Answering The Biomedical Challenge to Psychotherapy

(Abridged)

“What is a man, if his chief good and market of his time be but to sleep and feed? a beast, no more.”  William Shakespeare, Hamlet

It is a disturbing but unavoidable fact that the biomedical model is threatening, as much as it is expanding, our understanding of who we are.  The popular, scientific and therapeutic media are constantly reporting narrow and decontextualized discoveries as ‘facts’ that ‘prove’ that one form of suffering or another is really an ‘illness’, that the illness is ‘organic’ in its nature, and that it is best ‘treated’ by medication.  Most radically, brain scans and statistical studies of various sorts are now used to support the alienating and depersonalizing notion that the mind is reducible to the brain.  These distortions and simplifications can be found on the nightly news, in the daily newspapers, and in popular magazines as well as in scientific journals. 

The acceptance that mental suffering, and often all mental phenomena, are reducible to biology seems almost unanimous.  Clients come to therapists misinformed about the potential and value of psychotherapy, and often unaware that another model for understanding these scientific facts about the relationship between the mind and the brain exists.  Therapists themselves are often unaware that rather than proving the broader materialist and reductionist biomedical paradigms, these new discoveries can be understood to further confirm the importance and power of psyche/mind/soul in our understanding of the world and of what it means to be human; they too are beginning to buy into the biomedical myth.

In the field of mental health, the mistaken theories that support the biomedical model are used to justify the medication of staggering numbers of the most vulnerable members of our population, especially our children, our elderly, and our emotionally distressed.  Part of the larger materialist worldview, the biomedical model leaves little room for a spiritual crisis, meaningful suffering, or a moral journey.  Together the biomedical and materialist paradigms challenge psychotherapy in many ways, leaving it seemingly impotent, limited in breadth, depth and value.

I believe that there are important replies to the biomedical challenge that need to be voiced.  Good solid responses that subvert the basic premises of the materialist and biomedical models, and open the doors again to meaning.  I believe that we, as therapists, are especially called to voice these replies.

The Challenge

Francis Crick, the Nobel Prize winning co-discoverer of the double helix structure of the human genome, in his book the Astonishing Hypothesis, The Scientific Search for the Soul, succinctly condenses the biomedical challenge to its starkest form.  He says “You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more that the behaviour of a vast assembly of nerve cells and their associated molecules.” 

Similarly, Daniel C. Dennett, a philosopher and popularizer of the rapidly growing cognitive and evolutionary sciences, professes in his recent book Darwin’s Dangerous Idea, in a chapter provocatively titled Losing Our Minds to Darwin - “Of course our minds are our brains, and hence are ultimately just stupendously complex machines.” (pg. 370)

Developing from this philosophical stance and applying it directly to the issue of personality and therapy, Daniel G. Amen writes in Change Your Brain Change Your Life, “Many problems long thought of as psychiatric in nature – depression, panic disorders, attention deficit disorders – are actually medical problems that can be treated using a medical model.”  He continues with this painfully ironic idea, “I hope that by providing new insights into how the brain works, you’ll gain a deeper understanding of your own feelings and behaviours and the feelings and behaviours of others.  And I hope you’ll use the specific brain-based “prescriptions” to optimize the patterns in the brain to help you be more effective in your day-to-day life.” (pg. 15)

These are just three of a multitude of examples of how the biomedical model has begun to radically diminish our identities, our experiences and our suffering.  These are the roots of the problematic misunderstandings that cry out for response.

Response

What does it mean to feel ‘sad’?  What does it mean to feel ‘depressed’ or to be ‘clinically depressed’?  What is the difference between ‘feeling anxious’ and ‘having an anxiety disorder’?  More profoundly, what does it mean ‘to suffer’?  Does suffering have any meaning, or is it simply something to be avoided and medicated if it is too severe?   Are we merely dust?  Machines?  ‘Beasts that sleep and feed?’  Or are we also transcendent beings, dual in nature, both dust and image, and reducible to neither?  How we answer these questions, where we place our emphases, where we draw our lines and the stances we take as a result of our ‘answers’ will profoundly influence both the way we practice as clinicians and our hopes and goals for psychotherapy in our clients’ lives and our society as a whole.

