Humanizing Psychiatry E-Book

Niall McLaren

• Herausgeber: Modern History Press
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2010

Seitenzahl: 553

Beschreibung

Does psychiatry have a future?
Assailed from many directions, under constant attack for its reliance on "a drug for all problems" and increasingly unable to attract bright new trainees, the specialty is showing every sign of terminal decline. The reason is simple: modern psychiatry has no formal model of mental disorder to guide its daily practice, teaching and research. Unfortunately, the orthodox psychiatrists who control this most conservative profession are utterly antagonistic to criticism. Despite the evidence, they maintain a blind faith that "science will deliver the goods" by a biological examination of the brain. This book argues that their faith is entirely misplaced and is contributing to the destruction of an essential part of civilized life, the fair and equitable treatment of people with mental disorders. The author offers a rational model of mental disorder within the framework of a molecular resolution of the mind-body problem. Fully developed, this model will have revolutionary consequences for psychiatry--and the mentally-afflicted.
Acclaim for the writing of Niall Mclaren, M.D.
"This book is a tour de force. It demonstrates a tremendous amount of erudition, intelligence and application in the writer. It advances an interesting and plausible mechanism for many forms of human distress. It is an important work that deserves to take its place among the classics in books about psychiatry."
"Dr. McLaren brilliantly wields the sword of philosophy to refute the modern theories of psychiatry with an analysis that is sharp and deadly. His own proposed novel theory could be the dawn of a new revolution in the medicine of mental illness."
--Andrew R. Kaufman, MD, Chief Resident of Emergency Psychiatry, Duke University Medical Center
"I found Niall McLaren's book to be an incredibly well-written and thoughtprovoking. It is not, by any means, easy reading. It is also not for someone who doesn't have some form of background in understanding the various psychological theories and mental health conditions. I think that this would make an excellent textbook for a graduate class that allows students to question the theories that we already have."
--Paige Lovitt for Reader Views
About the Author
The author is a psychiatrist of some 35 years standing. He writes philosophy in the bush outside Darwin, northern Australia, with his family as critics. For six years, while working in Western Australia, he was the world's most isolated psychiatrist.
PSY018000 Psychology : Mental Illness
MED105000 Medical : Psychiatry - General
PHI015000 Philosophy : Mind & Body

Leseprobe

HUMANIZING PSYCHIATRY:THE BIOCOGNITIVE MODEL

Niall McLaren, M.D.

“Orthodoxy means not thinking—not needing to think.Orthodoxy is unconsciousness.”George Orwell, 1984

Humanizing Psychiatry: The Biocognitive ModelCopyright © 2010 by Niall McLaren, M.D.

No part of this publication may be reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or other otherwise, or stored in a retrieval system, without the prior written consent of the publisher.

Library of Congress Cataloging-in-Publication Data

McLaren, Niall, 1947-

Humanizing psychiatry : the biocognitive model / Niall McLaren.

   p.; cm.

Includes bibliographical references and index.

ISBN-13: 978-1-61599-011-5 (trade paper : alk. paper)

ISBN-10: 1-61599-011-9 (trade paper : alk. paper)

ISBN-13: 978-1-61599-012-2 (hardcover : alk. paper)

ISBN-10: 1-61599-012-7 (hardcover : alk. paper)

1. Psychiatry--Philosophy. 2. Cognitive neuroscience. 3. Psychology, Pathological. 4. Biological psychiatry. I. Title.

[DNLM: 1. Psychiatry. 2. Models, Psychological. 3. Psychological Theory. WM 100 M161h 2010]

RC437.5.M44 2010

616.89--dc22

2009035242

Distributed by: Baker & Taylor, Ingram Book Group, Quality BooksFuture Psychiatry Press is an imprint ofLoving Healing Press5145 Pontiac TrailAnn Arbor, MI 48105USA

http://www.LovingHealing.com [email protected] [phone]

F u t u r e P s y c h i a t r y P r e s s

For my wife and children.

Amici certi in re incerta

Acclaim for the writing of Niall McLaren, M.D.

“Dr. McLaren brilliantly wields the sword of philosophy to refute the modern theories of psychiatry with an analysis that is sharp and deadly. His own proposed novel theory could be the dawn of a new revolution in the medicine of mental illness.”

—Andrew R. Kaufman, MDChief Resident of Emergency PsychiatryDuke University Medical Center

“Not only does Dr. Niall McLaren point out the various shortcomings of the established views of psychology/psychiatry, and of some other scientific disciplines, but he also proposes the most cogent model of mind that does not violate fundamental scientific laws and is also compatible with the norms of common sense and logic. He has endangered the foundations of contemporary mainstream psychiatry while, at the same time, creating a rescue channel.”

—Ernest Dempsey, editor of Recovering the Self Journal

“This book is a tour de force. It demonstrates a tremendous amount of erudition, intelligence and application in the writer. It advances an interesting and plausible mechanism for many forms of human distress. It is an important work that deserves to take its place among the classics in books about psychiatry.”

—Robert Rich, PhD, AnxietyAndDepression-Help.com

“I found Niall McLaren's book to be an incredibly well-written and thought-provoking. It is not, by any means, easy reading. It is also not for someone who doesn't have some form of background in understanding the various psychological theories and mental health conditions. I think that this would make an excellent textbook for a graduate class that allows students to question the theories that we already have.”

—Paige Lovitt for Reader Views

“It is impossible to do justice to this ambitious, erudite, and intrepid attempt to dictate to psychiatry a new, ‘scientifically-correct’ model theory. The author offers a devastating critique of the shortcomings and pretensions of psychiatry, not least its all-pervasive, jargon-camouflaged nescience.

—Sam Vaknin, PhD, author Malignant Self Love: Narcissism Revisited

“McLaren's book has been thirty years in the making and is obviously well researched and thought-out. The author makes very strong, intelligent arguments that, I believe, will have a large impact on the future of psychiatry. McLaren's book would make an excellent read for a psychiatry student or for those already in the field.”

—Kam Aures for Rebecca's Reads

“This is an academic book about psychiatric methods. As a psychology graduate as well as a user of the various services, I find this a fascinating subject. It's not for a beginner, but for someone who has some experience of the mental health services, it's interesting and thought-provoking. We need to get over the stigma attached to mental health and see it on the same level as physical health issues. It's not a new theory, but more of an overview of what has gone before and where the future direction of psychiatry should lead.”

—Josie Henley-Einion, author of Silence

“Among the theories McLaren shows as severely flawed are behaviorist models, psychoanalysis, and eclectic models of psychiatry. Most importantly, McLaren states that no real foundational theory exists for psychiatry. While definitions of mental disorder exist, no real definition of mental order or normality has been determined. Until it is determined what a normal mental state is, psychiatry cannot accurately determine what is a mental disorder.

