Has Psychotherapy Lost Its Mind?

• Losing Our Mind
• Talking Neuro-Talk
• Reclaiming the Mind

Losing Our Mind

It’s happening so slowly that we are almost unaware of it. Little by little, psychotherapists seem to be losing their minds. Recent progress in neuroscience has led to the opinion that the mind is out and the brain is in.

We used to think in dualistic terms of body and mind, apart and together, or as two sides of the same coin. Now the mind is viewed as an expression of the brain, and not the other way around. Gilbert Ryle’s concept of the mind has triumphed: there is no ghost in the machine. The downgraded mind has become no more than a scientific misconception. According to Antonio Damasio, it is a remnant of Descartes’ error, the dualist split of mind and body. The only thing that truly seems to matter today is what’s happening within the brain. The mind is relevant only insofar as it has a physical correlate. The brain has won, and the mind has lost in their ancient competition for ascendancy. Maybe it’s just another stage in the evolution of Homo sapiens, or perhaps a paradigm shift in the way we conceive of ourselves as human beings?

The growing prominence of the brain and the body is not only happening within psychosomatic medicine, biological psychiatry, and neuropsychology. Psychotherapists of all persuasions have also been influenced by this paradigm change. Having lost faith in natural observation studies and self-administered tests, an increasing number of mental health professionals have gradually adopted data from biochemistry laboratories and neuroimaging data to explain why people do what they do. Psychological theories are now disposed of as primitive and unfounded folk psychology and have been replaced by scientific evidence from neuroscientific discoveries. The recent popularization of epigenetics has only reinforced this conviction. At every stage of these new findings, it seems as though psychotherapists are gradually losing another piece of their minds. Perhaps large-scale genomic analysis will deliver the final death blow to the mind?

Talking Neuro-Talk

Overenthusiastic media reports have convinced us that we are driven by blueprints in our genes and by various physiological processes. As heard in TED Talks and on YouTube, everybody now thinks that what’s going on in our minds is actually an expression of what’s going on in our brains and bodies. People now assume that when we are stressed out, something has gone wrong within the neural circuitry of our brains. When someone is too excited, for example, it is explained as an overactive amygdala, a deficient regulation of the prefrontal cortex, and abnormal hippocampus mediation. Faulty neurotransmitter messages explain what makes us fearful or sad. Action potentials and neural circuits have become more appealing than analyzing free associations. In the world of psychology today, there should be some kind of biological correlate of every mental occurrence. Psychotherapy should be informed by neurobiology and become neuropsychotherapy.

Perhaps the brain has become so popular because, as a physical organ, it can store data and process thoughts just like a computer? It’s even more powerful than a computer. It can also regulate emotions, modify the neuroendocrine and autonomic nervous systems, and enhance our overall brain functioning by engaging the temporal, frontal, parietal, cerebellar, and limbic structures. This is impressive stuff. As a result, we are no longer categorized as pessimists or optimists. Instead, Elaine Fox suggested we have “rainy” or “sunny” brains. Since brain cells are merely responding to electrochemical signals, Daniel Dennett called consciousness a user-illusion. As a result of these assumptions, Daniel Amen recommended that if we only change our brains, we will also change our lives.

Such neuro-talk is highly appealing to us because we have always had a problem with words such as the soul, spirit, consciousness, self, and personality. Neuronal circuits, on the other hand, or specific parts of the brain, can be observed and investigated. It is, therefore, easier for us to accept that they may in fact regulate what we do, think, and feel. This new language has been extended to everything that is happening in psychotherapy. As a substitute for talking about unconscious childhood trauma that causes later emotional problems, we now search for the various long-term biological effects of early life stress. Instead of talking about the id, ego, and superego, we now regard them as functions of the amygdala, the hippocampus, and the prefrontal cortex. Instead of suggesting that the unconscious is running our lives, we now investigate how the autonomic nervous system, the endocrine system, and the neural circuits in various parts of our brains are affecting us. Freud’s recommendation of putting the ego in the place of the id is now replaced with advocating a better homeostatic balance within all physiological systems. To remain relevant, neuro-psychoanalysis has assimilated this new language into its work.

As a result of this embracing of the brain, more hands-on avenues of healing are now called for when people feel down; psychopharmacological solutions, transcranial magnetic stimulation (TMS), or neurosurgical interventions, to name a few. Anything might work that takes the mind out of the equation. If classical psychotherapy is nevertheless recommended, the goal is no longer to achieve an open mind, but a well-regulated body in balance with environmental stress. It should be firmly based on a medical model of diagnosis, with a focused treatment plan and a follow-up outcome evaluation. Only evidence-based approaches that have been scientifically proven to be effective for specific disorders are recommended. Psychotherapy should be brief, focused, and goal-directed. Even the names of the recommended methods are abbreviated with only a few acronyms (e.g. ACT, CBT, DBT, EMDR, NLP, PE, PT, or SIT). They require following a strict protocol in which the therapist is implementing specific interventions to achieve the desired neurobiological results. If consciousness is at all endorsed, it is achieved through the manipulation of neurotransmitters (e.g. serotonin, norepinephrine, dopamine, and glutamate), rather than by gaining more personal insights. Everything should work quickly, efficiently, and…mindlessly. Therapists have no patience with a prolonged process of analyzing abstract dreams or unconscious fantasies. When the word “head-shrinking” is at all mentioned today, it refers to a reduction of brain cells and the decrease of synaptic connections in aging. It has even been suggested that a neuroscience-based diagnostic approach would be more useful than the present descriptive approach.

