A couple of the research blogs I follow lately have had some insight that really struck me as they fought off dualism in regards to the thorny issue of psychological vs. physical addiction and the brain, arguing that the elimination of mind and body distinctions is a good thing, as addictive pathways are real, physical represented by neuronal circuits.

This is an interesting argument, that collapsing psychology to the brain mechanisms brain can erase stigma by medicalizing it and making it a matter of physical function.    In addiction it makes quite a bit of sense.  We know what part of the brain is being stimulated, that dopamine reward pathways are building and feeding the habit.  The derogatory statement, “It’s all in your head,” remains technically true, but loses its bite when you can explain it in such a real and tangible way.

Psychology is moving more and more in this direction these days, drawing upon our burgeoning knowledge of neuroscience and the brain.   This is obvious in cases like bipolar disorder, or schizophrenia, which clearly have an inherited physical component.  It is true in any mental illness.

Clearly any process that physically effects the brain also effects the mind and behavior.  The two are irrefutably tied together.   Steve at Mormon Organon gave a vivid personal example of this a while back when he became delusional from a viral encephalitis.

There are some problems with this viewpoint, however.  For example, psychopaths lack a measurable empathy response in their brains.  Does this mean they aren’t liable for their crimes?  Did their brains make them do it?   If everything that happens in the brain is physical, are we ever responsible for anything we do, ever?  Do we really ever even really make choices?

The exact point where biology ends and consciousness and agency begin remains a mystery to me, but I know that point has to exist.  I don’t think simply knowing a mechanism seals our fate.  This determinism is faulty and lazy thinking.  However, It make me exceedingly glad that I don’t have to be the ultimate judge of others.  In the end, understanding biology certainly can make forgiveness easier.

More curious to me is this.  Why does our lack of understanding the mechanisms of addiction or mental illness lead inexorably to stigma in the first place.  Addicts clearly are not acting in their own rational self interest.  Their lives are blown apart by the object of their addiction.  Why isn’t it generally more clear in the first place that some powerful reality is causing the behavior.  What difference does it make if we know the neurotransmitters and circuits?

Why are we so quick to judge the minds and hearts of another, and assume we know what is going on and who is responsible?   Furthermore, why does knowing the physical mean we know all that there is?   Case in point,  physical stimulus of the brain has been shown to trigger spiritual feelings, Does this mean there can be no legitimate external stimuli causing the same spiritual feelings?

Do we have to doubt everything we see because an artificial stimulus can cause a hallucination?  Do we throw out everything we hear if a magnet can stimulate our auditory cortex and cause us to hear a voice? Should we pluck out our eyes because a magnet can trigger visual hallucinations?  If a seizure causes a false smell, is every smell we get henceforth and forever simply “all in the head?”

While we have abundant evidence that physical malfunction of the brain causes malfunction in the mind, we also have an abundance of evidence in the reverse direction, that the mind also controls reactions in the brain and body.  Most famous among these is the vaunted placebo response.  Our beliefs alone physically change the expression of a disease to such a degree it has to be accounted for in every clinical medication trial.

There are also numerous studies on the importance of prayer (unblinded), community, human contact, and pets all leading to better health as well.  These things change our thoughts which then literally change the physical function of our bodies.   On the negative side, anxiety, fear, worry, depression, poor self worth all lead to tangible effects in blood pressure, energy levels and all around health.

Doctors are often the worst of discriminators when it comes to psychology. We want very much to focus on the physical and explainable.  We spend years and years learning physiology and mechanisms of disease.  We learn solutions.  We see problems fixed.  Patient comes in, we diagnose problem, we fix it.  It is simple and beautiful.  We feel secure in our usefulness and all is well with the world.  Broken bone, I can fix that.  Strep throat, piece of cake.  Broken mind, well, that just complicates everything.

We do get frustrated.  We feel the pinch for our time and the pressure to keep a schedule or to keep billing up.  In this frustration, we may rail against certain patients in our weak moments.  More than anything we feel defeated.

You could say that all this stems from dualism. Yet, it is ironic that as physicians we want the body to be all that is left in this dualism.  Yet these wonderful neuroscientists want to solve the problem by extending the definition of the physical so that it is all that remains.   Perhaps we can successfully in many cases, but I believe this is just a backwards way of doing what is truly needed.   Dualism is only harmful when we isolate one part and ignore the other.

We really need to take into account everything that makes this person a person, and address issues from all sides. This was summed up brilliantly in a book described at length by Adiemus Free at the Health Skills Weblog When illness is a complex life altering problem, we have to realize we won’t be able to do this in an office visit.  We may not be able to do it in a lifetime, but we can stop and enjoy the journey.  It can sure make for one magnificent ride.

When it comes to doctoring, solving life’s problems, or just living life, what we really need is to pay attention to the mental, spiritual, and the physical.   What a healer really needs is to understand the whole person in order to make them whole again.

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