McLaren's thesis is that ‘human behavior is the outcome of a complex interaction between an emergent mind and the physical body.’ While psychiatry has focused on depression as the most popular mental disorder, McLaren believes the focus should be on anxiety, which is the result of the ‘fight or flight’ instinct in most creatures; traumatic events that cause anxiety can lead to depression, so consequently anxiety deserves to be studied as a source of depression. McLaren emphasizes that the human mind does affect the human body, as in cases of mass hysteria, anxiety, and fear that create panic attacks.

Ultimately, McLaren says that any theory of the mind has to provide a rational explanation of mental disorder. He boldly speaks his mind throughout the book, backing up his points with multiple examples, and he is not afraid to cry “Humbug!” when necessary. McLaren has been practicing psychiatry since 1977 in Australia. His discussion of his own education and the shortcomings of the education system he went through as well as weaknesses in current psychiatric practices demonstrate that psychiatry has many more steps to take before it is a completely effective science. This work may well lead to a new understanding of mental illness in future years as younger psychiatrists read his book and follow his example in rejecting the ineffective theories he derides.”

—Tyler R. Tichelaar, PhD

“This is a paradigm-challenging work, to say the very least, and McLaren's views require a person who has a vested interest in these subjects to confront their own resistance to challenge. It's worthwhile, because McLaren's book is affirmative concerning something which many people may have found lacking in modern psychology, and psychiatry: namely, a psyche.

With the technological revolutions occurring in the past century-and-a-half, it seems every scientist wanted to find a way to reduce the psyche to a physical property, or some combination of physical properties, or completely deny its existence (behaviorism). While this has certainly been in vogue, and has yielded many useful results in terms of understanding neurobiology and its connection to moods and perception, it has not been successful in penetrating an understanding of ‘the Self’, or the psyche. Some will say this is because the self/psyche doesn't exist, but is only a fiction that appears to the individual: still, this is just a reduction to absurdity- what is the person who perceives the self, but indeed the self?”

—Kevin Brady, Clear Objectives

Contents

Table of Figures

Introduction

I-1. The Gathering Crisis in Psychiatry

I-2. Summary of Part I: The End of Biological Psychiatry

I-3. Summary of Part II: A Resolution of the Mind-Body Problem for Psychiatry

I-4. Summary of Part III: The Future of Psychiatry

I-5. A Note of Thanks

Part I: Restricting the Scope of Biological Psychiatry

Chapter 1 – Defining Limits to Biological Reductionism

1-1. Introduction

1-2. Psychiatry and the Prizewinners

1-3. Psychiatry and Biology

1-4. Psychiatry and Psychoanalysis

1-5. Psychiatry and Reductionism

1-6. The Limits to Reductionism

1-7. Saving Reductionism?

1-8. Conclusion: A Post-Reductionist Psychiatry

Chapter 2 – Turing Computability and the Brain

2-1. Introduction

2-2. Turing's Universal Computing Machine

2-3. The Brain as a Collection of Turing Machines

2-3. Mens Insana In Sana Corpore

2-4. Conclusion

Chapter 3 – Science and the Psychiatric Publishing Industry

3-1. Introduction

3-2. Psychiatry as a Scientific Discipline.

3-3. What Do Psychiatrists Read?

3-4. Prejudice Masquerading as a Scientific Psychiatry

3-5. Conclusion

Part II: Resolving the Mind-Body Problem for Psychiatry

Chapter 4 – The Case for a Mentalist Psychiatry

4-1: Introduction

4-2: Why Brains?

4-3: Where is the locus of control?

4-4. The nature of control: mentalism vs. non-mentalism

4-5. Conclusion

Chapter 5 – Toward a Molecular Resolution of the Mind-Body Problem for Psychiatry

5-1. Introduction

5-2. Chalmers and Property Dualism

5-3. The Tasks of a Theory Of Mind

5-4. Turing's Account of Mindless Mentation

5-5. Conclusion

Chapter 6 – Embodied Logic

6-1. Introduction

6-2. The Brain as a Logic Machine

6-3. The Mechanism of the Brain's Logic Gates

6-4. A Molecular Resolution of the Mind-Body Problem

6-5. Conclusion

Chapter 7 – The Biocognitive Model

7-1. Introduction

7-2. The Other Half of Mind

7-3. Nature vs. Nurture, Emotions vs. Rules

7-4. A Fragile Logic Machine: Confusion and Dementia

7-5. Personality in The Cognitive Model

7-6. Conclusion

Chapter 8 – Language as a Test of the Biocognitive Model

8-1. Introduction

8-2. Language Divorced from the Brain

8-3. When Mental States Communicate

8-4. How Mental States Evoke Like Mental States

8-5. How Mental States Evoke Speech

8-7. How Speech Evokes Mental States

8-8. Summary of the Model

8-9. Scope of the Model

8-10. Conclusion

Chapter 9 – The Biocognitive Model and Human Nature

9-1. Introduction

9-2. A Materialist Reality

9-3. A Human Reality

9-4. A Humanist Morality

9-5. A Theory Of Society

9-6. A Theory of Law

9-7. Conclusion

Part III: Applying the Biocognitive Model to Psychiatry

Chapter 10 – The Role of Personality

10-1. Introduction

10-2. Models of Personality?

10-3. The Biocognitive Model of Personality

10-4. Normal Personality

10-5. Abnormal Personality

Case 10-1. Mr. LJ, aged 26yrs.

Case 10-1. Discussion.

Case 10-2. Mr. AT, aged 21yrs.

Case 10-2. Discussion.

Case 10-3. Mr. BT, aged 19yrs.

Case 10-3. Discussion.

Case 10-4. Mr. MS, aged 29yrs.

Case 10-4. Discussion.

Case 10-5: Ms. PR, aged 28yrs.

Case 10-5: Discussion.

Case 10-6: Ms. MA, aged 26yrs.

Case 10-6: Discussion.

10-6: Conclusion.

Chapter 11 – Circus Vitiosus

11-1. Introduction

11-2. Homeostasis

11-3. Homeostasis Mentalis

11-4. When Stasis Fails

11-5. Conclusion

Chapter 12 – The Culture of Complacency

12-1. Introduction

12-2. How Psychiatry Fails To Qualify As Science.

12-3. Is There A Future For Psychiatry?

Epilogue

Index

Table of Figures

Fig. 5-1: The Dual Aspect Theory of Mind

Fig. 5-2: Elements of a Turing Machine

Fig. 5-2: An array of Turing machines in three dimensions.