Personal memories, which were regarded as the most important parts of our minds, remain relevant only insofar as they can be neuroanatomically located. Such memories have been reduced to engrams: the electrochemical nerve-endings that store and deliver messages between one another. They are now studied as either explicit or implicit and in terms of their affiliation to the old reptilian brain, the limbic system, or the neo-cortex. Rather than talking about past traumatic experiences, episodic memories of fear are assumed to be located in the hippocampus. Nothing escapes such neuroscientific investigations. Even the location of consciousness itself has been sought. Contradicting Descartes’ view that it was situated in the pineal gland, some researchers have suggested that it may be found within the posterior cortical hot zone.

Whereas classical psychology was separated from the physiology of the nervous system, it now seeks to explain how the brain makes us behave, think, and feel. As a result, neuroscience has also become dominant in academic psychology. The hard science of the brain is where the grant money is, and it’s the only thing that truly matters. Research on genetic and environmental interactions has replaced studies in social psychology. Brain imaging has replaced dynamic psychiatry. Cognitive neuroscience has replaced cognitive psychology, and social neuroscience is searching for the neural basis for social interactions. The shift in focus to a biological and/or evolutionary bias is apparent among the 50 most influential living psychologists in the world today.

In our overstimulated world, we are not even asked to keep things on our minds anymore. It’s all stored in our computers and smartphones, before disappearing into the “cloud.” As our lives have become less mindful (and less meaningful), many have turned to mindfulness training. But as long as it is practiced as a quick fix within a biological and “evidence-based” framework, its effectiveness will be more doubtful than mindful.

Humanistic psychology, group therapy, and family therapy have been out of fashion for a long time. The interpersonal feedback promoted in these approaches has been replaced by bio-feedback, such as brainwaves, skin conductance, and heart rate monitors. This feedback is now regarded as more reliable than a compilation of biased human beings.

All of this is, of course driven, by technological progress. Sophisticated machines, such as large computers, optogenetics, electron microscopy, and fMRI, can uncover parts of our minds that were previously hidden. Neuroscientists all over the world are searching vigorously for the neural correlates of all mental phenomena and publish their findings in neuroscience journals such as Psychoneuroendocrinology or Cerebral Cortex, where they later become popularized through the online access of neuroscience blogs.

In today’s cynical world of disillusionments, we have downgraded our minds and our common-sense understanding of humankind because we have realized that our minds can be so easily manipulated. We have been told to stop trusting our own minds, to the extent that we sometimes doubt that they exist at all. At this time and age, some may even recommend getting rid of our minds altogether. It’s almost a relief, since the mind has created so much trouble for us in our lives. Without it, we would be able to cease remembering the past (an end to depression) and stop worrying about the future (an end to anxiety). Perhaps that’s why the power of now has become so appealing?

If we can completely lose our minds, we will be able to celebrate the creation of a true bionic human-machine: a mindless zombie without any complex human spirit. We’ve heard this before. In Vance Packard’s 1959 The Hidden Persuaders, he predicted that eventually, the depth of manipulation of the psychological variety will seem amusingly old-fashioned, and the biophysicists will take over with “biocontrol,” the new science of controlling mental processes by bio-electrical signals.

Reclaiming the Mind

At this point, predictions of the end of the mind have not materialized. Despite all the recent signs of humankind losing their minds, the mind is still very much alive and kicking (even if it is not always doing well).

Researchers couldn’t find the source of Einstein’s genius by analyzing his brain. Nor have they been able to diagnose or treat the personal beliefs, feelings, and thoughts of people by analyzing their brains. While a brain scan (or any other biomedical assessment procedure) may detect electrical currents and anatomical irregularities, they don’t necessarily add much additional information about our subjective vital force.

With all neuroscience research’s progress, we would assume that it could significantly improve the diagnosis and therapy of various mental disorders. However, at least until now, the data gathered from neuroscience have not made a substantial contribution to psychiatry¹. Most psychiatric disorders cannot be validated by laboratory tests, and diagnostic biomarkers are absent from psychiatry.

I had my own neuro-mance for a couple of years. But the honeymoon ended when I realized that there could be no definite biomarkers of Holocaust traumatization². As long as neuroscience cannot answer the “hard question”³of what it’s like to be conscious and experience something, neuroscience will remain neuroscience-fiction for mental health professionals. And since neurobiology cannot directly investigate mental events without reducing them to “something else,” our personal minds remain beyond its reach. Psychotherapists who justify what they do with presently available neuroscientific findings are speaking pseudoscientific neurobabble, similar to what we used to call psychobabble. To my ears, they sound like faith healers preaching gospels wrapped up in abstract medical jargon. Describing people as being “hard-wired” for a specific behavior or dominated by one side of their brains, remains a neuro-myth until these statements can be proven with reliable and valid devices and shown to be manifested in specific individuals.

The mind and body are probably interconnected and interdependent. And even though neuroscience cannot prove the existence of consciousness itself, it has presented valuable data on how our brains function. But at the end of the day, psychotherapists still need a more integrative bio-psycho-social explanatory model in their efforts to understand their clients.



References

1. Schmidt, U., Vermetten, E. (2017). Integrating NIMH Research Domain Criteria (RDoC) into PTSD Research. Current Topics in Behavioral Neurosciences, 38, 69-91. doi:10.1007/7854_2017_1

2. Kellermann, N.P.F. (2018). The search for biomarkers of Holocaust trauma. Journal of Traumatic Stress Disorders and Treatment, 7(1), 1-13.

3. Chalmers, D. (1995). Facing up to the problem of consciousness. Journal of Consciousness Studies, 2(3), 200-219.

 

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