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Philosophy And Mental Illness

“I think therefore I am” – Renee Descartes (1640)

It is​ a​ beautiful summers day and you​ are walking in​ the​ countryside. in​ a​ clearing to​ your right you​ see a​ cherry tree,​ the​ red fruit peeping from under the​ lush green foliage. you​ walk up to​ it. you​ touch it,​ feeling the​ rough bark under your fingertips. you​ can hear the​ breeze rustling the​ leaves,​ and smell the​ odour of​ the​ fruit. you​ take a​ cherry and pop it​ in​ your mouth,​ savouring the​ sweet juice as​ it​ floods over your tongue.

But does the​ cherry tree exist? you​ can see it,​ hear it,​ feel it,​ smell and taste it’s fruit – but this is​ not enough. you​ may be hallucinating,​ or​ asleep and having a​ particularly vivid dream. How would you​ know?

You wouldn’t. All our experience of​ the​ world and “reality” is​ governed by our five senses (I leave aside any discussion of​ a​ “sixth sense”). These senses are our only connection with the​ world outside our selves. a​ blind person has no visual contact with the​ outside world; somebody with a​ severe cold has little taste or​ olfactory contact with the​ outside world. And these senses are basically biochemical machines designed to​ send information to​ our brain. For example,​ the​ eyes collect and focus reflected light onto the​ retina (at the​ back of​ the​ eye). Receptors in​ the​ retina convert this light into electrical impulses (this electricity is​ produced by chemicals in​ the​ receptors). These electrical impulses are then fired along a​ network of​ nerve cells to​ the​ brain. the​ brain,​ another very complex mass of​ interconnected nerve cells,​ analyses these impulses – their strength,​ their rate,​ their pattern and frequency – and generates an​ internal picture based upon them. it​ is​ this brain-generated picture that we “see”. it​ is​ a​ similar case with the​ sensation of​ touch. Receptors in​ our skin are stimulated by physical contact and produce electrical impulses that are sent to​ the​ brain – what we “feel” is​ the​ result of​ the​ brain’s analysis of​ these impulses. And so on​ for taste,​ smell and hearing.

So the​ tree that we saw,​ felt,​ heard,​ smelled and tasted isn’t actually “out there” in​ the​ world – it​ is​ in​ our brains. More accurately,​ it​ is​ the​ brains image or​ impression of​ the​ tree constructed from the​ impulses it​ receives from our senses. Whenever our brain received this particular pattern of​ impulses from the​ senses,​ it​ would construct an​ image of​ a​ tree – colour,​ shape,​ smell,​ taste,​ touch and sound – whether or​ not a​ tree was actually there.

There is​ little controversy in​ stating that our brains can be deceived. We can block the​ path of​ the​ electrical impulses as​ they pass from the​ sense receptors to​ the​ brain – this is​ the​ case with local anaesthesia,​ where a​ patient can watch as​ his appendix is​ removed without pain. or​ we can interfere directly with the​ brains analysis of​ the​ sense impulses – a​ drunken person is​ aware that he has fallen over,​ but it​ doesn’t hurt (until the​ next day!). And we don’t need alcohol or​ drugs for this deception to​ occur – at​ some point,​ most of​ us have believed,​ albeit briefly,​ that we’ve seen or​ heard or​ felt something that has turned out to​ not be there.

It was this sort of​ reasoning that led Descartes to​ question the​ very existence of​ a​ world outside our selves. in​ light of​ modern science,​ Descartes is​ questioning the​ existence of​ a​ world outside our brains (our bodily sensations such as​ feeling hungry or​ having an​ aching leg are also mediated by our senses). in​ these terms,​ our own bodies are considered as​ part of​ the​ outside world. if​ all we see,​ hear,​ touch,​ feel and taste in​ the​ outside world is​ but a​ representation in​ our brains,​ and this representation is​ based on​ information from our senses,​ and these senses can be deceived,​ then we can never be sure that the​ outside world exists. Descartes talked of​ the​ possibility of​ us being hypnotised by a​ demon who is​ tricking us into believing we are moving around in​ a​ world with trees,​ houses,​ other people etc when in​ fact we’re locked in​ a​ dungeon somewhere. the​ film “The Matrix” provides a​ technological alternative.