Fig. 6-1: A simple AND logic gate gives a theoretical account of braking on a red light.

Fig. 6-2. A diagrammatic representation of cortical neuronal structure within the cortical modules.

Fig. 7-1: Logical Structure of the Biocognitive Model

Fig. 8-1: Diagramming a sentence

Fig. 8-2: Sequential Construction of sentences.

Fig. 8-3: Language array.

Acknowledgement: I am grateful to Prof. Peter Somogyi, Dept of Pharmacology, University of Oxford, for permission to use Fig. 6-2.

Introduction

The whole point of a religious or political education is to do exactly as your teachers say. The whole point of a scientific education is to overthrow your teachers.

I-1. The Gathering Crisis in Psychiatry

Since my monograph, Humanizing Madness: Psychiatry and the Cognitive Neurosciences, was published in 2007, I have had the chance to meet people in the US, and keep regular email contact with people all over the world. Talking to medical students, psychiatry trainees and junior psychiatrists has convinced me that, unless there is a radical transformation, even a revolution in psychiatry, then the profession will more or less cease to exist within the next twenty years. Some people might retort: And not before time, but I will answer that later. Here, I will briefly outline why I have this gloomy view.

The first thing I noticed in the US was a widespread and profound disenchantment among trainees with what they are being taught. From what I can see (and I have nothing to do with psychiatric training in Australia), today's trainees don't have anywhere near the fun we had thirty years ago. There is no sense of excitement among our junior colleagues. Their academic courses consist of dredging through thousands of papers stuffed full of statistics, of pharmacology, of brain enzymes and fMRI scans and the like, but there is no humanity in it. These days, psychiatrists see patients for a short time, quickly announce a diagnosis according to the DSM-IV, write a prescription and hand the patient over to case managers. A month or more later, when the patient comes back for more prescriptions, he is just as likely to see another doctor. The intellectual and emotional satisfaction at being able to step inside patients’ lives and see it from their point of view is simply not there. Psychiatry consists of drugs, one-size-fits-all programs, mission statements and endless forms to fill in.

The practice of psychiatry has been hammered into a bureaucratized and corporatized model of cut-price service delivery, where the demands of torts lawyers count for more than the needs of a person in pain. At an accelerating pace, psychiatry is being pared down. From my vantage point up here at the top of Australia, I see that hospital psychiatrists no longer take calls; no longer see patients as they walk in (or are carried in) from the street; no longer take detailed personal histories, no longer decide who will come into hospital, don't provide assessments or write discharge summaries, don't listen to people's problems and, very often, don't even listen at all. They are paid handsomely, of course, hospital psychiatrists earn much more than I do in private practice, even though I run a business and pay my own insurance and pension fund, etc. But what do they do to earn these breathtaking salaries? I don't know. If I ring a mental hospital, I can't talk to the psychiatrists. I have to talk to the triage nurse or the operations manager, the intake coordinator or even the allocations clerk. It reached its nadir when I rang a hospital to ask for a discharge summary on a patient I had sent to them, as the patient had been discharged and was told to come back to see me. “Yes,” the receptionist said, “you can have it but the fee is $20.00 for us to get his file from records and then $1.15 per page for photocopying, plus postage and it could take two weeks because it must be approved first.” Didn't they have an electronic copy they could email to me at no cost and no delay? “Definitely not,” the woman snapped. All records had to be kept in a secure environment that met national standards of privacy and security and, until they had the patient's written authority on the correct form, they didn't even acknowledge his existence. Could I have a copy of the form for him to sign, as he was sitting next to me while I called? Most certainly not, they couldn't possible release a form, it was a legal document. I didn't bother: people who created and worked in such a dehumanized system couldn't possibly have anything worthwhile to tell me about the drugged man sitting mutely next to his frightened wife. Because this is the problem with the institution of modern psychiatry: there is no room in it for humanity.

Three decades ago, when I trained, psychiatry was exciting. It seemed to be moving ahead in leaps and bounds as the gigantic mental asylums were dismantled and long-term patients moved into smaller hostels in the community. With the right combination of drugs and psychotherapy, we felt we could help people back into real life. All that has gone now. Due to an utter failure of intellectual leadership, psychiatry has drifted from the mainstream and is wandering aimlessly in the eddies. Psychiatry is going nowhere and, while it drifts, everybody else who likes can take a bit of the body of the profession and run away with it. It is going nowhere because its leaders have no agreed model of mind to guide practice, teaching and research. Because it has no sense of direction, modern psychiatry focuses on the bits it can see: drugs and questionnaires, blood tests and brain scans. The notion that humans have feelings is ignored as being too squishy to waste time on. Bothered by feelings, are we? Don't worry, just take more of the purple tablets and come back in a month. You can talk to a counselor but if you start to cause trouble, we'll lock you up for the heavy-duty treatment. Next please.

Psychiatry has retreated from any concern about people as sentient beings just because it has no convincing model of mind that can grapple with the notion of suffering but, rather than do battle with psychologists and social workers over the souls of men (and women), it hides behind a facade of pseudoscience. Granted, the senior academic psychiatrists who set the pace, as they like to say, take umbrage at this, insisting that they have a genuinely scientific grasp of mental disorder. Why, they declare, we have scientific journals, we have congresses and university departments, we have degrees and gowns and prizes, we meet government ministers and have research budgets, committees and publication lists… surely you can't deny that this is what all other medical specialties do? Well, that's true, except for one crucial point: the rest of medicine has a genuinely scientific program to pursue. We psychiatrists don't: take away all the stuff and clutter of a “science of psychiatry” and there's nothing left. There is no program which says: This is the path to understand mental disorder. There is no agreed model to use as the basis of a science that cares about mental disorder.

If you want to test this, take any journal in any area of medicine and look at the first research paper that takes your eye. It will start with a statement of its position on a particular topic, giving references to establish its validity. You can then check the references, and the references they refer to, tracking back along the intellectual history of the topic until it reaches the most basic bioscience. A cardiology paper will lead back to the original papers detailing the elementary biological features of the heart, an orthopedic report will end with a skeleton and an account of the fundamental physiology of bone, and so on. But psychiatry doesn't. It will fade out somewhere in the distant past with some great man's assertion that “This is how it is.” Quite often, it will be a pointless, hair-splitting argument over nosology, or some brave hope to find the final chemical cause of schizophrenia but what you will never find is how the paper fits into a larger, declared model of mental disorder.

