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"Philosophy matters in brain matters" (Hustvedt, 2013) (open access)

Discussion in 'Other Health News and Research' started by Dolphin, Nov 28, 2014.

  1. Dolphin

    Dolphin Senior Member

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    This may be of interest to somebody, or it may not. It is written by a person with medically unexplained seizures so is a different approach to the norm.

    It doesn't look there is much if any statistics which might suit some people.

    It's open access: http://www.sciencedirect.com/science/article/pii/S1059131113000034

    ETA: I haven't read it myself.

     
    Last edited: Nov 28, 2014
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  2. Sidereal

    Sidereal Senior Member

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    Interesting essay. She describes childhood onset periodic vomiting, migraine and dysautonomia, as well as these seizure-like events starting in adulthood, seemingly triggered by stress. I wonder if she has cyclic vomiting syndrome which appears to be a mitochondrial disease. A dude from Australia made a compelling case a few years ago in the Christmas BMJ that Charles Darwin actually suffered from this (or perhaps MELAS), not neurasthenia as commonly believed. SW wrote in to say that of course Darwin had CFS and why oh why do you moronic Cartesian dualists always try to come up with organic explanations for symptoms when a psychobabbling one will perfectly suffice. I am paraphrasing somewhat.
     
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  3. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    Very interesting. There are a lot of layers in there. Funny how that most emphatic materialists are the most dualist in a way.

    I would be interested to know what some other people think.
     
  4. adreno

    adreno PR activist

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    It's a rejection of dualism. Nothing new about that really. But I agree with Edwards that many who ascribe to materialism are often unwittingly dualist.

    I agree with this:
    and this:
    So the conclusion must be that psychological <-> physiological is a false dichotomy. But these terms, or labels, are logical rather than physical. We can describe phenomena at different levels. For example, brain scans describe the neuroanatomical level, neurotransmitters the biochemical level, reaction time the cognitive level, and impulsivity the behavioral level. It makes no sense to apply the term psychological to brain scans, even though the neuroanatomy is obviously part of any behavioral phenomena, and it makes no sense to apply the term physiological to impulsivity.

    In others words, when we describe complex human phenomena, we break it into subcomponents and label these anatomical, chemical, cognitive, behavioral aso. Even biology is broken down into subcomponents, even though we know it works as a whole. So in my view it makes no sense to get rid of the terms from the medical vocabulary. We just have to be aware that the psychological and physiological are different facets of, or different ways of describing, the same phenomena.
     
    Last edited: Nov 28, 2014
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  5. A.B.

    A.B. Senior Member

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    The author comes across as conflicted. She rejects psychogenic illness, but at the same time her view still seems profoundly influenced by psychogenic belief.

    I see a a similar attitude in some psychiatrists: it's no longer psychogenic, but aside from the words around it, nothing really changes. It's psychogenic belief reinterpreted through biology.
     
    Last edited: Nov 28, 2014
  6. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    The tricky part is knowing which dualism is being rejected. The one we can all reject is the one taken up by the followers of Descartes - the Cartesians ridiculed by Margaret Cavendish. But Descartes himself was, IMHO, more right than wrong on many issues. It is worth noting that 'spirit' for Descartes, of which the soul was an example, included all force, action or motion - i.e. everything we call 'physics' except inert matter itself. We now think of the physiology of the mind in terms of electrical forces - which are not matter, or certainly not in the sense meant in 1641. Descartes got that right.

    I personally believe that all science has to include deep dualities. Force and matter - Bose and Fermi if you like. Or dynamics and experience. Or cause and effect. And even deeper, past and present, as in AN Whitehead. And deepest of all, as Leibniz pointed out, subject and predicate - the two halves that are always present in a truth. I spend my days writing about these things and as a scientist I cannot conceive of a deep understanding of science without them.

    But for me what this paper illustrates so nicely is that if there are useful distinctions between mind and body to be made in medical diagnosis neither the neurologists nor the psychiatrists know how to do that in a way that is any use to human beings (sometimes called patients).
     
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  7. Marco

    Marco Grrrrrrr!

