Showing posts with label schizophrenia. Show all posts
Showing posts with label schizophrenia. Show all posts

Thursday, September 14, 2023

Two Kinds of Association in Our Conscious and Subconscious Minds

In my 2008 book Montessori, Dewey, and Capitalism (86), I wrote:

Freud was the first to identify that humans possess a dynamic, integrating subconscious, the activities of which he called primary process; he called the activities of the conscious mind secondary process. The subconscious is the portion of the mind that we are not aware of, so when asleep all activity of the mind is subconscious; when awake whatever we are not currently focusing on is subconscious. “Dynamic” means continuously active in the sense that our minds are constantly making connections whether we are awake or asleep; if awake, the connections are being made whether we are aware of what is going on in our minds or not. In short, the subconscious can be thought of as a “connection-making machine” (with no concessions to mechanistic materialism intended).
Dreams are the prototype of the subconscious, observed Freud, but dreams are often distorted and illogical (or certainly less logical than the processes of the conscious mind). But, he continued, and insisted throughout his career, every action of our minds has a cause. What is the exact nature of these subconscious mental processes? And what causes the connections that are made?
 
Psychiatrist Eilhard von Domarus (cited in Independent Judgment and Introspection, 89n8), based on his work with schizophrenics, hypothesized that the subconscious, at least in part, and subsequently called the Von Domarus principle, is guided by the formal fallacy in logic called the undistributed middle term. For example, in the syllogism: all dogs are four-legged animals; all cows are four-legged animals; therefore, all dogs are cows, the middle term is the one that appears in each premise but not in the conclusion. Four-legged animals is the middle term that is not distributed, which means that because four-leggedness is in the predicate of both premises neither accounts for all four legged animals. That dogs and cows have four legs does not mean they are otherwise the same.
 
The fallacy is one of overgeneralization—assuming that because two things have one attribute in common, they are overall the same. Young children, until they learn better, make the dogs-and-cows mistake. Members of indigenous tribes (or other adults who are being careless) also make the mistake.
 
And schizophrenics have drawn conclusions like this: The Virgin Mary is a virgin; I am a virgin; therefore I am the Virgin Mary. The predicate term “virgin” is not distributed. Or, they have said: Switzerland loves freedom; I love freedom; therefore I am Switzerland.
 
Silvano Arieti (229-41), agreeing with von Domarus, called the logic of our subconscious primary process “paleologic” and the reasoning of our conscious secondary process “Aristotelian.” The former is paleo because it is old or archaic, predating our educated control of thoughts using Aristotle’s discoveries, especially his three laws of logic. Children have not yet learned the skill of competent reasoning and schizophrenics in their psychotic episodes are living “waking dreams,” having fled reality and being controlled entirely by their subconscious (“flight from the unsatisfying reality” in Freud’s words).
 
Arieti recognized that the errors of schizophrenics are errors of association and generalized them, in somewhat less technical terms than the fallacy of undistributed middle, as the identity of predicates. The schizophrenic, young child, and indigenous person assume that because the predicates in their thoughts are identical, their subjects must overall be the same.*
 
When we are fully conscious, our subconscious is still operating and can make seemingly random associations, but the associations are not totally random. For example, a friend at dinner complains that the food is not well cooked, so I might say, “By association, that reminds me of last week when I was served almost raw chicken,” the predicate being poorly cooked food. And we often experience similar kinds of associations.
 
What determines the selection of predicate, considering that there exists a nearly unlimited field of possible predicates? “Emotional factors,” says Arieti (236). These emotional factors are especially important in understanding schizophrenics, who frequently come up with enormously bizarre connections not unlike those made in dreams. In last month’s post I made passing reference to one’s “private meanings” in understanding the meaning of symbols in dreams. Neither Freud (that I have read so far) nor Arieti use these words, but private meaning is on the Freud Museum’s website. Knowing a person’s emotions and emotional generalizations helps explain seemingly arbitrary associations.**
 
What these associations of the subconscious mind are not are the associations—let me now call them connections—of concept formation, the secondary process of the reasoning mind.
 
We now are talking about two different kinds of association.
 
The conscious mind is able to both connect and keep separate two entities with the same characteristic. The dog has four legs and the cow has four legs, but a cow and a dog are not overall the same. When we form concepts we look for fundamental or essential similarities.
 
Ayn Rand (45-46) gives us the rule of fundamentality to enable us to dismiss four-leggedness as the most essential characteristic of dogs or opposable thumbs, for example, as the essential distinguishing characteristic of human beings. The rule also allows us to dismiss the fact that all humans are capable of building roads, which other animals cannot do, but “building roads” is not the essence of being human. The rule says that the essential distinguishing characteristic of a concept must cause and explain all or most of the other distinguishing characteristics. This gives us the fundamental characteristic(s) and only the capacity to reason meets the rule (and causes and explains the ability to build roads).
 