Psychiatry has become a hollow shell in which the trappings of science conceal a pseudoscience. There are psychiatric journals, but not one of them addresses a declared model of mental disorder. This is why the profession is collapsing, this is why it can't attract the brightest medical students, this is why the average age of psychiatrists is rising and the average weariness of psychiatrists is so overwhelming that they simply acquiesce as yet another bit of the speciality is stripped away and handed to somebody who makes more noise. The greatest crime of the academic psychiatrists who are supposed to be leading the profession forward is that, having failed to deliver a formal model of mental disorder, they made psychiatry boring. That is why it is dying.

Perhaps this is how it should be. Perhaps we should take the Darwinian view that, if psychiatry had anything to offer, it would be thriving but if it doesn't thrive, then it shouldn't be kept on life support by legislation and government funds. Perhaps the psychologists and social workers and nurses and therapists and drug counselors and managers and accountants and lawyers are right: they can do it better. Perhaps they can, but I haven't seen any of them offer a valid model of mental disorder. It would simply set up more trouble for those who are least able to defend themselves. If nurses finally got control of the mental hospitals, then psychologists would soon demand their own institutions, then social workers and sex therapists, and so on. Instead of one mess, we would have a dozen squabbling empires, competing for funds and patients (in that order) and people in distress would still walk the streets at night because they can't find a mission statement that they satisfy. All this comes about because psychiatry has no formal, scientific model of mental disorder.

It is my view that, unless psychiatrists come up with a proper model of mental disorder as the basis for daily practice, teaching and research, then things will only get worse for the mentally-ill. This leads to an important point: Are there really mentally-disordered people out there? Or is the whole thing just a racket, designed to build empires and pay people to hide society's unfortunates?

I will argue on the one hand that any formal model of mind leads inexorably to the theoretical position that mental disorder should exist and, on the other, that it is an empirical fact that there are people who, by any definition, are mentally-disturbed through no fault of their own. Furthermore, I will draw in considerable detail the form of a suitable model, showing how it relates to philosophy, to the neurosciences and to common experience.

I-2. Summary of Part I: The End of Biological Psychiatry

It is the case that biological psychiatry is now in the same logical and sociological position as psychoanalytic psychiatry was in the 1970s. For decades, Freudian concepts dominated psychiatric thinking, especially in the United States. Gradually, however, psychoanalysis was coming under attack from a number of viewpoints. First, there was the historical evidence that a lot of what the early analysts claimed simply wasn't true. Secondly, major logical errors and inconsistencies were accumulating. Thirdly, there was very little evidence that it actually worked. From the late 1960s, psychodynamic concepts enjoyed a brief burst of popularity, a kind of agonal convulsion, especially from what was known as transactional analysis. This was psychiatry for the masses, mentalism for the mindless, and it generated an enormous industry in which everybody could diagnose himself or her neighbor (including children, don't forget “TA for Tots”) and prescribe a course of treatment. It collapsed in self-parody, and psychoanalysis quickly slipped into well-deserved oblivion.

These days, we have a similar social phenomenon of psychiatry for the masses but the emphasis is biological. Every magazine urges its readers to tick the boxes and find out whether they have “clinical depression.” TV advertisements urge viewers to call one of dozens of “hotlines” if they detect any deviation from psychic perfection in themselves or their families. Better still, “talk it over with your doctor who will prescribe the right treatment.” School teachers badger parents to take their sons to pediatricians for “the tablets.” Probation officers want their clients sedated until they complete their parole. Opticians frighten parents into buying spectacles to treat “central visual processing disorder” while every person charged with a crime claims to be the victim of a chemical imbalance of the brain. Antidepressants long ago passed antibiotics as the most commonly prescribed drugs. Everybody, it seems, is jumping on the biological bandwagon.

The worst thing that can happen to a science is for it to become popular. If couch potatoes can understand it, or think they can, then there is no hope. It says the theory is so simplistic that it probably doesn't even engage with its subject. In psychiatry, if every school teacher, social worker, psychologist, nurse, drug counselor, scout leader, chiropodist and neighborhood busybody can understand what makes people tick (a “chemical imbalance of the brain”), then they don't understand anything at all. This is because so-called biological psychiatry doesn't actually constitute a theory. Part I demonstrates this from several sides. Chapter 1 shows that biological reductionism is incapable of giving a rational account of human behavior. Secondly, the notion of there being but a single, physical cause of mental disorder is shown to be false. Finally, I use the example of the psychiatric publishing industry to show how the sociological phenomenon of modern orthodox psychiatry evades its primary responsibility as a science.

I-3. Summary of Part II: A Resolution of the Mind-Body Problem for Psychiatry

In fact, this claim is incomplete. What I do is detail a model which satisfies part of what we normally call mind, the part that is important for a theory of mental disorder. This develops the ideas first outlined in Humanizing Madness. Starting with common observation, I show how our concept of mind splits according to the “natural dualist” approach of the philosopher, David Chalmers. Next, his concept is applied to the work of the mathematician and logician, Alan Turing, which provides a conceptual basis for a cognitive theory of mind. At the same time, we have to give an account to what we know of the brain as a biological organ, and modern neurosciences are developing very rapidly. However, there is still a conceptual gap between brain and mind but it can now be bridged, and the concept of the logic gate fills the empty logical space between the mind as Chalmers envisaged it and the brain as modern technology is revealing it. Finally, we can move from brain to mind and back again without breaking any physical laws, without invoking the supernatural, and without denying our essential humanity. For want of a better term, I call this the “biocognitive model.”

I-4. Summary of Part III: The Future of Psychiatry

This is perhaps anticlimactic: we can no more predict the future of psychiatry than we can predict the next hit song, or next week's Dow report. However, my view is this: that if psychiatry embraces either my biocognitive model or something like it, then it has a future. If it refuses, if it obstinately continues to chase after glib mirages, then it has no future. I don't know what would be worse, more bad psychiatry or no psychiatry, but I think a good psychiatry would be an improvement on both. Whether anybody believes that the biocognitive model is an improvement on what has gone before is up to them. My duty as a scientist is satisfied if I put the model forward for the new generation of psychiatrists, to look at, to use, to criticize, to improve, or perhaps just to discard for something better.

I-5. A Note of Thanks

I would like to thank the many people who have contacted me from around the world to offer encouragement. Dr. H. Keith Brodie, of Duke University, very kindly arranged an invitation to visit North Carolina, while Dr. Andy Kaufman surpassed himself with enthusiasm and hospitality. Prof. Michael Ruse, of Dept. Philosophy, FSU at Tallahassee, Florida, offered not just the chance to meet his post-grad students, but also his own hospitality. Prof. Alan Patience of Sophia University, Tokyo, provides constant encouragement. In particular, I want to thank my publisher, Mr. Victor R. Volkman, of LH Press, Ann Arbor, Michigan, for taking a punt on an unknown author from the far side of the world.