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    Personally I subscribe to the notion that 'cognition' results from the ongoing interaction between an organism and its environment. From this perspective a simple marine organism that responds to salinity gradients is reacting 'cognitively' and any suggestion of mind/body dualism becomes redundant.

    That's why we will never create truly human artificial intelligence no matter how superficially convincing it appears. The Turing test set the bar ridiculously low. I had a rather unnerving experience the other day when I had to phone the help line of my internet provider and found myself having a conversation (in French - also unnerving) with a voice recognition programme and pretty convincing it was too except I knew that if I had strayed off the script and mentioned the weather or how 'she' was feeling then the illusion would have collapsed. Human intelligence requires inhabiting a human body (including one's internal feelings) and living in a human world.

    Funnily enough I noticed in Bansal's recent video presentation that he mentioned an association between ME/CFS and 'perfectionism' as a personality trait. I don't believe he supported this notion but it's one that's been frequently proposed by others with the implication that some abstract quality of the mind may be responsible for somatic symptoms. So what is 'perfectionism'? Some stable trait of striving for perfection perhaps due to early childhood experiences? I have to admit to 'perfectionist' tendencies myself – but only for things that matter to me otherwise I can quite happily live with an unkempt lawn or streaky window panes.

    An alternative concept of 'perfectionism' might be the brain's inability to filter out trivial noxious stimuli along the lines of the 'hypersensitivity' we've discussed many times here and due to neurological processes which can be manipulated experimentally. Impaired filtering or gating of stimuli is well known to be responsive to 'salience' and explicable with no need to invoke 'mind' or personality.

    As a psychology undergrad I quickly realised that most of it was fluff and it was a good subject area for those with limited ability to pretend to be doing 'science' (with apologies to any fellow psych grads). What I did take away from it though was a reluctance to step in to prevent an apparent assult when close to any university campus due to the high likelihood that it was just another undergrad experiment in 'bystander intervention'.;)

    Sorry for the rambling I don't really do philosophy – too much navel gazing for me.
     
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  8. Valentijn

    Valentijn Senior Member

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    Agreed - mind-body duality is a nice topic for philosophizing about, but of little use in science. The call to step back from making practical divisions between body, brain, & thought seems like it would it would result in forsaking scientific principles and progress in exchange for mindless (though perhaps spiritually fulfilling) chanting as we embrace our one-ness with the universe :rolleyes:

    It really does seem to be an effort to take some of the science out of science, and replace it with something (a BPS model?) where mantras and vague explanations are considered to be sufficiently rigorous. And anyone who ever tries to examine one part of the model in isolation (especially the biological part) is an unenlightened and hate-filled heretic.
     
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  9. Cheshire

    Cheshire Senior Member

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    This paper is the transcription of a lecture she gave. Here’s the link for those who have difficulty reading. It starts at about 14 min.

    She highlights very interesting things, whereas as A.B. said, she is very ambiguous about psychogenic explanations, both rejecting and endorsing them at the same time. Her resort to psychoanalysis is also problematic. (I think at best psychoanalysis can only be useful as a personal development tool, or a way to rewrite one's life, more a literature stuff than a scientific one).


    She cites that 1943 Stanley Cobb quotation that is really interesting.

    “I Solve The mind-body problem by declaring there is no such problem ... I Would Insist That The Old Dichotomies ‘functional or organic,’ ‘mental or physical’ are not only wrong, but lead to bad habits of thinking because they lead to static and obsolete ideas and do not allow for modern pluralistic and dynamic ideas of matter and structure ...

    Anyone who stops to think realizes that no function is possible without an organ that is functioning and therefore no function takes place without structural change.’”

    I think there’s much much to say about it… but it’s too big for me!


    “Nevertheless, it is interesting to ask whether the distinction between psychological and physiological should be erased from medical vocabularies or whether they continue to serve some useful purpose.”


    IMO, it’s not the distinction between psychological and physiological that is the problem. It’s the word psychological itself. Words reflect categories that have been drawn by men to describe the world or phenomena taking place in it.