This process is the operation of Aristotelian logic at its best. The conscious secondary process gives us control, should we choose to exercise it, over the content and processes of our minds.
 
The paleologic of the subconscious mind cannot, and does not, follow the rule of fundamentality. It follows the rule of “identity of predicates.”
 
Having said this, we can to some extent still control our subconscious mind. If we focus and volitionally exercise our conscious Aristotelian logic over time, we can correct the errors of the subconscious.
 
We can also influence the subconscious in problem solving of the creative process. When working on a problem—say, writing an essay—we usually beforehand must do a certain amount of research and thinking about the issue, building up a substantial context for the problem. To sleep on it, a suggestion some of our teachers may have taught us, now allows our associational subconscious to go to work. Sometimes, not always, we may have a solution or part of a solution the next morning.
 
And, occasionally, when I’ve seen a particularly distressful movie, I have been able to tell my subconscious at bedtime, “I don’t want to dream about this,” and often it works.
 
The significance for Freud of primary process in its dream operations, and especially for purposes of psychotherapy, is that the process is essentially the same process operating in the formation of neurotic symptoms, namely condensation and displacement. What seem to be random associations are condensed and displaced emotions with the ideation, the ideas originally associated with the emotions, repressed. And, identity of predicates and overgeneralization are more specific operations in the formation of these symptoms, which will be discussed next month.
 
 
* A valid Aristotelian syllogism, for example, would be: all dogs are four-legged animals; Fido is a dog; therefore, Fido is a four-legged animal. “Dog” is the middle term and is distributed in the first, major premise, because it tells us all dogs are four-legged. Aristotelian logic focuses primarily on the classification of subjects, rejecting the identity of predicates. In this syllogism the subject Fido is a member of the category “dogs” and therefore has four-legs. Arieti (236) is mistaken when he writes, “In Aristotelian thinking only identical subjects are identified.” It is more complicated than that. In the above syllogism, the subject of the conclusion is identified as belonging to the predicate of the major premise.
 
** And by association, “private meanings” reminds me of Alfred Adler’s private logic “to indicate neurotic reasoning, [though his] followers, including [Rudolf] Dreikurs, broadened [the term] to cover thinking patterns of both normal and abnormal psychologies” (Independent Judgment, 65-66n26). Emotion is probably the guiding link in all associations that our conscious or subconscious minds make. (Cf. Freud on wish fulfillment in dreams as discussed in last month’s post.) Subconscious “emotional generalization” is what psychologist Edith Packer has called the effect of repeated, habitual emotional responses to similar persons, objects, or events, formed—by association—without explicit conceptual identification (1, chap. 3; 2).

Wednesday, September 19, 2012

The Science Isn’t There

In my December 2011 post on “Nutrition and the Argument from Uncertainty” I cited and applauded the work of science writer Gary Taubes for unearthing the truth about nutrition science. The upshot was that the science just isn’t there for the conventional wisdom recommending a low fat diet and lots of exercise to protect us against obesity, diabetes, and heart disease. The science instead shows sugars and starches to be the most likely villains.

In a remarkable similarity of investigative journalism, science writer Robert Whitaker, in Anatomy of an Epidemic, demonstrates that the science isn’t there either for the chemical imbalance theory of biopsychiatry. In fact, the evidence in the psychiatric profession’s own literature shows that drug usage for depression, anxiety, and so-called schizophrenia causes more harm than help. In place of a genetic or chemical imbalance theory, Whitaker cites numerous studies supporting psychosocial issues as the causes of psychological problems and psychosocial treatment as the preferred technique to help victims of such problems improve.

To begin the presentation of Whittaker’s argument, let me repeat a point from last month’s post in which I reviewed his earlier work Mad in America: in the pre-drug era of the 1930s and ‘40s analysis of 1400 autopsied brains found no differences between the normal and the psychotic. Given this statement as a sort of prelude, what does Whittaker’s new book say about the chemical imbalance theory?

The theory for both depression and schizophrenia, as it has been tendered by the psychiatric profession, is quite simple. For depression, there is too little serotonin in the brain; for schizophrenia, there is too much dopamine. The drugs, therefore, according to the theory, should increase serotonin to combat depression and reduce dopamine to treat schizophrenia. Measurement of these neurotransmitters in cerebrospinal fluid is the benchmark for both existence and cure of alleged chemical imbalances.

What does the science show? For depression (pp. 71-75 in Whittaker*):

  • Studies in 1969 and 1971 revealed no significant difference between serotonin levels of normal and depressed subjects.
  • In 1974, serotonin levels were normal for unmedicated depressives.
  • Similar results were found repeatedly in subsequent years, leading to this statement (in PLoS Medicine, 2005) by Stanford psychiatrist David Burns: “I spent the first  several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.”
  • And this pointed conclusion by psychiatrist David Healy (in a PLoS Medicine news release, 2005): “The serotonin theory of depression is comparable to the masturbatory theory of insanity.”

