The Reality Is In Our Heads


The Reality Is In Our Heads

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.


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Dan Kriegman, PhD
The Politics of Diagnosis and Treatment - An Evolutionary Biological View: A practicing clinical psychologist, Dan Kriegman explores the negotiation of conflicting realities that lies at the heart of successful treatment, and how a healing discipline can help prevent the dictating of meaning and truth from one party to another.


  1. Although I appreciate this blogger’s acknowledgement that horrific childhood abuse may cause one to feel they are hearing the abusers outside their heads as one type of trauma response, I find it very prejudicial and unenlightened of him to proclaim his biological monism as if it is obvious fact along with Dr. Steingard and other commentors. He and others are also scathing toward those who believe in God/Spirituality/Quests for Englightenment and even agnosticism when many scientists have pointed to quantum physics as providing some proof there may be a good as with THE SEAT OF THE SOUL and THE TAO OF PHYSICS. I don’t pretend to be an expert on this, but I recall that studies showed that one one views a subject comprised of particles, the viewer INFLUENCES and CHANGES that subject causing a permanent bond of some kind. The author should be aware of betrayal/trauma bonds like the Stockholm Syndrome as well. I realize that some fundamentalist religions have done many evil deeds in the name of God, but they pale in comparison to those done in the name of science including the Nazi Holocaust and other eugenic massacres, the atomic bombing of Japan and other nations and the mental death profession’s past and present assaults on humanity from babies to the elderly in the guise of science and medicine in bed with BIG PHARMA and corrupt politicians for greed, power, profit and status.

    Eckhart Tolle and modern authors on spiritual enlightenment clarify some of the wisdom in traditional religions that has been misunderstood or hijacked for nefarious purposes as is the case of evil and fraud done in the name of science.

    Many studies including recent ones claim that those who have spiritual beliefs and even attend church are less inclined to be depressed or stigmatized with the horric label of “mental illness” another pejorative term for “crazy” that only a psychopath could invent to con a brainwashed public with the pretense of eliminating the stigmas that they impose to destroy people with impunity without their knowledge of the junk science and real purpose of social control behind it.

    By their own admission, psychiatry has made its mission the invasion and destruction of religion and all other social structures including families, schools, communities, courts, medicine and anything else they can coopt into their totalitarian world order of one global nation of sheep the psychopaths in the new pathocrocy can continue to exploit and rule with impunity as is happening now. The excellent book, POLITCAL PONEROLOGY, explains the process of how psychopaths infiltrate small and large organizations, groups, countries and the world to hijack and corrupt them from within so that they can perpetrate their world view of exploiting and destroying normal humans as the intraspecies predators they are. The author points out that the type of suffering in places like Nazi Germany and Stalinist Russia serve to wake up those who have slumbered and/or partied in good times to resist such evil assaults on humanity. He also provides information on how to recognize these predators and learn to resist them as does Dr. Robert Hare, the world’ authority on psychopaths, Dr. Martha Stout and many others.

    Finally, since there is no proof that atheism is any more true than belief in God, I do not think these bloggers have the right to impy that they speak the truth with their atheism and believers are implied to be crazy or delusional. Many holistic doctors like Dr. Andrew Weill and others advocate including our spirituality as we see it as part of our overall health. I do not wish to live in the barren biolgical reductionist world of the mental death profession as is true of most of those who learn the truth about it.

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  2. Wow, the intellectual effort being put into trying to resolve the “mind-body problem” as corrupted by modern psychiatry.

    True, thought and feeling seem to take place in our heads, most likely our brains, as opposed to, say, the elbow.

    On the other hand, there’s quite a bit of evidence that other organs, such as the digestive system, thyroid, etc. contribute to behavior, personality, and disposition. It’s an ecology.

    I predict that in not too long, our efforts to isolate the “brain circuits” for specific feelings or thoughts will be regarded as a crude, self-deluding fad, like we think of “chemical imbalance” now.

    There are lots of shades of green.

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  3. A wonderful essay touching on that sacred ground of our, encouraged to take it for granted experience of mind, and its creation. What exactly is “the mind,” this sense of self that normality takes so much for granted whether understood as God given or a product of evolution. Mind you, most of us can think and say the word evolution, aware of the concept as a biological process while not wishing to embody its “real” implications. IMO the great elephant in the room of human mental health is the dogma “I am not an animal!” Yet what else does the word evolution really mean?

    Is the phenomena of hearing voices stimulated by unconscious fear as a conditioning of sub-cortical areas of the brain and nervous system based on our mammalian hereditary and “predator fear.” And considering that the father of modern neurology Sir Charles Sherington makes a very specific statement about the mind, can we perhaps conclude yet never prove, that “the voice” is a manifestation of motor impulses? Consider;

    “The motor act is the cradle of the mind – The capacity to anticipate and predict movement, is the basis of what consciousness is all about” _Sir Charles Sherington.

    “We are exquisitely social creatures. Our survival depends on understanding the actions, intentions and emotions of others. Mirror neurons allow us to grasp the minds of others not through conceptual reasoning but through direct simulation. By feeling – not by thinking” _Giacomo Rizzolatti.

