There is a New Paradigm for Psychiatry. It is the ‘Play of Consciousness,’ not molecular brain diseases.
Here’s a newsflash – the hope for a molecular-biochemical explanation for psychiatry is a false hope. Most of my field has come to expect and believe that we are on the verge of a new paradigm. This paradigm is based on the illusion that the workings of the brain on the molecular level has anything to do with psychiatric conditions. The proponents believe we are on the verge of proving that psychiatry is a brain disease no different from cancer or diabetes. But all that the research has come up with is – nothing. The reason why researchers have no proof that psychiatry is a molecular medical disease, is because it isn’t so. Psychiatry is not about brain diseases.
We have spent billions of dollars chasing this illusion, and we are planning to waste billions more. The sad paradox is this so-called scientific pursuit has all the markings of a religious belief, not science. A false theory has taken on the certainty of belief, despite the absence of any real evidence. Molecular theories and neurotransmitter theories have been disproven at every step. In real science one exception disproves the hypothesis. But not here. False speculative claims just keep multiplying and are taken as fact. It is believed that it is just a matter of tying up the loose ends. We are on the verge of a brave new world. Salvation is at hand. But the whole deal is built on a house of cards.
However, there is a paradigm that fully illuminates psychiatry. It is not only consonant with biology and neuroscience, but evolution itself. The problem with the fruitless quest of molecular psychiatry is that we are looking in the wrong place. Psychiatric conditions operate on a much higher level of brain function – by which the brain maps the adaptations of responsiveness, deprivation and abuse in the context of our temperament through our memory, creating the ‘Play of Consciousness.’
Don’t get me wrong. I love neuroscience and the study of the brain. I am in awe of Sebastian Seung’s Connectome project (see the NY Times article, “Sebastian Seung’s Quest to Map the Human Brain“), and my friend Matthew Faw’s exciting research on the hippocampus and consciousness. (see his video, “Consciousness is Memory”) However, there is also a tremendous amount of poor brain science masquerading as fact. Don’t believe everything you read.
We evolve as a species, and we evolve as individuals in relation to our salient environment. All throughout our development – the embryo, fetus, newborn, baby, toddler, child, and adolescent adapts to its emotional environment. There are only three relevant issues – responsiveness, emotional deprivation, and abuse. Each of us fields our experience through the unique constellation of our temperament. The four elements of temperament are Internalization/Externalization, Introversion/Extroversion, Active/Passive, and Participant/Observer. (See “The Nature-Nurture question – Nature. The role of nature comes from our genetic temperament.”)
Each one of us is absolutely unique. I may process by being an Internalizer, Extrovert, Active, and Participant. You may be an Externalizer, Introvert, Passive, and Observer. We are all somewhere on an axis of those dynamics. With each dynamic we can range from 90-10, 60-40, or be balanced. And one temperamental element may be stronger or weaker in its influence. Each of us then fields the unique actualities of responsiveness, deprivation, or abuse in our emotional environment through our temperament.
By six weeks old we begin to write a play in consciousness. Initially consciousness is too immature to create representational form. At that point we only have the ‘feeling of our being.’ By age three we mature into representational consciousness where we create a three dimensional drama with personas, feeling relationships between them, scenarios, plots, set designs, and landscapes. Once our play consolidates, the rest of our experience is always filtered through the existent play in consciousness, which influences our ongoing experience. As the twig is bent, so grows the tree. When we reach adulthood, we consolidate our character. Our characters are as unique as our fingerprints. No two snowflakes are alike, but we are all snowflakes.
Significant deprivation and abuse generates a current of anger and pain in our personality. This creates the whole host of potential psychiatric symptoms. I’ll give a few examples of how this works. But of course, personality is far more complicated than these shorthand examples. Abuse fosters an ‘attacker’ and an ‘attackee’, who relate by sadomasochism in one’s character play. Externalizers will project the ‘attackee’ persona back onto other people. They will be prone to blaming and fighting with others. Internalizers, on the other hand are prone to an internal war where the attacker attacks the attackee inside of him on an ongoing basis. This generates self hate, as opposed to the Externalizer’s “I hate you.” When symptoms develop Internalizers are prone to ‘depression.’