Part I:Restricting the Scope of BiologicalPsychiatry

1

Defining Limits toBiological Reductionism

“If all possible scientific questions are asked, our problem is still not touched at all.” Ludwig Wittgenstein

1-1. Introduction

The first half of the twentieth century was the golden age of physics. The second half, from the elucidation of DNA in 1953 to the description of the human genome, was dominated by molecular biology. Many people now believe the most exciting progress in the twenty-first century will be directed toward a rational account of the ultimate scientific mystery, the human mind [1]. From the psychiatric point of view, this will not come too soon. By a major measure of intellectual achievement, the Nobel Prize for physiology and medicine, modern psychiatry has had little impact. Even though mental health is the single most important cause of morbidity and secondary mortality in the world, there have been only two Prizes directed toward matters of psychiatry since they were instituted in 1901. Thus, when the author of a book entitled “Psychiatry, psychoanalysis and the new biology of mind,” [2] is billed as “the first American psychiatrist ever to have won the Nobel Prize in physiology or medicine and only the second psychiatrist to have done so in the prize's 102 year history,” psychiatrists may at last feel they are coming out of the shadows.

In this chapter, I will examine one author's concept of a single idea in psychiatry. However, the idea dominates modern psychiatry and the writer is extremely influential. Eric Kandel offers the view that “radical reductionism” will convert psychiatry and psychoanalysis into genuinely scientific fields. I will argue instead that reductionism is a restricted model of science which can never account for the entirety of human behavior, and can therefore never form the basis of a general theory for psychiatry. Furthermore, when applied to the field of human mental life, reductionism becomes incoherent.

1-2. Psychiatry and the Prizewinners

The first psychiatric Nobel award was in 1927 when the Austrian neuropsychiatrist, Julius Wagner-Jauregg, was named for his discovery of the effects of malaria-induced fevers on the progression of tertiary syphilis, or general paresis of the insane. He had published his results in 1917 but his interest in the use of artificial fevers in treating psychosis dated from at least 1887, when he was attached to the university clinic in Vienna. He also worked on treating thyroid diseases and cretinism with iodine but this was long before modern biochemistry made accurate measurements of hormones possible. His conviction that fevers could improve psychotic states had no recognizable basis in the physiology of the time. It appears to have been an idea peculiar to his generation but he persisted with it long after everybody else had given it up. His major discovery was fortuitous, in that there were lots of people in mental hospitals with tertiary syphilis but, whatever the matter, Wagner-Jauregg‘s work is of no interest to psychiatry these days.

The next mention was in 1949 when Antonio Egas Moniz (1874-1955) was jointly honored for his work in psychosurgery. Egas Moniz was a Portuguese professor of neurosurgery who, remarkably, also sat in parliament and, as foreign minister, led his country's delegation to the Versailles conference in 1919. In the mid-1920s, after serving as ambassador to Spain, he returned to medicine and adapted the new techniques of contrast angiography to the brain, quickly gaining an international reputation for his pioneering work. In 1935, he attended a conference in London at which two researchers showed how cutting certain frontal tracts in chimpanzees’ brains resulted in increased tractability. Intrigued, he decided to apply this to mental patients. The results of the initial series of twenty patients were considered encouraging and the procedure was widely copied. For example, in England and Wales, over 10,000 leucotomies were performed between 1942 and 1954. The figure was very much higher in the US but, with the advent of powerful tranquillizing drugs, people lost interest in psychosurgery and it soon fell into disrepute. The story of how the operation was championed in the US by Dr. Walter Freeman, and its tragic cost, is recounted in a recent biography [3]. Egas Moniz himself was not a psychiatrist. He was a neurosurgeon who applied his techniques to a psychiatric population, but not without penalty: in 1939, he was shot by a dissatisfied patient. A reviewer at the official website of the Nobel Prize stated: “I think there is no doubt that Moniz deserved the Nobel Prize” [4]. Today, very few psychiatrists would agree.

By contemporary standards, the work which led to these prizes would not meet the most elementary concepts of what constitutes reasoned research, let alone ethical conduct. Thus, when one of the world's outstanding neurophysiologists, whose work is of the very highest intellectual and ethical standards, opines that the brain sciences can lead psychiatry from its intellectual wilderness, he can be sure of a large and eager audience. In his recent autobiography [5], Eric R. Kandel, joint winner of the 2000 Nobel Prize in medicine and physiology, describes how, after graduating from medical school in 1956, he did a year's internship in a general hospital followed by three years basic biological research in the NIMH as an alternative to national service [2, p109]. He then undertook a two year placement as a resident in psychiatry at Massachusetts Mental Health Center, which is affiliated with Harvard Medical School.

At the time of his appointment, American psychiatry was almost totally dominated by psychoanalytic concepts. His description of his training in psychiatry shows how things have changed over the years: “We saw only a limited number of patients… In those days, residents did not work very hard…” He continued:

“Few of (our supervisors) thought in biological terms, few were familiar with psychopharmacology, and most discouraged us from reading the psychiatric or even the psychoanalytic literature because they thought we should learn from our patients and not from books… We learned next to nothing about the fundamentals of diagnosis or the biological underpinnings of psychiatric disorders… a rudimentary introduction to the use of drugs… often discouraged from using drugs in treatment because… it would interfere with psychotherapy” [5, p153-155].

While in psychiatry, he was able to conduct original research in hypothalamic neuroendrocrine cells in goldfish but he subsequently “…left psychoanalysis because it was unconcerned with biology” [2, p387]. He did not sit his examinations and has never practiced as a psychiatrist. Eric Kandel's prize was for his basic neurophysiological research on sea slugs. While he is a renowned and esteemed member of the Columbia University Dept. of Psychiatry, it is stretching credibility for psychiatrists to claim that his award reflects credit on this profession. He cannot claim that his undoubted expertise in normal sea slug neurophysiology qualifies him as an expert on disturbed human minds, not the least because sea slugs don't seem to have much in the way of minds.

