It was too early in the morning on a Monday to have a disparaging thought about Rene Descartes. It all started — and gathered momentum — following a voice note left for me by my clinical psychologist colleague. The events were all too familiar. A young person whom both she and I had seen about three years ago was suicidal. The parents were desperately seeking an evaluation and were informed by my hospital switchboard that appointment slots for that day were full.
I called the father to understand what was happening. The young person, now 17 years old, had become very anxious and distraught about his forthcoming board exams. We had seen him for anxiety disorder earlier, following which he presumably got better as we no longer had any contact with him. On the day when his father contacted us, he had left a suicide note and was prevented from jumping off the terrace by his neighbour, who incidentally happened to be exercising there.
I asked his father to come to the hospital as soon as possible. He soon called back and said that his son has disagreed to come. The young person believed he could not be having a psychiatric illness as he is “not mad”. His father said that it would be impossible to convince him as it would further harm his morale, if they (the parents) insisted that he sees a psychiatrist.
He wanted me to prescribe something over phone. When I refused, he requested me to request any colleague of mine from the medicine or orthopedics department (he once had a sports injury) to see him and prescribe him anti-depressants without telling his son what they were. The parents were confident that he could be brought to the hospital to get a check-up for his bones or physical health but the word “mental” or “mind” cannot be mentioned. Hence, coming for my appointment was not possible.
Most psychiatrists have had this conversation so many times in their career that I assume we all now have a Zen-like attitude when we have these interactions. I no longer feel angry or upset, not the least at the person with whom I am having these conversations. I blame it on Rene Descartes, and it is justified.
Mind-Body Dualism
Most of us believe that mind and body are something separate. Our physical state, which we can see, touch, measure and quantify, is a more tangible “thing” than our minds, which one really cannot see, touch or directly measure. I can measure my waistline and biceps, feel my knees, and therefore know it exists in a physical form. But what about our minds? Can we see it with X-rays or scans? Can it be cut open during an autopsy?
In reality, there is nothing called the “mind”. Mind is located in the brain. Each of us is different with respect to our bodies and our minds. Our minds can be conceptualised as our “personalised” brains. My life experiences, my social environment, my genes, and a multitude of other factors leave an imprint on our brain and create this elusive, shimmering enigma, which we refer to as mind. And yes, it is dynamic, changes from moment to moment, because our brain changes from one moment to another. Hence, as my brain is in a constant flux, my mind can change from one moment to another. It is different from the minds of others because all our brains are different and are being impinged by different stimuli from one moment to another.
However, for centuries, more than 400 years to be precise, we have not been able to shake off from the clutches of a concept known as Mind-Body Dualism. Rene Descartes, a French philosopher born in 1596, has had an indelible imprint on our thinking.
He proposed the idea of Mind-Body Dualism, that is, mind and body are separate entities. He could not have been more wrong. The wide and deeply entrenched acceptance of a theory proposed in 17th century, and more importantly, a view which has been proven to be completely wrong, is at the root of many myths around mental illness. The propensity to view “mind” as something distinct from our “bodies” has contributed to the stigma around mental illnesses.
What did Descartes propose?
According to him, human beings consisted of two quite unlike substances which could not exist in unity. Mind was an immaterial but thinking substance and body was an extended, material but unthinking substance. The body was subject to mechanical laws and the mind was not. Therefore, as described by an academic: “A person lives through two collateral histories, one comprising what happens in and to the body, the other consisting of what happens in and to his mind. The events in the first history are events in the physical world, those in the second are events in the mental world.”
Neuroscientific research in the last 75 years or more have shown that mind and body are not separate entities and attempts to view them as separate is absurd.
French philosopher Rene Descartes had proposed the idea of Mind-Body Dualism
The division of illnesses of human mind from that of illnesses of our physical self is deeply erroneous. It has created a fallacious belief that suffering from a mental illness is a sign of weakness. We do not feel ashamed about our heart disease or osteoarthritis but do so about our depression, anxiety, or schizophrenia. This leads to denial in our accepting treatment
There were other developments in the late 19th and early 20th centuries, which further entrenched this idea that minds are something separate from our bodies. Discovery of microscope and other methods of investigation in medicine delineated that some diseases had consistent, identifiable changes in the organs of human body whereas many “mind” or psychiatric diseases had no identifiable pathological changes in the brain. Blood tests, microscopic examinations and other investigations, which were available then, did not show any abnormalities. Thus, the two separate disciplines of neurology and psychiatry were created. Neurology dealt with disorders, which had consistent pathological or abnormal findings in the organs, namely the brain, whereas psychiatry started dealing with diseases where no abnormalities were detectable. This further cemented the Mind-Body Dualism or divide.
Now we know that this division of illnesses of human mind from that of illnesses of our physical self is deeply erroneous. The division hurts in multiple manners. It has created a fallacious belief that suffering from a mental illness is a sign of weakness as it merely indicates we cannot “control” our minds. We do not feel ashamed about our heart disease or osteoarthritis but do so about our depression, anxiety, or schizophrenia. This leads to denial in our accepting treatment, which leads to needless suffering and at times loss of lives.
Many psychiatric illnesses are multi-systemic, that is, it usually affects a number of organs beyond the brain, during the course of the illness. Therefore, ignoring them often shortens life spans.
Unless we realise that mental illnesses are brain diseases, which are influenced by many factors, like our environment (amongst others), we will continue to struggle like the young person I referred to at the beginning of my piece. I finally managed to see him, after I told his parents to explain it calmly and unequivocally to him that seeking help for what could be a psychiatric illness is not shameful. He is better now.
Dr Jai Ranjan Ram is a senior consultant psychiatrist and co-founder of Mental Health Foundation (www.mhfkolkata.com). Find him on Facebook @Jai R Ram