A comparable pattern occurred in the studies of schizophrenia (pp. 75-79):

  • No difference between normal and schizophrenic dopamine levels (1974) and no abnormal level of dopamine in unmedicated schizophrenics (1982).
  • Similar results were found repeatedly in subsequent years, leading Steve Hyman, neuroscientist, former National Institute of Mental Health director and former provost of Harvard University, to conclude: “There is no compelling evidence that a lesion in the dopamine system is a primary cause of schizophrenia” (in Molecular Neuropharmacology, 2002).
  • And: “The evidence does not support any of the biochemical theories of mental illness.” Elliot Valenstein, U. of Michigan neuroscientist, in Blaming the Brain (1998).

How do the psychotropic drugs work? They “create perturbations in neurotransmitter functions.” The brain tries to compensate by doing the opposite of what the drug is striving to do. After a few weeks, the attempts at adaptation break down. The brain becomes “qualitatively as well as quantitatively different from the normal state.” Steve Hyman, American Journal of Psychiatry (1996). The drugs, in other words, make the brain abnormal. [Whittaker, pp. 83-84]

The drugs also worsen long-term outcomes. In schizophrenics relapse rates of psychosis increase when neuroleptics are stopped. When on the drug, the brain becomes supersensitive to dopamine, furiously trying to produce more. Upon sudden drug withdrawal, out-of-control, rapid firing of dopaminergic neurons in both the basal ganglia and limbic areas of the brain produce tics, agitation (sometimes leading to thoughts of violence or suicide), and psychotic relapse. The drug then must be brought back. Continued long-term use, however, at some point makes the wild firing of neurons irreversible. Tardive dyskinesia, frontal lobe shrinkage, and permanent psychosis result. (Guy Chouinard, physician, McGill University, in various psychiatric journals 1978-1991). [Whittaker, pp. 105-07]

Whittaker does not stop at depression and schizophrenia. He meticulously documents similarly flawed science and destructive outcomes of drugs for anxiety (the benzodiazepines, such as Valium and Xanax), bipolar disorder (Lithium), and so-called ADHD (Ritalin and its relatives).

Evidence for psychosocial causes of mental illness and the effectiveness of psychosocial treatment?

  • World Health Organization cross-cultural studies in 1969, 1978, 1997 have shown that medicated schizophrenic patients in the US and five other developed countries fared much more poorly—short term and long term—than the mostly unmedicated patients in India, Nigeria, and Columbia. [Whittaker, pp. 110-11]
  • In the pre-drug era, the majority of first episode schizophrenics were dismissed from their hospitals within a year, 50 percent as cured, 30 percent as relieved. Twenty percent or fewer needed continual hospitalization. Today, the recovery rate is 36 percent and patients over a ten-year period require three times as many hospitalizations as their counterparts a century ago. The mentally ill die 15-25 years earlier than normal and their death rate has dramatically increased in the last 15 years. [Whittaker, p. 335]
  • In Tornio, Finland (western Lapland), “open-dialogue” family-centered therapy has reduced first-episode schizophrenia by 90% since the 1980s. Psychotic symptoms often retreat within a month. Drugs are seldom used; if necessary, they are used in modest dosages and short term. One ward of the hospital is empty because schizophrenia is disappearing from the region! (More here: 1, 2, 3). [Whittaker, pp. 336-44]

Bottom line: the science is not there for biopsychiatry. And the above is merely the tip of Whittaker’s iceberg of evidence.

The science is not there for biopsychiatry, just as it is not there for low fat diets. But nor is it there for zero-rate interest and “quantitative easing” in economics as cure of our current Great Recession. What bothers me in particular about psychiatry is the immediate and concrete self-evidence that the drugs cause harm, such as flattened affect, subdued behavior, and the appearance in patients of looking and acting drugged.

One can argue that economic thinking is abstract and the chains of reasoning long. Therefore, failure to understand its arguments may be excused (despite the harm caused by the boom/bust cycle of the 2000’s). But psychiatry, where the effects of the practitioners’ actions are immediately evident? Where the effects of a legal drug show little difference from the effects of an illegal one? That I do not understand.

Whittaker has performed profound service to science by writing Anatomy of an Epidemic. As with the work of Gary Taubes, I urge you to read Robert Whittaker for the science he has uncovered, for the meticulousness of his method, that is, for his epistemology, and for his courage to expose a profession that refuses to examine itself.




*Page references are to Whittaker. Full journal citations are in Whittaker’s notes. For a concise, bullet-point presentation of source documents in both of Whittaker’s books, see this web page.