    When there is no consensus about what a category means, it loses its meaning. It’s particularly true for “psychological”, because I think people put very different things behind it. Some implicit definitions rely on the existence of the mind, which is also a blurred category.

    The cognitive and behavior school (and I talk about it in general, not only the ME/CFS part of it) has tried to get rid of that dichotomy by talking about cognitions, behavior, thoughts, emotions… and try to stick to describable phenomenon. And put emphasis on the fact that all these phenomenon arise from the brain.

    But in reality the CBT school for so called Medically Unexplained Symptoms (don’t know enough of the other fields) implicitly act as if this dichotomy was relevant because their theory only relies on maladaptive behaviors and unhelpful thoughts as being the only cause of our problem, and they are not at all interested in what happens in the brain apart that it’s where these thoughts and behaviors originate. (I don’t even talk about the fact that these thoughts and behaviors have not been consistently found in PWME, nor that no causation have been proven, that’s another story)
     
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  10. Marco

    Marco Grrrrrrr!

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    "IMO, it’s not the distinction between psychological and physiological that is the problem. It’s the word psychological itself. Words reflect categories that have been drawn by men to describe the world or phenomena taking place in it."

    It's the old nominal fallacy - by giving something a name you pretend to have explained it.
     
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  11. Cheshire

    Cheshire Senior Member

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    Here are other quotes that I found interesting.


    “After I published my book, I received letters from physicians and researchers all over the world. (The book was translated into several languages.) There were two kinds of letters: those from doctors who were interested in some of the points I had made and either elaborated upon them or complemented me on my insights and those in which I was offered a diagnosis. It is fascinating to note that I did not receive two diagnoses that were the same.”


    That really depicts what’s happening to us. As there is no scientific explanation for something, instead of acknowledging ‘I don’t know’, and relying on the rare facts, most people take our disease as an empty board, where one can write the story that they think can explain things. And it reveals more about what the writer thinks than what’s really happening…


    “Epilepsy is classified as an organic disease, psychogenic non-epileptic seizures or PNES as a functional disorder because no physical site of injury can be found. Nevertheless the two are often confused. EEG’s may be ambiguous, and not all epileptic patients have revelatory MRIs. The neurologist who suspects PNES must become a medical detective, relying on a clue from her patient, such as a seizure triggered by some powerful emotional event. Then again, there are epileptic patients who can seize after a shock or a strong emotional experience, too. The doctor may note the failure of medication to stop the fits. Of course, medication sometimes also fails to cure genuine epileptic seizures. And because some epileptic patients also have PNES, the picture can grow pretty murky.”


    This is also relevant to so-called psychogenic movement disorder, functional neurological disorder (historical hysteria) etc… For all those disorders, there are studies that ‘proves’ that nearly all the patients have psychiatric comorbidities, contradicted by other studies saying that mental issues can be found in only a minority of them, in a similar proportion as the ‘organic’ disorder they ‘mimic’. But a line has been drawn between what must be considered as psychogenic or not, whatever the mental state of the patient is.

    “The practical use of the word organic turns on visible location—a brain lesion or abnormal electrical brain discharges that explain the symptom—but its use also unearths ideas about what is real and unreal. The bias is: if you can see it and name it, it’s real. If you can’t, it’s not.”
     
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  12. A.B.

    A.B. Senior Member

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    The idea that some seizures are psychogenic rests on the lack of abnormal brain activity. The problem with this thinking is that EEGs only measure brain activity in the outer layers, and probably have a few other technical limitations that allow certain problems to go undetected.

    The psychogenic fallacy again: absence of evidence is taken to mean evidence of absence.
     
    Last edited: Nov 29, 2014
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  13. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    I absolutely agree. This is not about Descartes's so-called substance dualism, although getting clear what Descartes was about might make clear why not.

    Psychological has a very specific set of connotations for most people. For instance, when my wife lost her mind as a result of taking malaria tablets and refused to eat and drink, I doubt anybody would say that was 'psychological'. The psychiatrists pretend that they have a more scientific sense of 'psychological' to the extent of saying they do 'psychological medicine' (which would include my wife). But then how do we get biopsychosocial if psycho is just the bio of the brain - it is already covered by bio. Otherwise RA would have to be biorheumosocial. Psychiatric disease is the one sort of disease that cannot really be biopsychosocial I guess. The one thing that stands out for me here is that the psychiatrists are not good at this.

