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An Alternative Psychobiological View on Mental Illness (DRAFT)

Helfrich an595738 at anon.penet.fi
Wed Jul 17 15:01:54 EST 1996

An Alternative Psychobiological View on Mental Illness

by Serge Helfrich

DRAFT version 0.0
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Although it is widely accepted by now that the Kraepelinian
view on psychiatric illness is getting outdated, the
consideration of a mental disease as a well-defined entity
appears to be quite deeply embedded in human thinking. Using
terms as 'schizophrenia' or 'major depression' we seem to
refer to accumulations of symptoms that can rather clearly be
classified, as necessary for an unequivocal diagnosis and a
goal directed (pharmaco)therapy. Some symptoms (e.g.
hallucinations) seem to justify such a classification in many
cases while others, like more subtle cognitive and emotional
malfunctioning, make it more questionable. Without discussing
the major problems of psychiatric nosology I want to state
that 1) normal and pathological behavior do not just arise
from the brain but are part of a unity of organism,
environment and behavior, 2) normal and pathological behavior
cannot be unequivocally classified but are rather to be
considered as a continuum of behavioral variation with a clear
evolutionary function and 3) acceptable or beneficial behavior
is selected for by the environment, which means that the
boundary between normal and abnormal is determined that way.
Although these statements are not new, and in some sets even
well known, their impact on for instance psychopharmacology
appears to be largely underestimated. In this text I will
refer to the field of brain, behavior and mental events as
'psychobiology'. Now let's have a look at the field of
psychobiology and see what the problems are when we try to
explain illness and to treat it with biochemical corrections
of the central nervous system (CNS).
First we have to know what we are actually talking about
when we are discussing completely different types of events
like brain processes, mental events or behavior. Psychobiology
as I fuzzily defined it, comprises at least four frames of
reference for explanations on phenomena that are covered by
the field (e.g. neurological, mental, behavioral). These
comprise the physiological (dealing with neurons, ions,
potentials, etc.), the mentalistic (dealing with mental
phenomena like emotion and motivation), the conceptual
(considering the CNS as a black box that can be modeled based
on its input/output relations) and the behavioristic (only
accepting behavioral parameters as useful for scientific
practice). The different types of explanations within these
frames use a different terminology; talking about ions and
excitation is something else than talking about paw movements
or the formulation of English phrases. When we look closer,
the difference may be not as fundamental as it seems. It may
be just a difference of scale. We can't always jump from
neurons to networks to behavior because the matter is just too
complex at present, but the behaviors of ions, neurons and
organisms all take place in time and space, that means all in
a physical frame. Almost the same goes for conceptual
explanations: the idea model is a physical one although it's
not actually present in the physical world. What about
mentalistic explanations? Those are different because they
deal with events that do not take place in an outside physical
world, but that are abstract and personal. Let's leave them
what they are for the moment. It is beyond the scope of this
text to discuss and criticize the artificial distinction
between mind and body.
Yet when stating that physiological and behavioristic
explanations do not differ essentially, doesn't that mean that
we can easily join them into a single frame of reference?
Absolutely not. The complexity as well as the length and
ramification of the causal chains interfere here. When I
stimulate receptor R systemically or locally to induce
behavior B, there is often no general causal relationship
between those completely different events. Instead
correlations can be measured in populations. Individuals just
respond in a different way. Using the right paradigm, it's
easy to demonstrate the efficacy of an arbitrary psychoactive
drug by measuring it's desired behavioral effects in a
population, just as I can correlate the number of times I win
money to the number of times I play poker.
Returning to the subject of psychotic disturbances we'll
first have to realize what characterizes the disease as it can
be observed from the outside: the madman is recognized by his
deviating behavior, whatever may go on in his brain or mind.
His motor behavior, verbal behavior or performance in
psychological tests characterizes his illness. So it seems
that an ethological approach of mental illness can be
justified. But don't let us lose the (deviating) brain out of
sight as a possible source of causal factors. 
What do current neuroethological theories learn us about
all this? Usually those theories focus on physical factors,
like genetic predisposition, intoxication or trauma, as causes
of structural and biochemical brain aberrations. These result
in abnormal brain functioning and thus in abnormal behavior
which has in its turn psychosocial disabilities as a consequence.
Because of the exposure to psychosocial stressors brain
function is altered and the circle is closed. What quite a lot
of theories seem to overlook is that it is unlikely for brain
function in this case to be changed by environmental factors
directly. Instead the environment influences brain function by
modifying the brain itself, of course in both normal and
pathological conditions. The nowadays well known plasticity of
the brain is likely to play an important role here, and the
circle appears to be closed at the level of brain structure
rather than at the level of brain function. This insight
provides us with a clearer view on the unity of brain,
environment and behavior. In fact it is in concordance with
the insights of von Uexkuell that form the basis of behavioral
neuroscience, by underlining the reciprocal relationship
between subject and object ('Funktionskreis') in the origin of
behavior. More recent (in fact conceptual) theories, like the
'reafference principle', refined this view by postulating
multiple hierarchical layers in the CNS for behavioral
regulation. But what's more important here is that there is no
causal chain underlying (complex) behavior. Instead speaking
it of causal cycles is better. I should not forget to mention
Hebb here who stated that questioning wether behavior depends
largely on the brain or largely on the environment is as
useless as wondering if the area of a rectangle depends on its
length or on its width.
