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

[Snow Leopard]

Communication necessarily invokes dualism. When scientists talk about systems, it is impossible for them to talk in detail about the whole system (the entire universe). They have to break it down to what they believe is most relevant, the key determining factor (from a chemistry background, I was tempted to say kinetic or thermodynamic, but..).

If you call yourself a 'psychiatrist', or a 'neurologist' or whatever, you have given yourself a dualistic label. Congratulations. But the division is not between psychiatry and neurology, but between anything you focus on vs anything you have excluded. The dualism doesn't vanish if we were to merge psychiatry with neurology.

It has been there from the beginning. Aristotle vs Plato, it all depends on where you point your knife. (philosophically speaking)

 

[Snow Leopard]

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.

Read the etiology section of any book on psychosomatic illness and you'll see why they discuss childhood trauma so much. Many psychiatrists seriously believe that attachment & early development theory is the basis for psychosomatic illness. Why? Because they don't have much else.

Yes really.

Even the layperson understands that unconscious conflicts underlie all manner of neuroses, regardless of how they present. The lack of falsifiability of these notions was always problematic, until the emergence of a more integrative theoretical perspective.

The solution (to the unfalsifiabiltiy of ideas from Janet/Stekel/Freud etc) apparently, was:

Unlike the abstract models of the early psychoanalysts, attachment theorists put forth a strong psychobiological model which suggested that early experiences influenced neural development, as well as subsequent behavior.

This is from a presentation, which is a summary of a book:

Understanding Somatization in the Practice of Clinical Neuropsychology
Graduate School of Professional Psychology University of St. Thomas Greg J. Lamberty Adjunct Professor, Minneapolis. Oxford University Press, 27 Nov 2007

http://global.oup.com/us/companion....n/us/images/lamberty/lambertypresentation.ppt

(etiology section starting on slide 56ish)

 

[Helen]

Read the etiology section of any book on psychosomatic illness and you'll see why they discuss childhood trauma so much. Many psychiatrists seriously believe that attachment & early development theory is the basis for psychosomatic illness. Why? Because they don't have much else.

When I got ill I worked in a group of reserachers from different disciplines. One morning when there had been a real sad story about children abuse in the morning papers I asked one of the psychologists why they never stood up as a professional group for children in siuations like this.

He answered with a wry smile; Helen, you should know that psycologists and psychiatrists usually choose their professions to heal their own childhood traumas.

That might give a clue, although I don´t believe that is true for all of them.

@Jonathan Edwards I met Per Dahlén and talked to him in other contexts than psychiatry , and I am sure you both would have had great pleasure from talking to each other. He was a.o. interested in health effects from mercury and amalgam, including autoimmune reactions from mercury.

 

[Marco]

But this is not the place for Marco and I to have a heated philosophical debate, however entertaining that might be.

I'd settle for tepid these days

 

[Sasha]

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.

Thanks! I kind of regretted posting that and thought that I'd just been ranting on and adding to the sum of our misery with no good reason.

 

[adreno]

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.

I think it is likely that the social environment impacts epigenetics. However, you might argue that being overprotective would also leave one vulnerable to stress. What do you make of research like this:

Children exposed to extreme stress are at heightened risk for developing mental and physical disorders. However, little is known about mechanisms underlying these associations in humans. An emerging insight is that children's social environments change gene expression, which contributes to biological vulnerabilities for behavioral problems. Epigenetic changes in the glucocorticoid receptor gene, a critical component of stress regulation, were examined in whole blood from 56 children aged 11–14 years. Children exposed to physical maltreatment had greater methylation within exon 1F in the NR3C1 promoter region of the gene compared to nonmaltreated children, including the putative NGFI-A (nerve growth factor) binding site. These results highlight molecular mechanisms linking childhood stress with biological changes that may lead to mental and physical disorders.

http://onlinelibrary.wiley.com/doi/10.1111/cdev.12270/abstract

 

[Marco]

I wonder how many entrepreneurs, top athletes, scientists for that matter had traumatic childhoods?

 

[Marco]

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.

Isn't this worse than dualism by suggeting a 'multipartite' brain. Of course we can associate or definitively link certain basic functions to the brainstem, anxiety to the amygdala, arousal to the RAS or executive function to the pre-frontal cortex and of course also lesions to Broca's area have the expected deficits but It seems much more likely to me that what we experience as 'consciousness' results from a distributed and networked brain.

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.

Not convincing analogies I'm afraid. Humans need to train for space travel and even in zero gravity don't lose interoception nor I would suggest that having 'built up' a sense of being human over many years that experiencing a different environment would quickly erase that. Same for spinal cord injury although I'm not sure they aren't affected as I certainly don't feel the same person now with comparatively minor impairment. That said sensory deprivation seems to be quite an effective torture technique with hallucinations kicking in even after just 15 minutes. Had these people developed psychosis?