We can see here that some personalities will attack ‘out’ and others will attack ‘in’. The ongoing sado-masochistic war feeds on serotonin. When the war is chronic, the serotonin supply eventually gets overwhelmed, and symptoms develop. This should be a signal that the chronic internal war needs to be attended to and healed, so that the personality is no longer in a state of perpetual war. If one were to feed more serotonin into the system via drugs, this results in a hardening and numbing of the personality. This feeds and fosters the destructive internal war to continue, to escalate, and become more destructive. More damage will be done. The absence of conflict over a resulting selfishness, can sometimes make a person temporarily feel better. This is not a good thing. And eventually, it will make things worse. (Depression is not a biochemical disorder or disease).
Different personalities will translate the same attacker-attackee currents into other symptoms. For example, With a Passive temperament, one does not identify as possessing or dishing out aggression. Aggression is located in the other person. How does a passive temperament operate in the context of being a recipient of abuse? This individual does not identify as the possessor of aggression, but as the helpless one who is the object of aggression. He cannot protect himself from the steady state of sadistic attacks, which are too powerful and overwhelming anyway. This leaves him in the position of identifying as distressed and exposed, anticipating external attacks, with no possibility of protection. As the recipient of attacks, in this context, he is inclined toward masochism. But more importantly this defines the circumstances that generate anxiety. It derives from sadistic attack directed by the attacker toward the attackee, with insufficient and failed protection. And this position will express itself as anxiety later in life as a teenager and into adulthood. Anxiety is the inevitable expression of sadomasochistic attacks of the ‘play’ via a passive temperamental orientation. (Anxiety is not a biochemical disorder or disease).
On the other hand, if a person is active rather than passive in the context of a sadomasochistic play, he would generate the opposite scenario. He would identify with the active position of ‘dishing it out’, with the potential for sadism. He would be predisposed to become a bully, and make someone else anxious, as the unprotected object of his attack. (Bullying is not a biochemical disorder or disease.)
These are just a few examples as to how temperament creates symptoms. The entire array of psychiatric symptoms is generated by the way temperament fields responsiveness, deprivation and abuse. It’s far more complicated than this brief description. The pain of isolation from deprivation and the sado-masochistic currents from abuse generate the full scope of psychiatric issues. None of them are biochemical disorders or diseases. Life events happen that generate problematic adaptations that create suffering. All of our suffering flows from our damaged plays of consciousness. Since there are built-in fault lines to every problematic play, the way we break down follows along those fault lines. The way a person breaks down reflects the way he is constructed. Suffering is the manifestation of something having gone wrong in the characterological play.
The Play of Consciousness is the paradigm that encompasses all psychiatric conditions. This is the relevant story. Understanding brain mechanisms is exciting, but psychiatry does not operate on this level. When a new play is written in the brain, brain mechanisms follow, but they do not lead. By healing the character, the brain mechanism follow suit. I’ll repeat the list of the various forms of human suffering: People may feel unhappy, lonely, angry, or sad. They may have symptoms: obsessive, compulsive, anxiety, so-called depression, panics, phobias, paranoia, delusions. People have character behaviors that get them into trouble—drinking, drugs, gambling, eating (anorexia, bulimia, overeating, bingeing). sexual perversions, impulsivity, rages, emotional isolation, narcissism, echoism, sadism, masochism, low self-esteem, and psychotic and manic states. They may have crises in their lives—divorce, death, loss, illness, rejections, failures, disappointments, traumas of all kinds, and post-traumas. These all derive from the real paradigm, the ‘play of consciousness.’ As Shakespeare said, ‘The plays the thing’… not some imaginary neurotransmitter disease.
Mourning is the built-in natural biological process to deal with healing and recovery for all pains, loss, trauma, as well as death, in the human lexicon. The way to deal with suffering, in all its forms, is good psychotherapy. Therapy is a responsive relationship that fosters mourning the pain of past traumas, to write a new ‘play of consciousness’ which promotes authenticity and the capacity to love.
This new paradigm is a unified field theory of human consciousness, which includes psychiatry, neuroscience, dreams, myths, religion, and art—all elements of the same thing. It derives from and is consonant with our child rearing and culture. The “play” encompasses the ineffable human mysteries—birth, death, and the disparity between our ordinary sense of self and our intimation of a deeper authenticity. It includes as well the dark side of our nature. And finally, it holds the key to the nature of beliefs in general. Human consciousness and human nature are one and the same. The creation of our inner play by the brain is the consummation of our Darwinian human evolution.
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.