I believe that what I am calling “The Biomedical Challenge” is, in essence, a problematic negation of what Martin Buber called the ‘I-Thou’ relationship.  It is a misguided attempt to reduce human suffering to a function of the brain, in a move that necessarily leads to a similar reduction of our relationship to the one who is suffering.  As psychotherapists this move from an engaged, living relationship (‘I-Thou’), that in Buber’s words can only be achieved “with one’s whole being”, to a diminished, technical relationship of expert to disease (‘I-It’) that can never be engaged in “with ones whole being”, is clinically fatal.  The more we relate to our clients as diseases, as ‘It’, the more we betray them. 

If I talk to my clients about their ‘disease’, I lose my connection with them - I am no longer able to have a meaningful conversation regarding their struggle and the life experiences that make that struggle necessary.  I am no longer able to hope that their choices can make any difference to the inner workings of their ‘disease’, and I am no longer able to see their suffering as important and meaningful.  Buber might say that I am no longer talking to them at all.  Worse still, the moment my clients learns to relate this way to themselves, they lose much of their possibility for change, for growth and for healing.  In relating to themselves as ‘It’, they are diminished in a way that may become more terrible than their original suffering.

Today, we as psychotherapists have the opportunity and responsibility to add important voices to the ongoing conversation on what it means to be human, to affirm the crucial importance of the ‘I-Thou’ relationship to human life.  As therapists, our perspective is incredibly privileged; we have access to the intimacies of more lives in a week than many people will have in a lifetime.  We are called to the ‘I-Thou’ not only personally, but professionally, and the diminishment of the Thou is a real crisis in our field today.  On a broader societal level this negation of the Thou, of which the biomedical challenge is just the latest wrinkle, has a long and complex history.  There have been many replies to it, and replies to the replies, and so on and so on.  I believe that this deeply important conversation has powerful implications and ramifications.  It is a conversation that ultimately affects not only our treatment of how we suffer, but every aspect of our society including our justice system, our pedagogy, and even our foreign policy.

It is my assertion that this change of direction in our quest to understand the human experience and human suffering, from the realm of psychology to biology, is profoundly wrong.  Personally, clinically, scientifically, and socially the effects have been more harmful than helpful - and a major part of this error comes from the rooting of the biomedical challenge in the broader materialist paradigm. 

Materialism

In the materialist paradigm, causality is simplified into a unidirectional function of the material on the immaterial, the brain on the mind.  Levels of explanation and meaning are collapsed in what even some self professed ‘reductionists’, like Daniel Dennett, term “greedy reductionism”.  Often the immaterial - the mind, the soul, the living moment - is dismissed out of existence as irrelevant, illusory or merely an epiphenomenon.  When mind, consciousness and everything associated with them, are understood as mere shadows of the brain (basically Crick’s position), then we can further negate the layers of complexity and scores of processes associated with them.  In the materialist universe, phenomena like choice and meaning disappear, every thing is ‘caused’ and every thing is material - minds and/or souls do not really exist, but are merely illusions.  This may sound like an exaggeration of the materialist position, but unfortunately it is not.  These ideas are widely held and considered to be scientifically based.  Still, even if we were to accept this radical materialism as true, the over-zealous collapse of mind into brain is a further misstep of the biomedical model, a deeper misunderstanding of phenomena that are much more complex and significant. These greedy reductions are a little like ignoring the software in a computer, or believing that we could explain the mating habits of gorilla’s using physics.  The biomedical model of understanding human suffering is based on such over-zealous reduction.

Early in his career as an analyst Freud fantasized about unifying psychology and biology, leading the way, in the attempt to reduce our minds to forces, drives and the interactions of neurons.  Later Freud realized a crucial problem with this endeavour, and changed his position on its value.

