Friday, November 14, 2014

The mind and the body in (forensic) psychiatry

Throughout the history of human thought, few other distinctions have evoked so much controversy as the one between the mind and the body. In the DSM-IV-TR, it was regretted that the term “mental disorder” emphasizes mental as something distinct from physical, which is regarded as an “anachronism of mind/body dualism” (APA, 2000, p. xxx).

Causation is key to understand the relation between the mind and the body. The body influences the mind (most clearly shown by drug effects), but the jury is still out on whether the mind can influence the body. 

Material determinists deny that it can, mainly based on the lack of a reasonable mechanistic explanation. 

Bi-, or rather multi-directional causation body>mind>body>mind etc, is, however, indicated by e.g. real-life experiences of acts of will, the placebo effect and the influence of expectations on health.

This conflict partly stems from epistemology. The mind is considered in terms of “experience”, “knowledge”, and “being” that are distinct from how the brain and its physiological processes are conceived of. Different types of knowledge are difficult to join in a common model, even if the clinical psychiatrist approaches a person who happens to have a body and a mind.

And different ways of aquiring knowledge do not exclude that information refer to the same underlying phenomenon. 

Just as a notion of beauty may be applied to the same body that is scientifically examined as an organism, and perhaps to some extent even be causally determined by it (correlations between notions of beauty and physiological processes may be assumed), it is obvious that notions of beauty and of physiology operate according to different epistemological premises. The means by which we decide upon aesthetical matters are not the same as those we use in the natural sciences, nor are the concepts used in the different contexts inter-translatable in a straight-forward sense. The use of a plurality of concepts and methods does not in itself imply a plurality of real world items.

In order to meet medical or legal definitions, mental disorder are thought to refer to the form (processes, abilities) rather than the content (subjective experiences, as defined by Jaspers). The form is intuitively thought of as being more "brain-based" than the content. 

This remains an attractive idea. It is a common assumption in psychiatry that there are "real" mental disorders rooted in cerebral malfunctioning, and other, less severe conditions, which are more related to the person and her choices, life-style and experiences. 

But from the perspective of neuroscience, it makes little reason to think that one mental problem should be less "brain-related" than another. The body and the mind are intrinsically linked, mysteriously even.

The epistemological framework of psychiatry does not produce the concepts or the data that can give an answer to what is freely willed, morally good or bad. Science studies regularities, and acts of free will are unpredictable. Therefore, notions that presuppose freedom (such as evil) escape scientific explanations. Needless to say, this does not prevent the consequences of mental processes, e.g. behaviours, to be objectively good or bad.

As long as we do not know how the body and the mind interact to create a human person, nor whether determinism is true or there is a causal effect of free choices, scientific expertise for courts should be carefully worded to express what we know and what we don't know, and to refer to the findings of assessments rather than to legal or moral definitions that presume free will.

Medical conditions can preclude free choice and insight, but medicine cannot say that a specific act was done freely. This does not mean that a judge can't.    

This blog post is partly excerpted from the paper "Mental disorder is a cause of crime" co-authored with Susanna Radovic, Christer Svennerlind, Pontus Höglund and Filip Radovic in 2009. 

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