Here’s a topic that I share with one or more patients every day. (As, by the way, are all my blogs… nothing you read in one of my blogs is anything other than what I have said dozens or hundreds of times over the years to my patients and friends)
And, OK, I’ll just get out there with it my answer to the question. And having just written a little poem (my last blog) that speaks to a certain aspect of “depression”, it’s time that I clarify my stance on the subject.
Before those of you who suffer from, have loved ones with, or who are experts in the field of “mental illness” are tempted to open fire on me with both politically correct barrels, please bear with me in a little medical and philosophical brain-storming:
When a person has heart “disease”, or kidney “disease”, or bone “disease” we know exactly the “thing” we are talking about that is affected by “disease”. We have labs, and xrays, and scans, and all sorts of exams to qualify and quantify the extent of “disease”. But when a person is said to have “mental” illness, frankly, I get AGGRAVATED.
Tell me… Can anyone point to any “thing” or “structure” or “organ” that is the “mind” that part of the body that is afflicted by a quantifiable and definable “disease”? (And don’t be so quick to say, “It’s the brain, OBVIOUSLY.”…. there’s so much more to the “mind” than that!!)
To be sure, the Bible of Mental Health, the Diagnostic and Statistical Manual (DSM-7… or is it 8, 9, or 10… depending on the latest revision…. I forget) is the authoritative guide to the definition of “mental illness”, recognized by the medical, insurance, and legal professions. It is based not just upon research, and decades of clinical experience, but also upon accumulated opinion. It represents not only a consensus of objective and reproducible clinical trials, but also of changing social and cultural mores. Without mentioning specifics, let me just say that in the expert opinion of the medical profession, yesterday’s pathological behavior is today’s normal variant. No double blind placebo-controlled, cross-over studies or trials enabled the psychiatric profession to make these changes. This is because the vicissitudes of human behavior defy scientific quantification, (except, perhaps, in the “group-think” of Sociology).
So, again, I dare you to show it to me this thing called “the mind” so we can all see it, define it, quantify it, study it, and treat it. Thus we can properly define and seek to cure this thing we call “mental” illness.
This is not to say that we can’t tell a lot about someone’s “mind”, but this we can do only indirectly. The contents of one’s thoughts, ideas, expressions, choices, actions, etc. tell us about the “mind” but they are not “the mind”. To direct some type of therapy to any one “thing” that is a “mind” is not like treating a lung or a liver or a pancreas.
The “mind” is a function. A process. Not a thing.
The Greek Philosopher Heraclitus said, “You can’t step into the same river twice.” So it is with the mind. The mind is never still, a flowing torrent of thoughts, emotions, desires, motivations. We can point to the river and give it a name. It’s the same river that’s been there for eons, but its constituents of water, salt, minerals, silt, flora, and fauna from one millisecond to the next are never the same. You could say that Dr. Kunz, in his waning years (gee, I hope not) is losing his “mind”, but you would be hard-pressed to define what part of me is sick so that you can treat it.
To paraphrase Plato one would describe the human soul (the mind in today’s parlance) as consisting of three parts: Intellect/Reason, Physical Appetite/Emotion, and Will/Spirit… the first being the charioteer, the latter two the horses drawing the chariot. The Intellect in Plato’s view should provide the ultimate direction that the two horses follow. They fight against one another, no doubt, the baser physical passions warring against the higher more moral spirit. The steady hand of the Intellect keeps the chariot on course, but is influenced, to a lesser or greater degree, by both.
How in the heck do you treat that?
“HOLD YOUR HORSES!!!” Did you ever say that? Bet you didn’t know you got that from Plato. Come to think of it, until just now, I didn’t either.
Psycho-therapy and psychopharmacology are mulit-billion dollar businesses dedicated to corralling those horses. But what are we treating really?
It ain’t “mental illness”.
To be continued….
Sorry, this blog is over.