1-3. Psychiatry and Biology

Kandel's book consists of eight papers and essays published between 1978 and 2001, together with an introduction, an afterward and invited commentaries by eight eminent figures in the fields of neurophysiology and psychiatry. The longest of the papers is a joint review but the rest are Kandel's. The theme of the book is that “radical reductionism” will “transform psychoanalysis into a scientifically-grounded discipline.” He looks to the brain-based neurosciences “…to create a unified view, from mind to molecules… (a) new biology of mind…” This “unified psychoanalytic and biological perspective” can provide “a new science of the mind” from which would emerge “…a great unification into one intellectual framework of behavioral psychology, cognitive psychology, neuroscience and molecular biology.” The means of uniting the disparate fields of “biologic and psychologic explanations of behavior” is by explicating the “biology of human mental processes.” In essence, this means using molecular and genetic biology to provide “a new level of mechanistic understanding,” confirming that “the basis for the new intellectual framework for psychiatry is that all mental processes are biological…”

This credo is repeated throughout this particular book, as well as his autobiography [5] and both of his large and highly influential texts [6,7]. Biological investigation of the brain will allow us to “…understand the physical mechanisms of mentation and therefore of mental disorders.” He emphasizes that the proper means of investigating the mind is by reductionist biology. He sees no limits to the capacity of biology to explain human behavior: “All the behavioral disorders that characterize psychiatric illness… are disorders of brain function. The task of neural science is to explain behavior in terms of the activities of the brain.” Biology can transform psychiatry and psychoanalysis, turning them into a unitary scientific endeavor.

He defines mind as “the complete set of operations of the brain.” Without exception, this definition places any and all mental states squarely within the explanatory scope of the reductive biological sciences: “If the neural representation of a sequence like a birdsong can be successfully analyzed, why should a sequence like a sentence be, in principle, less tractable to a neurobiological analysis?” [5, p400]. This includes mental pathology, which will be explained at the same level of function as psychoactive drugs, namely subcellular chemistry: “…we will join radical reductionism, which drives biology, with the humanistic goal of understanding the human mind, which drives psychiatry.” If drugs work at the subcellular level, then that is the level where the primary pathology lies [2, pxxii].

In the main, the commentaries are supportive although Steven Hyman, a neurobiologist, warned that knowing everything about the component parts of the brain does not explain the whole of the brain's output. This amounts to a statement that the mind is an emergent phenomenon which cannot be explained by reductionism. Judith Rapoport wondered whether it was appropriate to try to reconcile biology and psychiatry. The last paragraph of the major essay (p316) suggests that reductionism might not answer all questions about human behavior: “Some might believe that all that is scientific about the study of life is illuminated at all levels from the molecular to the behavioral by what we know about DNA. But others might believe that there are issues about what it means to be a living being that are really not explained by the most detailed account of DNA.” This comment is not typical of the views in the rest of the book.

Essentially, Kandel's collection of essays expresses the hope that reductive biologism will lift psychiatry out of its doldrums, probably by a “super theory” of psychoanalysis. This optimism has been called promissory materialism, which is an ideological stance, not a valid empirical theory. It is materialism in the sense that it promises answers to the most profound questions about the nature and state of the universe, using only the evidence of the senses and elementary reasoning. That is, there is nothing in the universe that the senses cannot perceive, meaning nothing beyond matter and energy, each of which is sufficient unto itself and requires nothing more than itself for its existence. In this view, all materialism is promissory materialism just because it says: Wait a while, all will be revealed by the ordinary processes of enquiry (or, as we would now say, of science). Promissory materialism is a very easy doctrine to hold as it says we don't have to worry about any really difficult questions because, when a suitable technology emerges, they will all turn out to be a simple matter of matter and energy. Thus, any intellectual effort now will be a waste of time, if not completely barking up the wrong tree. Materialists often point to historical examples of how a widely accepted theory was shown to be nonsense by the march of science. Examples include the theory of phlogiston and the vitalism of Galvani and Bergson.

I don't trust promissory materialism. It presupposes empirical answers to the really difficult questions about life and experience when nobody has ever established whether those questions are susceptible to empirical analysis. The history of science shows that there have been enough mistakes over the years for the uncommitted to retain a deep sense of skepticism about anybody who claims that “science will deliver the goodies.” Nonetheless, I would be prepared to listen to anybody who wanted to argue the case for promissory materialism, but that is the one thing materialists will never do: argue a case. Their doctrine is all about not arguing cases. Theirs is the policy of “Just you wait and see.” Take Kandel's sentence: “If the neural representation of a sequence like a birdsong can be successfully analyzed, why should a sequence like a sentence be, in principle, less tractable to a neurobiological analysis?” If what he says is true, then this sentence is itself of the same order and nature as a bird squawking in a tree. His sentences might be psittacine, but I firmly believe there is something in this particular sentence of mine that, in principle, a parrot could never understand. In passing, it is worth noting that promissory materialists often present their case as a series of rhetorical questions, just as Kandel did. For them, the answer is blindingly obvious and doesn't need a response, as time will fill in the details. If only life were so easy….

However, assuming there might be some value in his plan, several questions immediately declare themselves.

1-4. Psychiatry and Psychoanalysis

First, of all the available theories of mind, why would anybody choose psychoanalysis?

Kandel's autobiography shows that his commitment developed very early in his career: “I entered medical school (in 1952) dedicated to becoming a psychoanalyst and stayed with that career plan throughout my internship and residency in psychiatry… I (was) convinced that psychoanalysis had a promising future” [5, p44, p155]. Yet, despite his unrewarding experiences as a training resident in the early 1960s, his emotional commitment remains as fresh as ever: “This decline (in influence) is regrettable, since psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” [2, p64]. He does not indicate that only a tiny minority would now hold this view [8,9]. He repeats the old error that Freud wrote a “metapsychology“ (he actually wrote a metaphysical psychology) then suggests that, while “(w)e do not yet have an intellectually satisfying biological understanding of any complex mental processes…” a biologically-rejuvenated psychoanalysis might provide it [2, p67-9]. This juxtaposition of uncompromising reductionism and irreducible metaphysics is logically flawed.

A closer reading of his most recent works indicates an unreconciled tension between biologism and the belief that humans are something rather special. As his autobiography makes clear, Kandel retains a firm religious commitment. Throughout his scientific work, he repeatedly insists that biology will eventually explain the mind yet he does not indicate how biology can explain whatever it is that religions celebrate. If the expression of religious beliefs is a matter of mind at work, and the whole of the mind can be reduced to matters of genes and proteins acting at the synapse, then where does God fit in? I suggest his long-standing interest in psychoanalysis is a way of saying: “…and yet I believe there is something more to us than just chemicals.”