 

[user9876]

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.

I worry that those pushing childhood trauma theories are not thinking through the problem as you say what is special about that state rather than an ideal childhood state. After all we are animals and watching David Attenborough's latest documentary makes me realise that many animals naturally have what I can only see as a traumatic childhood experiences and experience danger. Would man really have evolved to not be robust to at least some difficult childhood issues.

It seems to me that there are a lot of people with childhood trauma some go on to have a disease others don't. Equally there are some who develop the same disease without childhood trauma and some who don't. I guess someone could draw out the conditional probabilities P(Disease_x|trauma), P(~Disease_x|trauma), P(Disease|~trauma), P(~Disease_x|~trauma) and compare these to just P(Disease_x) and P(~Disease_x) (I've used ~ as not). But even if there were a slight increase in the probability of disease given trauma as compared to the probability of getting the disease we need to think more deeply. If there is a (slight) correlation why in some cases and not in others and why do some people get a disease without the trauma. This would give us some sort of clue and it may be that there is an underlying variable which is correlated to childhood trauma and cause. Hence a correlation but not a cause-effect relationship. For example, if there is a genetic disposition in getting a disease - this is likely to leave a number of parents with the disease in poverty - does poverty correlate with childhood trauma for example due to lack of safe housing or other social reasons.

We also need to look at the reliability of the measurement system. What exactly is meant by childhood trauma is it a single thing or is it a grouping of many different things. Are retrospective observations reliable or are they dependent on someones current circumstances. Is someone who is ill encouraged to look back and find stressful or traumatic events and interpret them as significant. Are these events reinterpreting what seemed normal to a child at the time in the eyes of an adult with different expectations?

The problem is it is not sufficient to show some slight correlation but to try to tease out mechanism and cause. There is a good statistics paper by David Freeman called something like statistics and shoe leather where he warns of the dangers of believing correlations rather than seeing them as something to be investigated. Where as reading some of the papers that associate childhood trauma with ME they seem to use complex stats models to make the point they want.

 

[JamBob]

Interesting article. It's always seemed odd to me that the default position (in medicine) for medically unexplained symptoms is to attribute those symptoms to a "psychological" cause - whatever that may be. This position assumes (somewhat arrogantly I feel) that medicine already knows everything there is to know about the body.

How much of what is termed "functional and/or psychosomatic" will become "organic" once better diagnostic techniques are discovered? If you take a "functional syndrome" like IBS as an example, if better imaging techniques are found, will it be then seen as "organic"?

http://www.gastroendonews.com/ViewArticle.aspx?d=In+the+News&d_id=187&i=January 2013&i_id=920&a_id=22460

"IBS No Longer Only Functional Disorder
by David Wild
Las Vegas—For the first time, investigators have documented structural abnormalities in the small bowel of patients with irritable bowel syndrome (IBS). These findings “will fundamentally change our thinking on the disease,” researchers told attendees of the 2012 American College of Gastroenterology annual meeting (abstract 52).

“Given the visible structural lesions in the small bowel of IBS patients, I think it is accurate to say that we can no longer call IBS a functional bowel disorder,” said principal investigator Julia Liu, MD, assistant professor at the University of Alberta’s Center of Excellence for Gastrointestinal Inflammation and Immunity Research in Edmonton, Alberta, Canada."
etc.

 

[Snow Leopard]

It seems to me that there are a lot of people with childhood trauma some go on to have a disease others don't.

To really investigate the specificity and sensitivity of such associations, we first need an unbiased sample. The problem is that most samples are biased through healthcare seeking behaviour. So the association may be that those with childhood trauma are more likely to seek healthcare and participate in studies, rather than an underlying association. This is one point of discussion that is strangely ignored in studies discussing trauma.

 

[alex3619]

There are so many issues here, covering ground I have been over repeatedly for years. I will try to respond post by post, but keep it short. When I have time I might make a final post, an attempt to put it all together as I see it. This thread very much reads like notes I have made toward writing my book.

 

[alex3619]

: http://www.sciencedirect.com/science/article/pii/S1059131113000034

This is an OK article but to me there is nothing new aside from some very nice quotes I have not read before.

I am a material monist on theory of mind.

To me the most important words in the article are about what doctors should learn to say, to be comfortable with. Just three words. "I don't know." Pretense at knowing puts doctors in a position where astute patients will discover their mistake, and trust will be lost. Avoiding certainty in an uncertain situation means you can keep options open. It also means you will see the perils of coercive treatments based on no more than an educated guess.