We know two kinds of things about what we call our psyche (or mental life): firstly, its bodily organ or scene of action, the brain (or nervous system) and, on the other hand, our acts of consciousness, which are immediate data and cannot further be explained by any sort of description.  Everything that lies between is unknown to us, and the data do not include any direct relation between these two terminal points of our knowledge.  If it existed, it would at the most afford an exact localization of the processes of consciousness and would give us no help towards understanding them.
Freud, An Outline of Psychoanalysis (pgs. 1-2)

How to bridge the “explanatory gap” between the material and the mental worlds, as it is referred to in philosophy and neuroscience where it is hotly debated, is still the most important question that the materialist - biomedical paradigm must answer. The question however, is rarely acknowledged in the biomedical literature and when it is, it is usually dismissed or trivialized.  Instead, in the tradition of the early Freud, it is becoming an ‘accepted fact’ that we are reducible to the activities of our brain. 

Article after article celebrates the localization of some mental function to some part of the brain.  Every couple of months a claim is made that the gene for one or another ‘mental disorder’ has been discovered (as yet all of these claims have proven false).  More and more, our psychological struggles are being ‘explained’ as genetically predetermined brain dysfunction and people are being understood as merely dust.   Depression, anxiety, and even post-traumatic stress disorder, are now being understood as “caused by the brain”.    Not only is psychiatry giving up on psychotherapy but many psychotherapists are giving up on clients who are now believed to have chemical imbalances or organic deficiencies and are (hopelessly) referred on to MDs to be medicated.

Our Gradual Diminishment

Unfortunately, our clients, already suffering from other kinds of interpersonal reductions and particularly vulnerable to such misinformation, are inundated with constant reports of new wonder drugs that will ‘best treat their conditions’, new studies proving that such and such an illness is ‘genetically heritable’, and theories that earnestly and ‘scientifically prove’ that we really don’t have any free will.  The inevitable effect of reducing the mind to the brain is that we correspondingly change our basic relationship to our suffering, our selves and to each other.  If we accept the biomedical model we unavoidably change from an ‘I-Thou’ stance, to an ‘I-It’ - from meaningful relating to a disengaged management, or clinically from psychotherapy (soul healing) to a more technical and impersonal handling (cognitive-behavioural therapy etc.).  I have experienced glimpses of this reduction from both my clients and my colleagues and it is an indisputable and pervasive theme of modern life.

Within the psychotherapeutic community there is a gradual acceptance of these new ‘facts’ and a defeated diminishment of the potential of psychotherapy to help what are now ‘understood’ as ‘disorders of the brain’.  Not only is the reduction of our humanity affecting when we practice psychotherapy but how we practice.  More and more I hear colleagues despair that clients cannot change because their brain is defective, has been damaged by early trauma, has been ‘biochemically unbalanced’ by some ‘environmental trigger’, or permanently underdeveloped because of deprivation. 

I believe that when we fall into these kinds of misunderstandings we are radically failing our clients.  As psychotherapists, we are called to tune into and counter the web of ideas and forces that negate our client’s humanity and help heal the alienation it fosters in them.  They come to us, in part, to fight the very destructive diminishments that they have had to endure.  The biomedical worldview cannot help to heal them, alleviate their suffering, or even begin to address many of their diminishments, because it is in fact a powerful manifestation of and contributor to them.

Our definitions and understandings of our humanity, of the meaning of suffering, and of the causes and best treatments for depression, anxiety, and schizophrenia, aren’t merely professional, semantic, scientific or philosophical problems.  The answers to these questions cannot be solved by science or statistics, but are in fact powerfully determined by, and determining of, our own humanity.   I believe that the diminishment of that humanity to a function of brain, is in fact a misguided attempt to relieve the deep and powerful sufferings of our clients and our own sufferings, by cutting them off at their meaningful roots.