Or Why We Couldn’t Get it Together Even if we Wanted To
You would expect the most exciting developments in psychiatry to have something to do with medications, or diagnostic procedures, or even some mysterious power of magnetic fields or crystals.
Instead we have learned that we are seldom really conscious. Rather than sitting in the drivers seat, we ride the crest of a multitude of mental functions. Perhaps we attend a kind of secret committee only a minority of whose members are known to us.
Let me try to defend this rather dramatic statement. Research in neuroscience suggests:
- Our brains consist of a number of systems or modules. Although interrelated, these systems can display a surprising degree of independence.
- We all have the experience of being conscious and having control of our thoughts and actions. However, consciousness resists attempts at location in place and time.
- If we ask when in time we become consciousness of an experience, the answer depends on details of the way in which we phrase our question. Different parts of the brain react to an event well before we first know that something has happened. Our conception of what it was that happened changes over seconds, minutes, weeks, and years.
- Brain modules control our emotions, behaviors, and thoughts more than we can guess or imagine.
- These modules manage different aspects of our minds, selves, and perhaps even our souls. Identification of events and their agents, perceptions of beauty, moral judgments and ambiguities, and the emotional color of experience are determined by distinct modules of the brain.
- The ability to be informed by past memories and to form expectation of future events are organized in particular brain regions, functional circuits, and neurochemical states.
Such ideas constitute an exploding area of knowledge in neuroscience. They bridge conventional destinctios between psychiatry, psychology, philosophy, and even spirituality and religion.
How does this impact my personal psychiatric practice?
When a person comes into my office and asks for assistance with a problem or for insight into behavior, I can always fall back on my training. For instance: Such a symptom constellation suggests such a diagnosis and might predict a favorable response to a particular medications. Cognitive and behavioral strategies (all the rage) might offer recipes for altering reactions to persons or events. Psychoanalytic strategies (out of favor and probably socially incorrect) might seek a deeper understanding dating from patterns laid down in childhood that would catalyze personal growth.
Now a different option presents itself. Perhaps we can take a moment to observe the many aspects of ourselves that ultimately are synonymous with self. They must be respected and given due consideration. An undesired emotion or impulse might be understood as an essential element of the whole. It might be appreciated for its intrinsic value and constructively directed. A more functional version of ourselves might result.
One of my mentors used to say that we are all a little like Humpty Dumpty. Sometimes we fall off the wall or sometimes we are pushed. In either case we break into many pieces, which we must try to reassemble. Each piece must be turned over and examined. Some are better discarded. Perhaps there are new pieces to be added. We only hope that in the end we may function better than before.