That does not mean that the brain disappears into the
background nor that its role becomes completely unpredictable.
Evolutionary old regions (e.g. in the brain stem and
hypothalamus) that are likely to play an important role in
several forms of mental illness are often much less plastic.
Yet realizing that they operate in reciprocity with
neocortical areas is important. Therefore, they can seldom be
considered as autonomous initiators of brain processes.
The point here is that the concept of causal cycles is
extremely unattractive if we want to unravel the mechanisms
that underlie our thoughts, feelings and behavior. Not to
mention the problems we inevitably encounter when we are
trying to correct those mechanisms with pills and not taking
into account the unique situation of an individual. We may
wonder if it's still attainable to generate workable
hypotheses that can be verified and falsified, taking the line
that many processes we study do not have a real assessable or
deducible origin. Therefore, this view seems to be beyond
reach of realistic empirical research programs. (Theoretical
model systems like 'behaving' neural networks, in contrary, do
use the unity of 'organism' and environment, although largely
simplified.) In many experimental situations an artificial
causal chain is studied by taking out a segment of what is in
fact a cycle, e.g. by reducing all influential environmental
factors to a minimum. So the experimental situation is quite
far removed from the everyday life situation because of many
concealed variables. One may reject that actually all
empirical science achieves its results that way, by reducing
the noise, and often with a spectacular success. But there are
some essential discrepancies. First, the number of concealed
variables in applied brain research must be huge, as in the
brain everything interacts with everything directly or
indirectly. Besides we can add an almost infinite number of
environmental factors to this complexity. Second, and probably
even more important, several concealed variables arise as a
result of the (studied) brain activity itself as discussed
Of course it is perfectly legal to object that some
etiological factors and symptoms of mental illness can be
rather clearly defined and are by no means part of any causal
cycle. For instance a genetic predisposition can hardly be
considered to be subjected to behavioral factors. However, the
problem is that such a predisposition can take only partly
account for the variation in behavioral symptoms (e.g. in twin
studies). The same goes for gross anatomical changes in brain
anatomy (e.g. ventricle enlargement and loss of asymmetry in
schizophrenia) which may on their turn well have a genetic
cause. And what about nuclear symptoms like hallucinations and
delusions in schizophrenia or persistently depressed mood as
in major depressions? It is interesting not only to assess
*that* they occur in some forms of mental illness, but also to
look closer at *how* they occur and what they are like. Then
it may appear that they're not as clearly defined as they seem
and that social and cultural factors determine for a large
part how they arise. But first I must briefly discuss the
possible role of genetic predispositions for psychopathology
in terms of evolutionary advantages. That brings us directly
to the concept of a continuum of behavioral variation
comprising healthy as well as pathological behavior.
Discussing the barely discovered field of evolutionary
psychiatry in only a few paragraphs is impossible. So I only
mention a few theories that might explain why mental illness
has been preserved during human evolution. The relevance of
evolutionary explanations is obvious: if there is a genetic
predisposition there must be a reason why diseases that mostly
occur during the reproductive episode are not strongly
selected against. Presumably there must be an advantage in
fecundity for the individual or for the group as a vehicle of
natural selection.
Most evolutionary theories consider variation in
personality, sociality and intelligence to be of major
significance for the genesis of psychotic disturbances like
schizophrenia or manic-depressive illness. When personality
and social skills are, at least partly, under genetic control
that means that at the extremes of distribution by variation
deficits may occur that can be related to the different types
of psychopathology. So in that case there is a continuum of
behavioral variation in which abnormality is inevitable at the
extremes. Mental deviation is a side-effect of advantageous
social and intellectual human traits. In an extreme view
focussing mainly on psychosis (Jaynes) traits that are now
considered to be pathological were once essential for the
primitive precultural man to survive, and necessary in the
evolution of modern consciousness. Without knowing language or
logic the primitive man had to experience the world partly by
the voices of gods and imperative auditory hallucinations.
Later when language and culture evolved, reflected by an
increase in brain asymmetry, human experience changed. (And we
may even go much farther back in time, as MacLean's famous
theory states that even 'protoreptilian' elements are still
present in our brains so psychiatric syndromes may be
homologous to ancient fixed action patterns [Gardner].) A
number of psychiatric disorders are a relapse into the early
stages and indeed brain asymmetry appears to be reduced in
many schizophrenic patients. We can extend such views by
postulating real advantages of psychotic experiences for human
societies in which art and religion are of social importance.