    Considering the latest scientific theories of reality, should we really consider an individual mad for uttering a statement which is perhaps proving to be the reality of our species? As you write;

    “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.”

    Consider the cosmos as creator and the human species as its manifest sentience, and the mad individual is perhaps uttering a statement of fact and experiencing a species phenomenon, during a state of hyper-sensitivity?

    Shame this thought provoking essay has attracted so few comments, then again people are motor-vated by emotional “valence” and probably don’t sense the relevance in psychological terms, to their own needs?

    Readers may consider Jaak Panksepp’s thoughts on our taken for granted sense of “I”

    “The Self-Referencing “I”

    In neuroscience, many claim that there is no coherent neural referent for the pronoun “I” No ultimate observer for the “Cartesian theater” of our philosophical thought to ponder. Yet what if nature’s theater of “I feel therefore I am,” is the body’s primary-process consciousness of ancient neural processes for the generation of spontaneous physiological reactions, motor-actions which are “observed” within our mind’s conscious Cartesian theater, by a series of more recently evolved “monitors” or sensory-perceptual processors?

    The existence of an archaic-Self, especially one that is purely referenced in motor coordinates, can help solve the “ultimate observer” dilemma. If the higher monitors of the “Cartesian theater” are entranced via a central process that itself does not observe, but exists as a primordial neuosymbolic representation at the core of individual existence. This archaic-Self does not have thoughts or clearly defined perceptions, but does help elaborate primitive feelings, and it serves as an anchor that stabilizes or “binds” many other brain processes.

    At a practical neurobiological level, the existence of a primitive motor-action homunculus that is the primal representation of the Self allows us to envision ways in which primary-process consciousness can begin to be empirically studied. In its essential state this archaic-self provides the first executive mechanism for behavioral coherence and bodily awareness. In brain-neural representational terms, the-self may be topographically like a body of quite primordial shape. Perhaps an image of a stingray may serve as an appropriate symbolizing-metaphor.

    This is the type of primitive but developmentally flexible and intrinsically dynamic substrate of consciousness that we should be seeking deep within the brain stem–not the ultimate observer of the Cartesian theater, but a spontaneous active “stage manager” that helps create a neuro-psychic focus of existence for a multitude of higher observers to that emerge as SELF-processes migrate upwards through higher regions of the brain. Thus, a fully developed consciousness is reflected in hierarchical but recursive sets of neural processors, all still rooted in some primal aspects of SELF ontogenesis. Our neuroanatomical focus should be on the underlying circuits of an intrinsic, motor-SELF.

    A Motor “I”

    The idea that a primary template or “seed” of our SELF-Consciousness processes, and hence the roots of a primary-process consciousness, reside deep within medial zones of the brain stem; is uncontroversial in the sense that the reticular formation of the brain stem, with extensions into the thalamus and hypo-thalamus, has long been considered an essential substrate of our conscious, attentional activities.

    However, we have chosen to focus almost exclusively on the basic attentional systems of the ascending reticular activating system, which allow higher brain areas to work efficiently, rather than the deeper layers of the colliculi and underlying circuits of the pariqueductal gray (PAG), as the neuroanatomical focus of an intrinsic motor-SELF. A remarkable amount of neuropsychological and neurobehavioral evidence is consistent with the possibility of a primordial, motor-SELF.

    These deeper layers of the colliculi constitute a basic motor-mapping system of the body, which interacts not only with visual, auditory, vestibular, and somatosensory systems but also with nearby emotional circuits of the PAG. The PAG elaborates a different visceral-type map of the body, along with the basic neural representations of pain, fear, anger, separation-distress, sexual and maternal behavior systems.

    Adjacent to the PAG is the mesencephalic locomotor region, which capable of integrating neural patterns that would have to be an essential substrate of various coherent action tendencies. In evolutionary terms, a level of motor-coherence had to exist, before there would arise a need for its sensory guidance. Neurophysiological evidence indicates that the somatomotor, eye-movement map that borders the PAG is intrinsically a more stable tectal circuit than are overlying sensory maps.

    While the superficial layers of the superior colliculi flexibly harvest information about the location of visual stimuli, the underlying motor system generates orienting movements using a remarkably stable set of action coordinates. This stability of the somatomotor system indicates that it has primacy in the evolution of the psycho behavioral coherence, which this system spontaneously generates. Underlying PAG tissues, which contain representations of all emotional processes, may constitute an even deeper and more primitive visceral-SELF.

    Even though the extroceptive contents of consciousness are obviously created by sensory zones, these zones must send massive outputs into motor areas in order for coherent behavior to occur. I suspect this has led many thinkers to mistake sensory awareness for consciousness itself, as opposed to the toolbox of consciousness that sensory awareness really is. In sum, a careful consideration of underlying issues, indicates that primary-process and intentional consciousness is more critically linked to motor than to sensory cortices.”

    Excerpts from, “Affective Neuroscience: The Foundations of Human and Animal Emotions.” by Jaak Panksepp.

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