So we can’t know if​ the​ outside world exists – it​ could all be in​ our brains. But in​ that case can we know that anything exists? Thankfully,​ yes. We can be sure our thoughts exist. How? Because we think them. There seems no way that we can be deceived about our thoughts existing – in​ the​ very act of​ having a​ thought,​ that thought exists. the​ thoughts may be based on​ deceptive information from the​ senses,​ but they are still real,​ they still exist. it​ is​ difficult to​ conceive of​ deceiving someone into believing they have thoughts when,​ in​ fact,​ they don’t. you​ need to​ have thoughts to​ be deceived.

So we can safely say that our thoughts definitely exist! Descartes moved on​ from this “rock of​ certainty” and went on​ to​ “prove” the​ existence of​ the​ outside world. Unfortunately,​ this further “proof” is​ highly suspect and relies on​ the​ notion of​ a​ beneficent and all-powerful God – but then Descartes was writing on​ behalf of​ the​ Catholic Church! Most modern philosophers discount this extension of​ his theory,​ but they do still accept his earlier reasoning - “I think therefore I am” has stood the​ test of​ time. if​ we are being pedantic,​ Descartes quote is​ better rendered as​ “There are thoughts” – just because I experience thoughts doesn’t mean they are mine! But this isn’t as​ memorable as​ the​ original.

So what has all this got to​ do with mental health? Well,​ if​ the​ outside world doesn’t exist as​ such and all we have is​ thoughts,​ then (potentially) the​ world is​ what we think it​ to​ be. I’m not saying we can change things dramatically. it​ would take a​ lot of​ effort to​ “create” a​ thought-world where trees can talk and people fly by flapping their arms – for this to​ be “real” one would have to​ interact constantly and consistently with trees and people as​ though they could do these things. Rather,​ I am talking about how our thoughts and feelings can “colour” our experience of​ the​ outside world (I am using the​ terms “thoughts” and emotional “feelings” interchangeably here). Depressed people (i.e. people with depressed or​ depressing thoughts!) experience the​ world differently to​ others. They see colours less vividly,​ food can seem tasteless and unpleasant,​ and harmless everyday situations can appear threatening. They predict bad consequences from actions and events where others see only benefit. a​ depressed persons world is​ very different to​ a​ happy person’s,​ but to​ an​ observer they will seem one and the​ same.

A person with depressive thoughts who is​ looking to​ “get better” has three courses of​ action open to​ him.

Firstly,​ he can accept the​ “medical model” of​ mental illness and depression. This model sees the​ brain (rightly) as​ a​ complex neurochemical structure,​ and postulates that depression and other psychological illnesses are due to​ defects or​ malfunctioning in​ this system. the​ brain,​ when examined anatomically,​ consists of​ millions of​ various cells,​ each of​ which is​ in​ turn composed of​ smaller structures. When these structures are examined in​ turn,​ they are found to​ consist of​ chemicals (as does all physical matter). the​ medical model thus presumes that it​ is​ a​ defect or​ malfunctioning of​ these chemicals that adversely affect the​ brains cells,​ leading in​ turn to​ the​ malfunctioning of​ the​ brain and finally a​ “malfunctioning” of​ thinking – depression or​ whatever.

On this model,​ the​ course of​ action is​ clear – correct the​ malfunctioning of​ the​ brain. This is​ done using drugs that enter the​ brain and interfere with the​ cells chemical structure and functioning. This all makes perfect sense. Unfortunately,​ there is​ a​ vast gulf between the​ theory and the​ practise. Medical science just does not know enough about the​ brain at​ present. There are numerous different cell types,​ numerous different chemicals in​ and around these cells,​ and numerous different interactions and connections between each cell and the​ others. No test has been developed that shows which chemicals/cells/connections are malfunctioning. the​ best that the​ scientists can do is​ make an​ educated guess as​ to​ those chemicals/cells/connections seem likely to​ be defective,​ and choose drugs that act on​ these. the​ initial guesses (based on​ drugs that were found in​ the​ 1950’s - by accident!) are still the​ main focus of​ research today. the​ result is​ predictable – a​ large number of​ different drugs that work seem to​ work sometimes and not at​ others and have side effects (because they are also affecting perfectly healthy cells). This is​ likely to​ remain the​ case for the​ foreseeable future.

