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A biosocial model of mental distress and treatment

There is a long controversy about what causes people to go mad or become depressed. Broadly speaking, two kinds of causes are put forward as explanation - first that people become distressed or psychotic in response to oppressive circumstances or poisonous relationships, and secondly that these states are caused by some kind of biochemical or physiological malfunction in the brain. Each of these positions has a consequence in terms of how people are treated: in the first an attempt is made to make an empathic relationship with a human being in distress, in the second people are treated with drugs or electroshock.

This division between social/psychological cause on the one hand versus biological on the other, implies that there is a process of social causation of madness or depression operating in the brain independently of biological processes - a split which goes back to the 17th century French philosopher Rene Descartes. It leads to overwhelming confusion when people refer to an interaction of biological and social factors - how do they interact if they're ontologically distinct - surely not in the pineal gland - Descartes solution.

The view I want to put forward is different - biology, psychology, sociology are studying a unitary phenomenon - the conscious activity of human beings interacting with the world, but they are studying it in different ways.

The different areas of enquiry can be seen as different levels of analysis of a pillar of knowledge. Each discipline studies phenomena using techniques, methodology, concepts, appropriate to their particular level. So, for example, at the bottom there would be atomic physics and above it chemistry, then biochemistry, physiology, psychology, sociology etc. As you descend the areas of knowledge become more universal; thus a stone is a physical or chemical phenomenon but not a biochemical or physiological one.

Professor Steven Rose has analysed the muddled thinking that results when the scientific concept of causation is used to relate objects from different levels of analysis. He has identified five major different ways in which causation is used by biologists, but argues that the appropriate use of the concept is restricted to describing the interaction of objects over a time period - within a single level of analysis. An example would be a nerve cell generating an impulse after stimulation arriving from another nerve cell.

He argues that the correlations between sequences of events at different levels are best described as 'translations'. Although a phenomena describable at one level may be described at the level above or below it using the techniques and concepts appropriate to that level, it is not 'reducible' to that level.

A theoretical concept which has come into prominence in Biology in the last 20 years is autopoiesis, developed by Chilean scientists Humberto Maturana and Francisco Varela. Autopoiesis defines a living structure as a network of components each of which plays a role in maintaining and reproducing the network. An autopoietic network is one which is open to matter and energy, but organisationally closed.

Each component exists in relation to several of the others in the network and relationships are characterizable as positive or negative feedback loops.

Autopoiesis can exist at all of the different levels I have been talking about - at the level of a cell, at the level of an organism, at the level of society. However, for an autopoietic network to operate at a particular level, it constrains the components of the level below it

Anyway, what I have just realised in trying to think through what the difference is between say, behaviour associated with brain damage, and say, a conversation, (both describable in biological terms) is that in the one with brain damage, autopoietic networks at a high level have been broken in to and the autopoietic network destroyed. Which is also of course what happens in electroshock and lobotomy.

With drugging, the situation is more complicated. To explain I will first outline some elementary biochemistry

Seen from a biochemical perspective, the body is an interconnected metabolic web of a vast number of interconnected biochemical reactions. A reaction is a process which transforms molecular structures of one kind or another (the reactants) into different ones (the products). In very few reactions are the reactants entirely converted to products - the proportion is determined by the relative energy states of the products and reactants. The reaction 'goes forward' until a balance point, or chemical equilibrium is reached - if the proportion of 'products' exceeds that of the equilibrium point the reaction goes 'backwards' until it is reached.

One of the first things you learn in biochemistry is that in a living organism, no reaction ever goes 'to completion' (to the equilibrium point) The body is constantly taking in (high energy) food, using it to create structures and maintain processes, and excreting low energy waste. All biochemical reactions are in a permanent state of imbalance - if they weren't, you would be dead. Each biochemical reaction is using as reactants the products of previous reactions, and its products will in turn be reactants of new reactions. If this stopped happening, there would be no metabolic web. So it is indeed a very interesting question to consider what psychiatrists mean by the infamous 'biochemical imbalance'.

When someone is in a psychotic (mad or depressed) state, their brain biochemistry reflects that. As I have made clear, it is meaningless in any sense to say that any of that brain biochemistry 'causes' their madness or depression. Their experience is a product of their lives and their (physical/mental) interaction with society. Their brain biochemistry is constrained by autopoetic networks at a higher level than a biochemical perspective - the interaction of the brain/mind's components through feedback loops and reflected in the metabolic web certainly corresponds to a different physiological configuration than, say, when someone is in a very relaxed or happy state. However, I would argue, it is in an appropriate state relative to their life/the world.

A recent insight in biochemistry is the concept of 'dissipative structures' developed by Professor Ilya Prigogine to describe stable webs of reactions where all the reactions are connected by the fact they are all in imbalance. What Prigogine has been doing is to investigate the pattern of events in dissipative structures far from equilibrium. He has modelled this using non-linear mathematics to explore the 'strange attractors' (mathematical models of the most stable energy states) produced by dissipative structures, and how very small initial changes can flip these patterns into something completely new. The mathematical models show that the further the reactions are from equilibrium, the more often possibilities of new directions in which the complex of reactions can go (called 'bifurcation points') arise, and the less predictable changes become.

The journey of someone who has broken with 'normality' and is in a terrified, crazy state can (given support) result in order - new insights about oneself or the world. This process is paralleled at a biochemical level by the order emerging from transformations of dissipative structures.

If a psychiatrist gives someone psychotropic drugs to change the pattern of excitation of particular sets of neurones they may well make someone a bit happier on a temporary basis, but they have changed the interaction of the components of an autopoietic network which has made the person mad or depressed and in fact artificially pushed the whole metabolic web in an artificial direction - with all the 'side-effects' so well documented by Peter Breggin. Precisely because it is an autopoietic network maintained by feedback loops the brain will fight against this artificial shift. This is why when someone tries to come off psychotropic drugs they often go into a worse state because the brain has tried to compensate for the drugs and it takes some time for the brain to come back to a stable state again.

Treatment with drugs is simply tampering with brain physiology by altering patterns of conductivity across synapses. The drugs are not part of any cognitive process - they have no information content relative to the other person's crisis - they represent a refusal to engage with the person as another human being. Of course they alleviate distress on a temporary basis, but you could argue that removing someone's brain is even more effective. In fact if we adopted mind control on a global scale, we could make everyone in the world 'happy' by drugging them - you don't like the American invasion of your country, or your childs just died of disease or starvation because of an IMF structural adjustment programme - have some Prozac sir. Psychiatric diagnosis represents a refusal to engage with the content of people's thinking and feeling in psychotic states - because within the madness, there is truth which threatens their ideological world view.

What we should be doing is responding to people in distress in an empathic or supportive way - at a biological level the interaction of two brains. Here is a process which is biochemically and physiologically specific to the individual person and the crisis they are going through. As a product of the evolutionary process, we have developed the ability to be with someone in extreme distress and to intuitively know how to 'reach for' the heart of the problem and to 'be with' that person.