The pernicious effect of mind/body dualism in psychiatry

Abstract

The purpose of this review is to clarify and demystify a set of ideas and assumptions, which pervade the field of psychiatry and cause confusion and unfortunate consequences for the practice and teaching of psychiatry. These crystalize in the so-called mind/body problem or mind/body dualism. Mind/Body dualism has adverse consequences for psychiatry, such as stigmatization of mental illness, restricted funding for research and patient care, discrimination against patients with psychiatric or addictive disease in the insurance market place and leads to cognitive distortions affecting the training and practice of psychiatry. This paper attempts to deconstruct a set of ideas, which tend to under girth our intuitive mind/body dualism and proposes that neuroscience is increasingly capable of describing human cognition, emotion and psychopathology as the manifestations of brain activity. Psychiatry operates in a border region of the neurobiology of the brain and mind. Mind is the overarching concept incorporating notions of consciousness, phenomenological experience, free will and the idea of the soul. Psychiatric practice involves modifying brain functions by the use of medications and other means, as well as interventions broadly described as psychotherapy. Psychiatry as a medical discipline has an ambivalent and uneasy relationship with the idea of mind/brain. In this paper, we attempt to trace this tension to the pervasive, intuitive mind/body dualism that lay people as well as scientists tend to adopt. A rapidly growing empirical literature is eroding the idea of mind/ brain dualism. We will review claims that consciousness, first person phenomenological experience or "qualia," and free will are ontologically beyond the grasp of empirical study. A growing number of neuroscientific research results are placing increasing constraints on these claims. We suggest an alternative view based on the philosophy of pragmatism, which we believe would recommend a critical reappraisal of our intuitive beliefs, by means of an empirically responsible stance. The literature on these topics is extensive. We restrict our review to very recent results from neurobiology.