Big ideas: Knowing yourself – and your mental state – in new ways

Each one of us will be touched by mental illness.

According to the World Health Organization’s (WHO) 2011 Mental Health Atlas, more than 450 million people worldwide suffer from neuropsychiatric disorders, – and the numbers continue to grow. For those of us whose lives have been, or will be, impacted by mental illness, the predominant question is:

How can the mental health of those who are suffering be restored?

A variety of answers have been put forward in response to this question.

In 2013, WHO identified four objectives for promoting mental health including:

  • Better leadership and governance for mental health;
  • Development of comprehensive and integrated community-based mental health and social care services;
  • Implementation of strategies for promotion and prevention; and
  • Improved information systems, evidence and research.

While each of these objectives is equally important, the last objective is the one I want to focus on here, because it leaves open the question of what kinds of improvements to information systems, evidence and research are relevant for promoting mental health.

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I want to make a recommendation for one such improvement here, from the vantage point of philosophy, which may seem like a very small, mundane and even obvious idea. However, I think it is actually a big idea, which has been around for centuries, which we sometimes lose sight of, if we even realized it in the first place.

It has to do with the conceptual-theoretical framework we humans use to describe our suffering, and what role that framework does and ought to play in both clinical and research settings.

One fundamental aspect of being human is, we learn to adopt what philosopher Daniel Dennett dubbed “the intentional stance.” Specifically, we come to believe human beings, as well as some non-human animals, have some special quality – a mind, consciousness, awareness – that other kinds of things, like rocks, stars and trees lack. We describe ourselves as having beliefs, desires, feelings and intentions. We ascribe similar internal states to other human beings, and some non-human animals. We appeal to these states to explain our own and others’ behavior.

In the context of psychiatric care, it is the predominant conceptual-theoretical framework clinical psychiatrists, psychologists and medical practitioners use to understand their patients’ experiences and diagnose them. It is the predominant framework patients use to explain the ways in which they are suffering. I take it, then, recognizing the role this conceptual-explanatory framework plays in understanding and explaining mental illness to patients, and their loved ones, is fundamental for promoting human mental health. This may actually be a fact no one would deny.

However, it is also vital for us to understand this conceptual-explanatory framework has come under attack by philosophers like Paul Churchland, who claim it is antiquated and should be eliminated in favour of a conceptual-explanatory framework that places the mind squarely in the physical world. There are certain negative implications of clinging to our current conceptual-explanatory framework of beliefs, desires and feelings.

The most notable is it is compatible with dualism – the idea the mind and body are separate things. Dualism, in its extreme forms, jettisons the mind and mental disorders from the physical world, placing them beyond the realm of scientific understanding.

Yet, this conclusion is unpalatable.

If the mind cannot be understood by science, and we concede medical science is essential for restoring mental health, persons with mental illness are beyond hope. But why shouldn’t physical and mental ailments be regarded as on a continuum? Is having a broken mind really so different from having a broken leg?

Maybe we currently know more about the causes of broken legs and how to treat them. When it comes to mental illness, perhaps Churchland offers a perspective more conducive to promoting mental health. His view serves to eliminate the stigma associated with mental illness, and insofar as it allows for the possibility that advances in science will improve our understanding of mental illness, and point the way towards viable strategies for intervention, it also affords the hope of a cure.

It is important to realize, however, while there is a growing and widespread consensus the mind is the physical brain, the relationship between the two is far from clear. Although neuroscience made great strides during the Decade of the Brain (1990-99) and continues to do so, it remains an open question how the mind, mental states and consciousness fit into the physical world.

It is thus premature to abandon one conceptual-explanatory framework in favour of the other.

If we now start treating broken minds like broken legs, we may neglect relevant psychological, social and cultural causes of mental illnesses and overlook potential avenues for treating mental illness. If we devalue the conceptual-theoretical framework that laypeople use to understand their own health and well being, we run the risk of alienating them to the extent that they will not seek treatment. Yet, we also must make them aware of advances in science that are relevant to their well-being.

So, the big idea is this:

SULLIVAN

SULLIVAN

Engaging patients who suffer from mental illness, if they are able, in a dialogue about the different, and even opposing conceptual-explanatory, frameworks that are relevant for them to understand the nature of their suffering will empower them with information that is crucial to restoring their mental health. Gaining such information is fundamental for ‘knowing thyself,’ and knowing themselves in ways perhaps patients have not thought about, may bring those who suffer from mental illness one step closer to health.

Jacqueline Sullivan is a Philosophy professor who explores the research areas of neuroscience, mind and science.