Materialism and Psychiatry

How materialism determines a lack of progress in mental health

I already wrote something about the naive, and so far unsuccessful, materialistic approach toward psychiatric disorders here. Even though I’m not a psychiatrist, I believe, one can fairly frame some opinions based on sound reasoning on a subject where one does not have much expertise by resorting to the good old Hegelian dialectic. Start from a thesis of someone who has the expertise, look for the antithesis of someone else who has the same expertise, and only after pondering about the two opposite standpoints, conclude with a synthesis.

As a thesis, I propose an article by Camilla Nord, head of the Mental Health Neuroscience Lab at the University of Cambridge. The antithesis is a letter, of the opposite tone, by Richard Bentall, psychology Professor of Clinical Psychology at Liverpool University and Former Uppinghamian. Bentall’s letter is from 2016, but remains more than ever actual and worth reading. Going carefully through both could be a good weekend read.

Let’s first briefly summarize Nord’s standpoint.

She claims that the mind-body problem is ruining our health because of the prevalent, antiquated idea that mental health and physical health are considered separately. We should finally get rid of the Cartesian dogma that sees mind and body as separate entities. At the core of several failures in medicine is the assumption that physical and mental health are completely independent, instead of realizing that they are intertwined. We can’t categorize any condition as being either ‘mental’ or ‘physical.’

For example, we know that mental illnesses shorten life expectancy, or that inflammation can cause poor mental as well as further poor physical health. The immune system, the gut, the heart, and even our metabolic processes, like blood sugar, are connected to the brain. These can not only determine our mental health but contribute to our ‘interoception’—that is, our perception of the internal bodily condition. An altered sense or awareness of our bodily experiences can lead to depression or develop chronic pain.

Thus, Nord concludes, it is time to accept the breaking down of the mind-body divide and embrace a fundamental paradigm shift. “Dualism is appealing but wrong.” Let’s face it: “The brain is the ‘final common pathway’ for mental health,” and “our mind is constructed from biological processes.” This will explain everything from the medical to the mystical.

This, in essence, is Nord’s ‘discovery’ and that may sound reasonable and plausible. Even though she doesn’t state it explicitly, it is clear how she favors and advocates for a strictly materialistic approach to mental illnesses: Less psychotherapy, more chemistry, and genetic-based reductionist research on the subject.

And here we can connect to Bentall’s letter to English actor, broadcaster, and narrator Stephen Fry in his gene-centric exploration of maniac depression as he portrayed it in a BBC series on mental health.

I guess that Nord would consider Bentall as one of those “dualists” who are “ruining our health” and responsible for “medicine’s Cartesian struggle.” Because Bentall asks us not to “decontextualize psychiatric disorders, seeing them as discrete brain conditions that are largely genetically determined.” Viewing mental health conditions only as brain conditions suggests that “the only appropriate response is to find the right medication.” Yet, so many cases have been reported of people recovering without any medication. Bentall points out also that “the latest research in molecular genetics challenges simplistic assumptions about ‘schizophrenia’ and ‘bipolar disorder’ being primarily genetic conditions.” “… it is very unlikely that studying [genes] will lead to therapeutic innovations anytime soon.” “… there is still no sign of a medical therapy for this simplest of all the genetic conditions.” “…research funding in mental health is being almost exclusively channelled into genetic and neurobiological studies, which have little realistic prospect of yielding practical interventions.”

Bentall critique is mainly focused on a gene-centric view of mental illness and mentions less the holistic bodily perspective that Nord highlighted. But this doesn’t make much of a difference. Because he reminds us that there is a wide range of social and environmental factors that increase the risk of mental ill health. For example, poverty in childhood, early exposure to urban environments, migration and belonging to an ethnic minority, early separation from parents, childhood sexual, physical, and emotional abuse, bullying in schools, etc. These are combined with a myriad of adult adversities such as debt, unhappy marriages, excessively demanding work environments, unemployment, etc. At least in those cases where these are the underlying causes of mental illness, it makes no sense to look for a causal relationship in the brain, let alone for a drug that fixes people’s issues.

An interesting point he raises is that “exclusively biological theories of mental illness contribute to the stigma experienced by mental health patients.” Because this “makes it all too easy to believe that humans belong to two sub-species: the mentally well and the mentally ill.”

This, in essence, was Bental’s standpoint. Now, here is my synthesis.

I would also add that a purely materialistic understanding of our mental and physical health induces a nocebo effect. If you believe that you can recover from a mental or physical illness only through medication and that any psychologically based therapy is useless, the chances are high that this might become a self-fulfilling prophecy.