    So what would 'psychological' be in the context of CFS/ME or unexplained seizures? One might think its had something to do with something one was aware of, or 'experienced in the mind', or was 'voluntary'. Yet it has always been said that in psychosomatic illness the person is unaware of generating their symptoms in the brain. It seems to have more to do with something that implies a motivation (which might be 'irrational') and some rationally based strategy for satisfying the motivation, even if all unconscious.

    If I trip and put out my hand to break my fall, even though I am not actually falling, is that 'psychological'?
    If I change the way I speak because I think somebody is a foreigner, is that 'psychological?

    It all seems very complicated but I actually take the opposite view to Marco's 'embedded behaviourist' view on this. I think what is needed is to work out exactly where in the brain these various aspects, like awareness, motivation, reflex response, and rational decision making occur and to work out which illnesses relate to which bit or to none of them. I have just been reading Descartes's Passions of the Soul. Although he gets some things wrong at least he has a coherent scientific theory of what does what. In comparison I find people like Damasio or Thompson and Varela totally unhelpful. A human mind can function as a human mind totally outside its normal environment or disconnected from a body. We know that from space travel and severe spinal cord injury. The explanation needs to be found inside in the way it works. But this is not the place for Marco and I to have a heated philosophical debate, however entertaining that might be.

    A final thought, which I agree is raised by the fact that this lady seems to buy in to the childhood trauma story, is that I see no reason why illnesses should always be blamed on trauma. Why cannot it be that some ME/CFS is due to an unfortunate byproduct of having a totally ideal childhood? There is paternalism in psychiatry. But there also seems to be a sort of maternalism that wants to protect people from childhood 'harm' and wells up in do-gooder psychotherapists bosoms.
     
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  14. Sasha

    Sasha Fine, thank you

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    This is a very philosophically unsophisticated contribution from me, but BPSers seem to use the word 'psychological' to mean 'thinking irrationally'. Thus CFS is due to 'false illness beliefs' based on irrational ideas.

    It all then proceeds to fall down because if you feel exhausted and ill, and then carefully try to grade up your activity from a low baseline but find that you become more exhausted and ill and that that's a reproducible effect that gets worse the more you persist, it's entirely rational to deduce that you actually are ill and that graded exercise makes you worse.

    Let's not divert things down a BPS-kicking ranting of agreement on that point but I think this is it: they think 'psychological' basically means 'silly'.
     
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  15. Sasha

    Sasha Fine, thank you

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    ...and the 'social' bit seems to mean 'influenced by silly others'. I think that from their point of view you could write 'biopsychosocial' as 'bio-silly-internet'.

    I said my contribution was unsophisticated and I've probably just dragged this thing right down but I don't perceive them as holding a philosophically sophisticated position either - just a facile and unexamined one.
     
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  16. A.B.

    A.B. Senior Member

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    When psychiatrists influence each other, they make great progress. When patients influence each other, it's just mass hysteria.

    Or maybe it's the other way around?
     
    Last edited: Nov 29, 2014
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  17. Cheshire

    Cheshire Senior Member

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    Psychological symptoms are often considered both symptoms and causations of a psychiatric disorder.
    Except when an organic cause is found.
    It has allways seemed weird to me.
     
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  18. Helen

    Helen Senior Member

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    In this article written 2003 by late Dr. Per Dahlén, who was a sharp and humble psychiatrist, many of the issues are discussed in an interesting way , I think.

    http://art-bin.com/art/dalen_en.html
     
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  19. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    There you go again: over modest. I think you just said what I wanted to say but rather better.

    And the real irony is that the first thing you learn in psychiatry is that irrational beliefs do not respond to reasoning, so CBT is completely irrational, as is the belief in tis efficacy. So they are doing it wrong by their own rules. But I agree that we should resist lapsing into throwing tomatoes.
     
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  20. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    That looks a good one Helen, thanks.
     

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