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Sunday August 25, 2013 MYT 12:00:00 AM
Sunday August 25, 2013 MYT 8:26:51 AM
by d.d. guttenplan
Some experts argue that each half of the brain generates a fundamentally different way of experiencing the world. -AFP Relaxnews
Crossing the mind-body divide: when philosophy meets psychiatry.
WITH its battered desks, fluorescent lights and interactive whiteboard showing an odd creature that, depending on how you look at it, could be either a duck or a rabbit, this could be a class in any university philosophy department.
But this is a class with a difference. It is the Maudsley Philosophy Group, a seminar that meets regularly on the grounds of the Maudsley Hospital, Britain’s largest mental health teaching hospital, which is affiliated with the Institute of Psychiatry at King’s College London.
Participants at the last session included psychiatrists, psychologists, philosophers and an actor who had just finished working as a chaplain in a locked men’s ward at the hospital and who was about to organise a storytelling group there.
“We started out as a reading group for trainee psychiatrists,” said Dr Gareth S. Owen, a researcher at the Institute of Psychiatry who co-founded the group in 2002. “Then, gradually, we developed and started inviting philosophers – at first it was quite low key. We would talk about our clinical experiences and then they would relate those experiences to their way of thinking.”
Dr Robert Harland, another co-founder of the group, said he had known Dr Owen since they “cut up a corpse together at medical school”.
“The analytic philosophers brought a real clarity to our discussions,” Dr Harland said. “We were looking at various models to help us understand what we were doing as psychiatrists.
“There is lots of applied science now in psychiatry: neuroimaging, genetics, epidemiology. But they don’t have much to say about sitting with a patient and trying to understand that person’s experiences.”
Tania L. Gergel, a philosopher whose work stretches from Ancient Greek ideas about ethics to dilemmas in contemporary medicine, was drawn to the Maudsley seminar out of intellectual curiosity. She also relished the chance to “come into contact with people who have actual clinical experience”.
“You can only learn so much from reading journal articles,” Gergel said. “The problem is that, as you move towards abstraction, it’s easy to lose sight of the fact that people are dealing with real suffering and real dysfunctions. We need to remember that those dysfunctions – whether of the brain or of the mind – are linked to a real individual who is going through a devastating crisis.”
The question of whether a mental illness has a bodily, physical cause is one aspect of what philosophers call the mind-body problem.
For Plato, the mental world was the real world, while Descartes argued that mind and matter were distinct.
More recently, some scientists have tried to locate consciousness in different parts of the brain. But the dispute over its location and origins is not just confined to philosophy or neurology departments.
A longtime member of the Maudsley seminar, Richard Sykes, a social worker who has studied both the physical and mental sides of chronic fatigue syndrome, or CFS, said there was a “terrific animosity between psychiatrists and patient groups”.
“There is an immense hostility to psychiatrists because they have got CFS wrong for such a long time,” he said. “At first, they thought it was hysteria. Then they said it was depression. But the absence of a medical explanation is not a good reason for saying it’s a psychiatric illness.”
For Sykes, the Maudsley group “is a chance to make use of my own philosophical background”.
The mind-body problem also preoccupied Dr Jacqueline P. Owen, a clinical lecturer in child and adolescent psychiatry who is married to Dr Owen of the Institute of Psychiatry. Her own doctorate on functional neuroimaging charted which networks in the brain lit up while performing certain tasks.
When she graduated, she discovered that “psychology in its pure form didn’t help very much when you are seeing patients”.
“A lot of what I studied was based on subjects who had damage to specific parts of the brain,” she said. “But in psychiatry, your patients often have no discernible brain damage.”
The Maudsley seminar offered “a different way of seeing things”. she said.
How different? Dr Iain McGilchrist, the group’s most recent visiting lecturer, started on familiar ground, describing recent research showing how differences in the structure of the two halves of the human brain are reflected in the way the brain functions. But Dr McGilchrist, who taught English literature at the University of Oxford before training as a psychiatrist, soon left the strict confines of neuroscience to touch on poetry, politics, painting and anthropology.
He eventually circled back to his announced topic: “What the reciprocal organisation of the cerebral hemispheres could tell us about some problems in philosophy.”
In his book, The Master and His Emissary, published in 2009, Dr McGilchrist argues that each half of the brain generates a fundamentally different way of experiencing the world. The left “constructs a virtual world, a self-enclosed world” whose representations we can manipulate and analyse, while the right sees “things as they are” in a more fluid way.
He compares the “gestalt” perception of the right hemisphere to a master who relies on the emissary of the left hemisphere for information to make sense of his experiences. He also argues that, since the Renaissance, the emissary has become more and more assertive.
At the Maudsley seminar, he invited his listeners to consider what it might be like to live in “a world where knowledge has been replaced by information, where skill and judgment has been displaced by abstraction”.
“Our lives would be governed by bureaucracy, losing any sense that each of us is unique,” he said. “It would be a world where quality no longer matters and quantity is the only criterion of success,” he added, suggesting provocatively that the condition he had just described was the world in which we all now live.
Not everyone in the group seemed convinced by some of the more sweeping historical claims, which set off a vigorous debate that continued through dinner.
Dr Jacqueline Owen said that the talk offered a new way to think about a problem she often encountered in her work. “I’m on a ward with teenagers – boys and girls – who complain of hearing voices,” she said. “So how do I discriminate between the ones who are really having hallucinations and those who are just listening to their own thoughts?
“Perhaps what we need to do is step back and think about what they are experiencing in the first place. Philosophy can provide a way into that – something that isn’t a gene, or a drug, but that can still be useful.”
“Psychiatry crosses domains,” Dr Gareth Owen said. “So it is important that the people who do it can cross domains as well. Our aim with the seminar is to provide a kind of third space – outside academic psychiatry or clinical practice or academic philosophy.” – IHT
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