Coming to Nord’s thesis. Of course, as she points out, the mind and the body are not two disconnected entities. But precisely this is what I find so problematic. There is something in her subjective perception of how her colleagues think and work that doesn’t square. As far as I know, no psychologist, let alone a psychiatrist, doubts that there is a link between mental and physical health. It is something well-known, and I'm not aware of anybody denying it. Even not among dualists as, in a sense, I am. I never heard someone saying that mind and body are completely independent (perhaps with the only exception of Descartes, and I’m not even sure about that.) Making a quick search on GoogleScholar for “relationship between mental and physical health” I get 1396 results, with research starting in the 1970s. It is about at least half a century that science is telling us how this link exists.

The logical fallacy of Nord is that of conflating dualism with a philosophical perspective that conceives of complete independence between mind and brain. Dualism declares a distinction between mind and brain, not independence. Once you have locked into this perspective, all the apparent contradictions dissolve and reconcile. There is nothing conceptually or logically irreconcilable in stating that the mind (or consciousness, the spirit, life, or whatever aspect of our psychological nature) is ‘non-material’ or ‘non-physical’ (whatever that might mean), and accepting that mind and body are co-dependent. And there is nothing in modern science that rules out some sort of dualism, idealism, or other non-material (spiritual, mystical, or … name it) perspective, only because of this co-dependence.

Of course, new technologies and new scientific evidence have further confirmed this interdependence. But, since it is, in itself, nothing new under the sun, one wonders what Nord is talking about. If there is a ‘Cartesian struggle’ in medicine, it is precisely because the approach she advocates for has been adopted for decades, and did not produce the expected results. It is precisely the long-held belief that we could finally explain away everything about the human mind by studying with increasing detail the human brain, and by dogmatically posting a mind-brain identity despite the tons of neuroscientific facts suggesting otherwise (see my paper about this aspect here) that has led to an exclusively materialistic approach to mental health with potentially catastrophic consequences.

For example, in line with Bentall, the American psychiatrist Allen Frances, former chairman of the Department of Psychiatry at Duke University School of Medicine in North Carolina and member of the task force that produced the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, since 1990 states that “the National Institute of Mental Health (NIMH) suddenly and radically switched course, embarking on what it tellingly named the ‘Decade of the Brain.’ Ever since, the NIMH has increasingly narrowed its focus almost exclusively to brain biology—leaving out everything else that makes us human, both in sickness and in health. Having largely lost interest in the plight of real people, the NIMH could now more accurately be renamed the ‘National Institute of Brain Research.’”¹ While, a review showed that “…despite three decades of intense neuroimaging research, we still lack a neurobiological account for ANY psychiatric condition”.² (emphasis mine)

After all, my impression is that paradoxically, Nord ends up dismissing her own initial statement: She does not accept the mutual interdependence between mind and body. It is all about the body only.

However it is, the point I’m trying to make isn’t just a philosophical, metaphysical, or theoretical rumination about the mind-brain problem. What is at stake here is much more than a physical vs. metaphysical worldview. Everything indicates how this physicalist and reductionist paradigm applied to the brain, body, mind, cognition, and psychiatry may be one of the root causes of a lack of progress in improving mental health. From 2000 to 2019, the proportion of people living with a mental health condition has remained unchanged at 13 percent. According to a research “Between 2011 and 2030, the cumulative economic output loss associated with mental disorders is thereby projected to US$ 16.3 trillion worldwide, making the economic output loss related to mental disorders comparable to that of cardiovascular diseases, and higher than that of cancer, chronic respiratory diseases, and diabetes.” Yet, it is much more likely that you will get billions for funding research on cancer than a few million dollars for mental health. If any, they will be devoted to genetic, molecular, neuronal, and brain-based forms of investigations. While, what people really need are psychological therapies, not the latest biochemical cocktail that worked in mice under artificial laboratory conditions, but that has been largely ineffective for humans. Yet, almost nothing goes into the research and validation of psychotherapeutic approaches. Why?

Because deep down our collective mentality, mindset, worldview, intellectual perception of reality, and, especially, of ourselves, is deeply rooted in a mechanistic and materialistic mind-brain identity preconception. And I’m not talking only of scientists and politicians who, ultimately, have to decide what and how much must be funded and what not. I’m talking of us all, the ordinary citizen, your brother, sister, mother, fiance, husband, or wife. We all live fully immersed in this unconscious dogma that wants us to be none other than biological robots that can be fixed only like a car by the motor mechanic. We believe in this narrative and thereby, perceive naturally a sense of skepticism towards every approach that is not primarily biochemical, mechanical, and material with issues related to mental health. It is a perception and conception rooted in our society that is hard to overcome. And this is only one of the many aspects of our society that are strangled by the suffocating claws of materialism. And, by the way, research on cancer didn’t produce the expected results either. Perhaps for the same reasons?

1. A. Frances, "The lure of ‘cool’ brain research is stifling psychotherapy," Aeon, 4 March 2020.

2. M. Nour, Y. Liu and R. Dolan, “Functional neuroimaging in psychiatry and the case for failing better,” Neuron, vol. 110, no. 16, pp. 2524-2544., 2022.