The brain, unlike the stomach or the heart, is a quiet organ. In contrast, people's minds speak up and tell them things all the time. The mind, which is a function of the brain, is accessible; the brain is not. But despite the brain's silence, and the fact that no one's brain has ever said anything, people often say, "My brain is telling me..." Perhaps one reason for all these references to the talking brain is that they sound so scientific - and yet they are exactly the reverse: a distortion of reality. It is the mind, not the brain, that is speaking. As the human mind is typically quite irrational, it should not be surprising that the advances of science, including neuroscience, are accompanied by pseudoscience and fantasy.
One of these fantasies is that brain = science, mind = non-science. The consequences of this notion are far-reaching. One area that is affected is diagnostic understanding. When we interview a patient, Mr. A, who is depressed, we may find evidence that he is self-critical, and that he feels sad, angry, and guilty. Some professionals will discuss this with him. But others may suggest to him that he has a chemical imbalance. Do we have evidence that he has a chemical imbalance? It's possible, but can we really know? If he were happy, would he have chemical balance? Or a different imbalance? Would we suspect a chemical imbalance if he were grieving? More plausible than a chemical imbalance is that certain of Mr. A's neural circuits are underactive or overactive, but once again we can't know this from talking with him. The inferences for which we have clinical data involve his mind, not his brain.
The brain - mind "imbalance" influences treatment as well as diagnostic assessments. Antidepressants are sometimes remarkably helpful, despite the fact that they are very non-specific: they affect many different neuro-receptors, many brain regions, and they are distributed throughout the brain and the body. They affect the brain directly, and the mind secondarily. Little is known about what sorts of long-term neuro-protective or problematic neuro-accomodation they may cause, but they have the unmistakable stamp of brain and science. In contrast, psychotherapy, which does not affect the brain directly, but only via the mind, is regarded in many quarters as un-scientific, even as empirical studies which demonstrate its benefits, including effects on the brain, multiply rapidly.
While a number of psychotherapies have been empirically demonstrated to be at least as effective (or more) compared to medications for various conditions, little consideration has been given to the idea that psychotherapies may act more specifically than medications can. And of course psychotherapies can approach matters that medications cannot, such as relationships with others, secret guilts and shames, or the meanings of anxious fantasies. Given that people learn from talking, or reading, there must be some kind of neurological changes that occur in the brain. But these changes are likely to be in particular circuits, and unlike medications, not generally distributed through the entire brain. Thus it is possible, perhaps likely, that psychotherapeutic interventions may be much more specifically targeted than can ever be possible with medication. As Freud pointed out a century ago, nothing significantly affects a person's state of mind more quickly than a few well chosen words of praise or insult. In fact, of all the psychotherapies, the therapy that Freud developed, psychoanalysis, is the one that most specifically identifies and isolates particular emotional conflicts. It may prove that psychoanalytic interpretations of such conflicts provide very targeted influence not only on the mind but perhaps indirectly on the brain as well. We may not yet have any more evidence for this than for Mr. A's having a "chemical imbalance," but empirical evidence bolstering many basic psychoanalytic ideas (e.g., motivated unconscious, transference, defense mechanisms against emotions, free-floating attention in free association) continue to accumulate.
An additional aspect of the emphasis of brain over mind is its frequent use by people to distance themselves from their emotions and motives. The tendency to consider potentially any psychiatric ailment a brain illness becomes a psychological defense, almost a type of imagined somatization. (I am not referring of course to those serious illnesses in which the brain significantly alters and impairs the mind.) The occasional professional acceptance of this kind of defense promotes a devaluation of the importance of human emotions. And again, it is a turn away from science. There is nothing scientific about overlooking things such as emotions and wishes that are at the core of human experience. The psychotherapy that is supposedly the most scientific, and which is certainly the most empirically tested, cognitive behavioral therapy (CBT), often does precisely this. Although there are now many varieties of CBT, many retain its original preference to emphasize cognition and behavior and discourage exploration of emotion. This avoidance is not only unscientific, but at times may limit the treatment: some studies have found that the best results are achieved by the CBT therapists with the best (emotional) relationships with the patients, not the therapists who adhere best to the treatment manual's formula.
Even in child psychiatry, in which children's developmental and emotional struggles are so immediate and important, the mind has been eclipsed by a narrowly biological focus. A reductionistic understanding of what is scientific leaves many child patients with little help for their struggling minds. While stimulants are obviously helpful to many children with what we currently call attention deficit disorder, the frequent rush to medication can also serve to obscure many crucial developmental conflicts, as well as many problematic family situations. We tell ourselves that we know about brains and fail to help children with their minds.
One of the exciting things that neuroscience is discovering is how much the brain is influenced by experience and by goings-on in the mind; the effects of trauma on the volume of the hippocampus, or of love on the activity of several brain regions, are but two of many recent examples. We need science of the mind as well as of the brain, and we need to understand the incredibly complex interactions between the two. In this endeavor, neuroscience, focusing on the brain, and developmental, experimental, and psychoanalytic psychologies, focusing on the mind, are natural partners. Any comprehensive approach, one that comprises mind as well as brain, must incorporate the contributions of psychoanalysis in providing a rational approach to understanding humans' pervasive irrationality.
Brain science keeps producing fascinating - one might say mind-boggling - new findings. A well-functioning brain supports extraordinary human mental activities remarkably unobtrusively. The brain makes our precious minds possible.
Lawrence D. Blum, M.D.
For More Information: lawrenceblum.com philanalysis.org
http://www.theparentchildcenter.org