A second course of​ action for the​ depressed person is​ to​ change the​ outside world i.e. their circumstances. This makes perfectly good sense. if​ you​ are feeling depressed because you​ hate your job or​ your relationship,​ then change it. if​ you​ feel depressed because you’re overweight,​ then diet. of​ course,​ this is​ rather flippant. if​ it​ were that easy to​ do,​ people would just do it. And it​ must be acknowledged that depression often saps the​ will and motivation to​ change just these sorts of​ situations. Further,​ many situations cannot be changed by our own actions – the​ loss of​ a​ loved one,​ poverty,​ ill health,​ war,​ famine etc. the​ outside world can be very resistant to​ change.

The third course of​ action takes a​ leaf out of​ Descartes book. We are what we think – a​ depressed person is​ no more and no less than someone with depressed thoughts. if​ they stopped having depressed thoughts,​ then the​ depression disappears. it​ is​ possible for people to​ be happy,​ or​ at​ least content,​ even in​ the​ direst of​ circumstances. Most of​ us have known people face up to​ unpleasant and distressing events with resilience and even cheerfulness. We say they are “naturally happy” or​ are “positive people.” One can also say that they think “happy thoughts” or​ think “positive thoughts.”

Perhaps they were born like that. or​ perhaps they learnt to​ think like that as​ they grew up (I believe this is​ more likely). Either way,​ though,​ they enjoy life a​ lot more than many of​ us. But this needn’t be the​ case – if​ we can learn to​ think a​ little more like them,​ learn to​ think in​ a​ more pleasant,​ positive way. it​ seems unlikely that depressed people are “born like that”,​ just as​ it​ is​ unlikely that happy people are “born like that.” Even the​ wackiest psychiatrist will hesitate to​ diagnose a​ baby as​ depressed! Young babies can’t think as​ we do – and they can’t have depressed thoughts. as​ they grow,​ their thinking abilities develop under the​ influence of​ their parents,​ siblings and peers. Patterns of​ thought are developed,​ ways of​ thinking,​ with each person having their own particular patterns,​ unique to​ them. By the​ time adulthood is​ reached,​ these patterns are likely to​ be “ingrained” in​ us,​ to​ the​ point where we’re not even aware of​ them – we automatically process situations,​ events,​ and interactions with others in​ terms of​ these thought patterns. the​ thoughts we actually think (and are aware of) are the​ results of​ this processing. Therefore,​ if​ this processing is​ “set wrong” (e.g. if​ it​ constantly produces thoughts that are depressive),​ then psychological problems are likely to​ follow.

This is​ the​ basic theory on​ which are based the​ cognitive therapies for psychological problems. With the​ prompting and guidance of​ the​ therapist,​ an​ individual is​ taught to​ examine his or​ her thinking patterns,​ searching for maladaptive and detrimental ways of​ thinking. This is​ not an​ easy task – the​ patterns are usually “automatic” (like a​ habit) and the​ individual is​ likely to​ be unaware of​ them initially. an​ important task for the​ therapist is​ to​ elucidate these “faulty” patterns. These can then made explicit to​ the​ individual,​ and the​ first steps taken towards challenging these ways of​ thinking. the​ aim of​ the​ cognitive therapies is​ to​ minimise or​ remove entirely the​ identified faulty patterns,​ and for the​ individual to​ learn more adaptive and helpful ways of​ thinking in​ their place. a​ successful therapy can change a​ persons life forever – when a​ person no longer automatically thinks depressive thoughts,​ they are insulated and protected from becoming depressed in​ the​ future. Karen practices NLP and CBT in​ Herts.

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