He might argue that this is taking things too far but the justification lies in his own work: “An ultimate aim of neuroscience is to provide an intellectually satisfying set of explanations, in molecular terms, of normal mentation, perception, motor coordination, feeling, thought and memory…(and)… neurological and psychiatric diseases” [2, p193]. In a paper entitled “Genes, Brains and Self-Understanding,” delivered in 2001, six months after his Nobel award, Kandel stated: “We already know that not only psychiatric disorders but almost all long-standing patterns of behavior—from wearing bow ties to being socially gregarious—show moderate to high degrees of heritability” [2, p381]. Because religious expression is unquestionably a “long-standing pattern of behavior,” he must therefore believe that it will necessarily be explained by reductive biologism. However, since belief in God is a central part of many organized religions, especially Abrahamic, it inevitably follows that belief in God can be explained “in molecular terms.” This case can be generalized, in that every living person has at least one belief which he or she regards as absolutely fundamental to daily life. It may be religion, politics, cosmology, anything, but the essential point is that, even at great personal cost, the individual will claim to hold it as a moral question, i.e. of freely choosing between right and wrong. There is, however, no conceivable, non-question-begging, deterministic model of freedom of choice. It is on this point, which we can call the ‘supreme belief’ test, that all biological models of mind will founder: either the person concedes his most prized beliefs (religion, politics, football club, scientific reductionism, etc.) are a matter of genetically-determined brain molecules, and therefore not his moral choice, or he must accept a non-biological model of mind, meaning reductionism can't explain everything about humans. They can't have it both ways.

This is not to deny that intraneuronal molecular changes occur, because they are the basis of brain activity, but where is the evidence that these changes are primary, that they have no prior cause? Biological psychiatrists assume they are primary but never bother to prove their case. I am no more convinced by the all-embracing claims of today's biological psychiatrists than I was convinced by the all-embracing claims of earlier generations of psychoanalytic psychiatrists. As it happens, I do believe there is more to human mental function than “mere molecules swirling in the dark” [10] but it is emergent, i.e. neither supernatural nor reducible. The prime mover in mental life is, as a natural phenomenon, prior mental events. That is, the arrow of causation in mental life goes from the mind to the brain, which is not what naive reductive biologism requires. Information processing by the brain constitutes a causative entity, above and beyond “mere neuronal activity,” which augments the brain's computing capacity by many orders of magnitude. This gives us a mental ability vastly exceeding that of the great apes, even though our brain capacity isn't that much more than theirs. By this means, there can be beliefs that are not just “matters of genes and proteins influencing the synapse.” This saves the moral basis of religious beliefs but immediately contradicts the reductionist “new biology of the mind,” which requires that all beliefs must be explained in molecular terms. In short, the reductionist position is self-contradictory. Answering the next question may show why it is so widely held.

1-5. Psychiatry and Reductionism

The second question is this: Why reductionism?

Asking a committed biologist this question will evoke much the same incredulous stare as asking, say, “Why oxygen?” That is, to a biologist, the answer is simply common sense but, in such fundamentally important matters, common sense isn't enough. Richard Dawkins defined a philosopher as somebody who doesn't take common sense for an answer, meaning somebody who looks for the systemic faults in the standard view just because he is sure there will be some. These days, reductive biologism is certainly the standard view. Biological psychiatrists claim that the same physical explanation of the output of a bird's brain will necessarily account for the totality of the human experience. I disagree: while reading this commentary, your brain is functioning at levels which are in principle irreducible to the biology of an avian brain responding to a territorial call. Claiming otherwise, as Kandel does, is a misapplication of the principle of reductionism.

To answer the question, “Why reductionism?” we have to go back in time.

At the end of the medieval era, usually taken as the fall of Constantinople in 1453, mankind's place in the universe was fairly secure, if not always comfortable. As creator of the unvarying geocentric universe, God was omniscient, omnipresent and all-powerful, as well as jealous, vengeful and interfering. His special creation, man (with some doubt about woman) was positioned halfway between animals and angels. Knowledge of the (male) god-head was delivered to a select clique (of men) by divine revelation. Kings ruled by divine right, implementing divinely-inspired laws (as it suited them). Knowledge of the natural world had been revealed to semi-mystical figures during some heroic age in the distant past so that a medieval education consisted of ever-closer readings of the ancient masters. Daily life included a malevolent supernatural world in which the devil and his consorts lurked behind every tree. Diseases such as the Black Death were divine punishment which could only be propitiated by further torture and executions, usually of the most vulnerable in the society (e.g. women past breeding age). Life was, as Hobbes gloomily noted, “solitary, poor, nasty, brutish and short.”

With the awakening of intellect we now call the Renaissance came a revulsion against superstition. Some of the most original and creative thinkers in history questioned the received view of the universe and realized the ancients had it all wrong. In 1543, two major but unrelated events occurred which are generally taken as the beginning of the Age of Reason. On his death-bed after a lifetime of diligent work, Nicolaus Copernicus published De revolutionibus orbium coelestium. On the other side of Europe, after a short but brilliant career, the youthful Andreas Vesalius published the equally momentous De humani corporis fabrica, after which he left the world of anatomy for good. These monumental works showed convincingly that anybody who wanted to know about the natural universe should start by looking at the universe itself. At an accelerating pace, revelation was replaced by deductive reasoning, while orderly observation took over from disputatious reinterpretation of the classics. In about 1597, the astronomer Johannes Kepler declared his ambition “…to show that the machine of the universe is not similar to a divine animated being, but similar to a clock.” By 1616, Galileo was able to argue that examining the heavens themselves would reveal the underlying geometric rules governing the motion of planets. These general laws would eventually yield a further set of rules by which human behavior could be determined. However, the new breed of scientists didn't have it all their own way, as Galileo wrote to his colleague: “My dear Kepler, what would you say of the learned here who, replete with the pertinacity of the asp, have steadfastly refused to cast a glance through the telescope? What shall we make of all this? Shall we laugh or shall we cry?” (I have never found the original reference to this; it may be an urban myth).

Under the influence of such thinkers as Boyle, Bacon, Descartes, Newton, Leibniz and so many others, the revolutionary concept of a coherent and general scientific program gradually took shape. Its objective was to show that the universe was not a “universal mystery” but was a rational place, essentially a vast machine governed by laws which humans could discover by their own efforts. This program was the exact opposite of ideas that had dominated European intellecttual affairs for well over a thousand years. An essential part of the new rationality was to dispense with superstition, the idea that there exist entities and forces which can interfere at will with the natural world yet are not subject to the same rules as mortals. But once the process started, it could not be stopped. Soon, theism was replaced by deism, the notion that God could be discovered by reason rather than revelation, and that, while he had created the world, all he did was set in motion the rule-governed cosmic machinery then sat back, distant and uninvolved. From this point, it was but a small step to atheism, the actual negation of the idea of a Creator.