If that were true, those advantages would turn into severe
disadvantages when culture changes to focus on rationality and
production. We see that cultural factors and selection run
parallel here. If one doesn't fit into the settled cultural
patterns, his fecundity will obviously be reduced.
If such speculative evolutionary theories were true, we
would expect that psychiatric disorders are at least partly
characterized by some sort of 'prelogic' or nonverbal way of
thinking and perceiving. Of course this is exactly what
characterizes almost all forms of madness as we think of it. I
have to make a shift towards a more mentalistic viewpoint to
argue that a trace of irrationality is present in our healthy
mental live and that it is necessary for it. In psychosis it
is predominant and as I suggest merely because of
precipitating factors in the (social) environment. The ideas
of Matte-Blanco form a useful tool to formulate what is going
on in the logical human mind.
According to Matte-Blanco there are two main forms of
logic simultaneously acting in the mind: symmetrical and
asymmetrical logic. The latter is the classical logic that we
use in everyday conscious thinking and communication. It
allows us to conceptualize time and space and to think and
speak in terms of for instance succession, causality,
location, distinction, individuality and classification.
Symmetrical logic, which is the logic of unconscious,
comprises the principle of symmetry and the principle of
generalization. The principle of symmetry means that all
relationships are treated as equal to their converse, e.g. A
is the father of B so B is the father of A. In general the
absence of succession characterizes this type of symmetry. The
principle of generalization means that classes and subclasses,
wholes and parts, are exchangeable, e.g. a horse is a mammal
so a mammal is a horse, if my nose is a part of my face it's
also my whole face. So by the elimination of space and time
(symmetry) or the elimination of predicates which equals an
object to classes or sets (generalization) many mental
functions like symbolization, substitution, association and
representation can be described in terms of symmetrical logic.
Both asymmetrical and symmetrical logic are necessary for
thought as we know it (as a 'vital bi-logic' structure). In
these terms psychotic thought is characterized by an excess of
symmetrical logic (in a rigid 'non-vital bi-logic' structure).
(Just as in emotional states that Sartre describes as
'magical' a term that resembles Matte-Blanco's 'symmetrical'.
But -somewhat oversimplifying- when the emotion fades away,
common sense gradually returns except in abnormal conditions
like major depression or pathological mourning.)
Now starting from this view (which comprises an idiom
rather than an explanation ground) we can bring to light the
role of environmental factors in mental derailment focussing
on the phenomenon of symmetry and its advantages or
disadvantages. We already saw that symmetry must be present in
common sense but we also know that it is necessary for all
kinds of speculation and believe. For example metaphysical
thinking (which is not seldom considered to be a mild form of
insanity) requires to go beyond empirical knowledge and
classical Aristotelian (asymmetrical) logic. When metaphysical
thoughts cannot be verified or falsified, as is usually being
the case, they'll have to remain in the domain of believes.
But when there is hard empirical evidence against them I must
be fancying when I hold on to them with vast conviction. Would
that be a problem? Only if that conviction interferes with my
everyday physical and social functioning. I can believe what I
want but if the rest of the world believes something else and
functions more successfully than I do, I certainly do have a
problem. Besides a social stressor is created here that won't
do me any good. I'll have to change my tack or I'll sink
deeper. In other words, the world has to correct me or
discriminate me (even if the rest of the world is wrong too
but has a better consensus in being wrong). Maybe I have a
genetic predisposition for having weird ideas but it certainly
escalates while I'm thinking and acting in my 'Umwelt'. (We
could bring up as many trivial examples as we wish to
illustrate this principle of selection and exclusion or
correction. E.g. Different societies may have a different
political or religious reality as long as there is a certain
amount of consensus within a society.)
Maybe the idea of selection of bi-logic holds even true
for sensory perception. Isn't that what epistemology is all
about to find a consensus for how we perceive the world? That
consensus still turns out to be non existent (even after
Kant). Aren't we all hallucinating in our perception of the
world, for example in our seeing of colors and our experience
of time? Without bringing up all those philosophical cliches,
I assume that it's clear that our perception of the outside
world must be a product of that world and what we are
ourselves. The 'Umwelt' of a hedgehog is really another one
just because it's another organism with different senses. But
there's no need to worry. It only goes wrong -again- when
perception doesn't fit the facts extorted by the outside world
or when consensus within the community is lost, e.g. when
little green men crawl out of the wall socket.
