Posted on by admingpb

Observing Ego

There is a rather delightful aphorism from the yogic traditions, which will paraphrase, and perhaps mangle a bit:

I have feelings, but I am not my feelings.  I have thoughts, but I am not my thoughts.

This pearl of exceptional wisdom should probably be on a plaque on the wall of every therapist and psychiatrist in the world.  For this is, in essence, the purpose of many forms of psychotherapy.  In cognitive models one learns to identify negative thoughts as not intrinsic to the person.  In psychodynamic models, one learns that we are distinct from the patterns we unconsciously repeat in life.  In family therapy on learns that one is affected by and affects the family system but is not identical to it.  This is the essence of developing an observing ego.

Posted on by admingpb

Psychiatry and Consciousness

One of the most amazing questions I’ve found is the mystery of consciousness. The quest to explore it drove me towards the study of psychology as an undergraduate, and towards psychiatry after medical training. Psychiatry, at least historically, had a depth and breadth that seemed to allow real exploration of questions of consciousness. After nearly two decades in the field, and experience in academic and clinical psychiatry, it is truly peculiar to observe the minimal interest of my field in even asking the relatively hard questions. Many colleagues comfortably assume that all the questions of relevance have already been answered in the form of biology.

Until quite recently, consciousness was considered a taboo subject for research or consideration in mainstream academia. Not only ignored or defined into non-existence, the topic was considered quite dead until several authors began raising the timeless questions with new and serious discussion: authors such as David Chalmers, Roger Penrose, and Daniel Denett. The first two of whom used Godel’s Theorem as the starting point of their discussion on mind, brain, and consciousness. The discussion of the forbidden “C” word re-entered both public and academic life for the first time in decades.

David Chalmers has been credited with formulating the “hard question,” which is essentially the question of why is there mental experience at all. Or, how does the physical presence of a brain actually lead to subjective awareness, which he terms “qualia.”

Much more on Godel, Chalmers, Penrose and others later, but this essential question that Chalmers so perfectly framed remains the focus. Why indeed would a complicated physical system, such as a brain, necessarily result in subjective experience for you or for me? Answers to this question range from monistic versions of reality to dualism of various sorts. We’ll start this exploration looking at those two general models and later consider the limitations implied by Godel.

Posted on by admingpb

Transformation

One of the newest fads in the field of psychiatry and neuroscience in general is the notion that addictions to various substances or behaviors are in some manner biologically “caused.” This is usually an argument based upon the connection of activation of the reward circuitry of the brain with the substance or behavior. Aside from the basic logical truth that this confuses a simple correlation with potential cause and effect, it also assumes that individuals with no addictions have minimal activity within the reward circuitry.

I would have to imagine that if I sit down and enjoy a favorite food and truly savor it, that the reward circuitry of my brain in in some manner mediating this experience. However, my enjoyment of the food does not necessarily lead to out of control eating or addiction.

The errors of the deeply biological explanation ignore the basic realities of experience that patients and friends clearly describe when they change their behavior in pretty profound ways. As an example, a patient I evaluated described ceasing the use of tobacco, one of the more biologically addictive substances on the planet. She said that at the moment her grandchild was born, she had in instant revelation that if she didn’t stop smoking she would never see her grandchild graduate high school. She ceased a several decade history of smoking in an instant. She reported that there had been a few carvings which she ignored and then she knew herself to be a non-smoker.

What changed? How could this addiction disappear in a moment?

The biological answer can only be that a rapid change occurred in her association cortex, which altered the meaning and neural networks related to the behavior of smoking. Even if the desire for the substance is mediated by the reward system, it seems that the connection with the reward system can be instantly disconnected by a transformation of the meaning of the behavior.

Brings to mind the people, places, and things comments of the 12-step groups. All things related to the association network of neurons.

This simple question of how an addiction can be broken really opens a phenomenal series of questions about who we are, how we change, and what layers of the self regulate thoughts and behavior.