On the human level, philosophers argued that the body was a machine of exactly the same order as other animals. Humans differed from the beasts of the field only in respect of having an immaterial soul. Accordingly, the nascent scientific program was directed at explaining the basis of the bodily machine. Harvey's discovery of the circulation of blood, the development of the microscope, etc., soon showed that practically everything the ancients had said was simply wrong. Perfection did not lie in the past, it lay in the future, and would be revealed by human efforts, not through secret conclaves of bishops meeting among the musty tomes of jealously-guarded libraries. Since the body was a machine, its activity would be shown to be a matter of mechanics, of things acting on each other in accordance with the laws of motion etc., which the new thinkers were determining by reason and experiment.

Because they had no other conceptual models, the corollary to the new approach was that, where there is no magic in human affairs, there must be mechanism, i.e. rolling back magic revealed mechanism. Mechanism is properly examined by dismantling the machine to its component parts and seeing precisely how they interact with each other to produce observable behavior. This is called reductionism, the two-fold notion that larger things can be shown to be “merely” clusters of smaller things assembled according to standard physical laws, or that the behavior of complex beings can be shown to be the law-like outcome of the behavior of less-complex entities acting in concert [10]. Given the universal laws of nature which disciplined enquiry was already yielding, reductionism states that a proper understanding of the function of larger bodies flows exclusively and inexorably from knowledge of their microstructure.

It would probably be fair to say that reductionism has been the single most successful intellectual program in human history. Indeed, its many modern applications are increasing exponentially, even explosively. As success breeds success, researchers have widened the scope of the reductionist program to the point where they now see no limits to its explanatory power. As Kandel explained: “I spelled out my belief—almost a manifesto—that to understand behavior, one had to apply to it the same type of radical reductionist approach that had proved so effective in other areas of biology” [4, p236]. “Indeed, the underlying precept of the new science of mind is that all mental processes are biological… Therefore, any disorder or alteration of those processes must also have a biological basis” (p336, his emphasis). This emphatically states that there is nothing more to human affairs than “mere mechanism” in the form of molecules, genes, chemistry, etc. It positively excludes a controlling non-physical element which cannot be understood as the outcome of the same types of processes as govern, for example, the replication of viruses, or putrefaction. It states that understanding how the brain acquits its myriad functions which, collectively, we call the mind, is pure chemistry, mere push-pull, key-in-lock physical causation at the molecular level. Is this true? If a detailed knowledge of the microstructure of some large bodies accounts for the whole of their output, is this necessarily true of all large bodies, or do some defy reductionism?

1-6. The Limits to Reductionism

My case is that attempting to stretch reductionism to this point forces it beyond its natural limits. It is just this notion that causes biological psychiatrists to stare in disbelief: the idea that reductionism has limits, that it can't explain everything in the universe. I suggest the widely-held idea of ‘reductio ad infinitum’ has arisen through an historical mistake, that of believing that anything that cannot be explained by push-pull mechanism (and sub-cellular chemistry is very much of this nature [6,7]) is necessarily mere superstition. Flushed with success, biologists have come to believe that there are only two sorts of explanation in the universe, theirs (the good sort), meaning everyday physical causation, or the bad sort, meaning magic. It is worth recalling that, at first, Newton himself had the greatest difficulty accepting the concept of gravity because it implied action at a distance, which was the hallmark of magical thinking. He could only think in terms of straight mechanics or straight magic.

This leads to another test which, with respect, I will call ‘Newton's Apple Test’: for any question of control, can we conceive of a natural “Third Way,” a causally-efficacious alternative to mere mechanics and the supernatural? In brief, do we need to abandon our current models of explanation because they are restricting our intellectual development?

The natural limit to scientific reductionism is just this: it does not apply to anything controlled by some factor more than mechanism or “mere physical causation,” specifically, the processing of coded information. Thus, a computer cannot be reduced to “mere chemistry” because there is more to it than chemicals. It has a program which, while actualized by tiny physical changes taking place in the machine, is nonetheless something more than those changes: it is driven by a higher logic than that of simple mechanics. Physical changes at a molecular or even subatomic level in the computer are the mechanism or agency of its data processing, but they are not the explanation. Psychology, which aims to explain human behavior in toto, is more than the sum total of chemical changes occurring in the brain at the neural or subneural level. Of course the brain runs on chemicals: psychology doesn't deny that, but its goal is to discover what controls the chemicals. While chemical changes in the brain are the mechanism or agency of belief, they are not the explanation. Further, since psychology has a physical substrate, there is no such thing as disembodied information processing, i.e. by developing a materialist alternative to mere mechanism, we can positively exclude the supernatural, which solves Descartes‘ classic problem.

Once we move into the area of belief, etc., reductionism is out of its depth. There is a crucial conceptual disjunction between the rules or laws of mechanism, which govern matter-energy interaction in a time-space matrix, and the rules of logic, which determine truth and falsity and thence meaning, value, etc., in a semantic (virtual) space. Mechanism and logic are not continuous but occupy different conceptual fields: as part of the material universe, matter is governed by the laws of thermodynamics whereas logical operations are not. By definition, matter cannot stray from the material universe to any immaterial realm (such as the semantic) and back again. This would breach the laws of thermodynamics because they do not apply in the semantic realm. Symbols, of course, cannot stray into the material realm because physical objects have no meaning. This argument applies to and negates any theory that tries to equate matter and mentation. I also suggest that the widespread and erroneous belief in unlimited reductionism is at least partly based in a semantic confusion. People seem to think that, because there are “higher order” laws, such as laws of the land or laws of logic or of chess, they will necessarily translate into the “lower order” laws of physics. This is incorrect: the “laws of physics” aren't laws in any formal or logical sense, they are mathematical relationships.

Kandel's concept of “radical reductionism” therefore cannot complete his projected program for psychiatry. He might object to this conclusion on the basis that his theoretical approach can account for the whole of mental life by another means, that of identifying mental function with brain function: “The basis for the new intellectual framework for psychiatry is that all mental processes are biological, and therefore any alteration in these processes is necessarily organic… Demonstrating the biological nature of mental functioning requires more sophisticated methodologies (than the microscope)” [2, p47-8; on p50, he hedges this slightly]. This amounts to Mind-Brain Identity Theory (MBIT), which states that mind and brain are identical. MBIT was popular in the 1950s and 60s but has since lost favor. The reasons are quite clear: identity is an absolute relationship which does not admit degrees. Quite apart from the small problem of thermodynamics, mind is not and never can be identical with brain, just because there are attributes of mind that are not also attributes of brain, and vice versa. The following example will show where MBIT breaks down.