Based on these views I raise the hypothesis that there
are two other subtypes of symmetry (or magic or
irrationality), the acceptable and the unacceptable, and that
the boundary of selection within the existent variance
(depending on internal and external factors) is determined by
the 'Umwelt'. In the historical process of civilization there
must have been a transference from nature to culture and the
selection boundary must have been shifting during that
process. I already mentioned that magic and irrationality
might have been of importance for prehistorical man (as long
as it helped him to function better in his natural
environment). Besides the 'Umwelt' acts as a precipitant of
mental aberrations just because it reacts to aberrant behavior
(e.g. in the emergence of social stressors). Some examples
might illustrate this. These are not meant to explain the
pathogenesis of serious mental illness but just to illustrate
the precipitation of problematic notions.
Suppose that I'm convinced of Gods ubiquity and that
there is no direct empirical evidence for that conviction.
Besides I believe in God clemency and I don't allow any prove
against my belief (I won't believe it anyway). Although I live
in the same physical world as the heretics around me, the
world of my experience is suffused with Gods ubiquitous
clemency that might even help me to be successful as a descent
human being with respect for the world and his fellow human
being and with a positive attitude. In this case there doesn't
*have to* be a precipitation of debilitating delusional
thought and it could be perfectly stable. I can live well with
my irrationality and maybe even better than many others can.
Suppose that I'm convinced that my boss keeps an axe
under his desk and that he will cleave my skull as soon as the
suitable moment comes. This is obviously a paranoid delusion
(if there is no visible reason for my conviction). But what is
the difference with the previous one (or with the believe in
freedom and democracy or the obvious success of
psychopharmacology)? The major difference is that my
conviction is challenging myself and will change my behavior
accordingly. I create a stressor in my environment. Without
listing all possible details we can imagine that this process
feeds back on my personal experience in a possibly infinite
cycle. Thus the balance is lost and my thoughts derail if the
cycle isn't disrupted. The delusion precipitates.
The presented view ties in with Foucault who can help us
to understand the historical process to which insanity has
been subjected. In the classical period insanity was
dissociated from the thinking subject by the Cartesian
rationalism. Thus an area of experience was created that lies
beyond rationality and truth. This area is a challenge to the
rational subject. Yet notice that reason and unreason can be
defined in relation to each other thanks to this dissociation.
Not that insanity wasn't banned before the classical period,
but it wasn't cut out from society. The imaginary ship of
fools symbolizes the idiots sent away by boat but these boats
were also considered to be pilgrims' ships. On the wide ocean
the fool had to conciliate with the will of God. Insanity was
part of the Divine truth. In the 17th century the fools became
separated in asylums. Later during the industrial revolution
they became subjected to disciplinary techniques in order to
be turned into useful productive subjects (when possible). Not
their bodies but their minds were chained. The effect of this
'power' by rational discipline is twofold: it allows
management of irrationality and it allows knowledge, a truth,
about irrationality. Of course these two aspects are
As I showed, human behavior and experience comprise a
broad continuum of phenomena in both time and space (e.g.
'Funktionskreis', genotypical and environmental variation)
through which boundaries are drawn by several factors in
nature, nurture and culture. This view illustrates not only
the variation in behavior and mental processes but also the
possible variation in the way we look at it (and in fact these
two aspects are essentially the same). That is my major
conclusion. All attempts to obtain a clearly defined
classification of aberrations have to fail. We seem to be
hunting ghosts when trying to develop our goal directed
strategies and pills to treat those aberrations. I think that
using oversimplified concepts like metabolite deviations
measured over populations or behavioral effects in laboratory
animals can hardly justify pharmacotherapeutic practice
nowadays. That is *if* we want to treat the patient; the
individual case. Increasing his productivity is a different
story and justifies psychopharmacology for a large part. Of
course now I'm oversimplifying myself. I don't want to plead
here for all kinds of behavioral, cognitive and psychosocial
therapy, but if we take this issue seriously we need to
rethink our strategy. (But note that those therapies are often
successful in the treatment of many disorders like depression
and even neuroleptic resistant schizophrenia - of course
depending on the individual case.) Whatever may be necessary
to rethink we must overcome a major delusion first without any
drugs. In a world where depression rates seem to be correlated
with political and economical changes and our mental abilities
have developed to a level that isn't supposed to tolerate
simplistic and childish views we cannot expect to solve some
of our major problems with a pill. The principles of symmetry
and especially the principle of generalization seem to rule
our psychotherapeutic strategies with non-vital bi-logic. But
would an alternative be feasible? Possibly not. But let's not
be too pessimistic. Maybe we wouldn't need all those attempts.
Maybe it's much easier to admit fully what we want with those
pills. Maybe a new scientific paradigm arises that also
affects health care, and we do no longer need momentous terms
like truth, reality, verification or falsification.
Vendibility will determine the new scientific value. This is
already being the case in pharmaceutical development that is
already called science in some sets; a science using wonderful
human terms like 'safety' and 'efficacy'. Thank God it all
turns out all right at the end. Our new scientific practice is
justified while the salesman crushes the scientist under one
foot and the artist under the other.

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