some form of psychosis, the vast majority of my patients have shown no signs of psychosis. Yet all of my patients hear voices nobody else hears. Almost all the time.
I confess that I too hear a continuous dialogue in my head. It is true that I experience the voice in my head as my own voice; I feel like I’m talking to myself. But I hear my voice in my head. I actually talk to myself. Paraphrasing Jackie Mason, I typically enjoy talking to myself because I happen to agree with what I say. When I talk to myself, I don’t start any arguments. I find my thoughts to be quite intelligent. If I have something stupid to say, I say it to somebody else. When I die, I’m afraid I’ll have nobody to talk to.
But seriously, there need be no discernable, no significant difference between brain processes that are correlated with a voice that no one else hears that is experienced as emanating from oneself and a voice that no one else hears that is experienced as coming from someone or somewhere else. We all have brains that produce both voice sensations, though some of us seem to feel the voices we hear (that no one else hears) are our own voices most of the time, except maybe when we are very tired, physically ill, dreaming, or just awaking. Others more often hear voices no one else hears and feel like they are not their own voices.
The point is that the biological differences between such experiences may be so negligible or subtle or so far beyond our rudimentary understanding of how brains and psychological experience are related that it may be many, many centuries before we are able to pinpoint them, if indeed we will ever be able to do so.
I would suggest that the fundamental difference between the two experiences — between hearing a voice that no one else hears and feeling it is your own voice and hearing such a voice and feeling it is not your own voice — may not be profitably understood by talking about something going on in a person’s biology, neurological processes, biochemical functioning or any other materialistic metaphor.
It may be far more profitable to talk about the fundamental misery experienced by people who have been subjected to horrific abuse and trauma when their worlds are inundated with alien voices that only they hear that often criticize, abuse, cajole, and/or appear to be harshly ordering them around. Rather than analyzing the biochemical processes involved, it may make far more sense to try to understand the attempt to stitch together a stressed, depleted, fragmented sense of self with a voice that speaks to the subject and tells the person that he or she is the divine offspring of the Almighty Creator, an experience that religious mystics throughout the ages have voiced.
I am not suggesting that Dr. Steingard doesn’t understand this. Indeed, she may practice in this manner when she does psychotherapy; her piece clearly demonstrated that she is a thoughtful, sensitive clinician who is struggling to make sense of a field that has become quite muddy, at best. However, I am suggesting that, as of today, the point she was making — derived from the notion that every human experience can be understood as biologically mediated, a notion that I happen to agree with — may be virtually inconsequential in developing our best understanding of the human experience called “madness.”
As the founder of self psychology, Heinz Kohut, pointed out, we can try to understand the human experience of a great painting by analyzing the pigments used by the artist. It is doubtful, however, that we will make much progress in deepening our appreciation of inspiring art using that method. Not today. And even if pigment analysis progresses to levels unimaginable today, I doubt we will ever be able to use it very profitably to understand the moving human experience produced by great works of art. Just so, there is nothing on the table or the scientific horizon to indicate that the analysis of bouncing, molecular, billiard balls in nervous systems is likely to illuminate the human experience of green, not to mention beauty, love, heartbreak, overwhelming anxiety, or the sense that a voice that no one else hears is not our own.
Also by Dan Kriegman:
A Phenomenological View of Madness and Medicine
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.