The current working title of my book is "Embracing Uncertainty" for a reason.

 

[alex3619]

We can describe phenomena at different levels.

I think this is a very important point that is often overlooked. Some of those levels are abstract or linguistic, and not "real" as well. That is they have no physical reality, but are described in our philosophies.

 

[alex3619]

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.

We create categories and also rules to use those categories. Yet reality frequently transcends simple limits we want to put on it.

When a category has multiple meanings it doesn't lose that meaning typically, what people do is sit different meanings side by side and use them as they see fit. One of the issues with much of the psychobabble is it deliberate constructs alternate meanings and hides that they are being used.

 

[alex3619]

Maybe I should describe, briefly, what I think mind is. Its not a thing. Its an abstract notion of what we see the brain do. Its about function of the brain, and the outcome of that function. There is no evidence of mind without brain. We can see the mind become dysfunctional as the brain is damaged in various ways.

The mind arises out of the brain's function, its what is called an emergent property in systems theory. I will come back to this last point in a minute, as it touches on several posts.

The mind is a convenient shorthand description of something so complex we still don't really understand it. Research the brain is a big frontier we have yet to master.

 

[alex3619]

The psychogenic fallacy again: absence of evidence is taken to mean evidence of absence.

I have blogged on the psychogenic fallacy, which is a term I use. Originally it was called the psychogenic inference, but since the inference is a fallacy I think my use of fallacy is more clear.

Richard Sykes formalized this thinking, and gave real world examples. I blogged about it here, in the Siren Call section:

http://forums.phoenixrising.me/index.php?entries/the-witch-the-python-the-siren-and-the-bunny.1149/

It is exactly as you said @A.B., having probably eliminated some possibilities they ignore every other possibility and give preference to their favoured view. This is logically, rationally and ethically unsound.

 

[alex3619]

Human intelligence requires inhabiting a human body (including one's internal feelings) and living in a human world.

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 think both views are right, they are like two side of the same coin.

Let me start by giving a few of my rules of thumb:

1. To understand something you need both the big picture and the fine details. The big picture without the details is a house of cards. The details without the big picture will be used unwisely. In military terms a fine detail thinker is a tactician, a big picture person is a strategist, going into war without both is a mistake. You might only need a few big picture thinkers to a lot of fine detail thinkers, but you still need them.

2. A corollary to the big picture rule is that if you want to change something, you need to understand the details of everything it changes in turn, or risk unintended consequences. This includes feedback loops which are very resistant to conventional reasoning. How many drugs have been developed in which the associated pathways affected were never adequately investigated?

3. The difficulty with big picture thinking is that there are no boundaries and no limits. Boundaries are purely for pragmatic reasons.

I don't think we can really understand the mind without considering the brain as an embedded system. However I also think we need to understand all the mechanisms. Then we need to understand how they combine, under what conditions, what changes etc. etc. The human brain is one of the most complex things we have ever tried to figure out.

Changes in the brain are as a result of both internal mechanisms and interaction with the world.

I would like to introduce a term from the early days of systems biology, one used by Maturana and Verela - "structural coupling". In evolutionary terms, systems that survive in an environment survive because they is congruency between how the system works and the environment it is in, congruency which enhances survival unless the environment changes. There is a coupling between brain and environment, and the structure of the brain reflects that. Human environments include not only the natural world but a social one

In case there is any doubt, I think the base notion of BPS is sound, but it was deliberately and systematically used to justify psychosomatic medicine from Engel's first paper and even before. From a sound basis he created a house of cards.

Structural coupling is actually an essential notion in systems evolutionary biology. Biological species don't just evolve, they evolve in an environment with other species that are evolving. Humans have two additional layers to that, language and culture.

My best guess is that what we call mind arises out of many mechanisms with complex discriminatory and feedback loops, and that conventional isolate and test can only go so far. Yet if we don't understand how the bits work, how can we figure out the big picture?

 

[alex3619]

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 loved this article, and have not reread it just now, but I recall I had some cautions about what was said as well.

 

[alex3619]

But the division is not between psychiatry and neurology, but between anything you focus on vs anything you have excluded. The dualism doesn't vanish if we were to merge psychiatry with neurology.

I am not sure I would want to call that dualism, it could lead to confusion. Its about pragmatic boundaries, which I cited in my third rule of thumb. You have to put boundaries somewhere, restrict things, or you would still be pondering the big bang at the end of the universe without having progressed at all.

We choose where to put boundaries, from training biases, resource constraints (including time), and purpose. Its very much a human centric slice of reality, with all the limitations that go with that.