“If you think your body and mind are two, that is wrong; if you think they are one, that is also wrong. Our body and mind are both two and one” (Shunryu Suzuki, Zen Buddhist Monk).
When a client presents in your therapy room (or perhaps more recently, virtual therapy space), are you aware of your core beliefs and confirmation bias around the ‘Mind Body Question’? Perhaps you offer a specific pure therapeutic approach, or you adopt an integrated approach. Do you believe that you offer your clients a ‘holistic’ approach to psychotherapy?
Mind-Body or Mind and Body?
As a Psychotherapist, perhaps you are familiar with and also working withing a Bio-Psycho-Social framework. No doubt you are aware of professional boundaries. However, does your training and expertise on the mind encourage you or deter you from asking about a person’s history of physical illness and current physical symptoms during an intake assessment? Here are a few hypothetical questions I invite you to reflect upon whilst thinking about your current client intake procedure and ongoing case formulation:
• Does your therapeutic approach allow you to take note of your client’s medical history (Heart disease, depression, cancer etc) and extended family’s medical history?
• Do you take into consideration any / all current medication your client may be taking?
• Do you ever take into consideration your client’s physical ailments such as recurring injuries (like back problems), autoimmune disorders (e.g. Chrohn’s disease), chronic medical conditions (e.g. diabetes type II) as influencing factors on your client’s mental health?
• Would you ever take into account nutritional variables (such as an over consumption of caffeine or sugar as a contributing factor to a person’s insomnia or anxiety)?
• As therapist, do you take into account the physical effects of chronic sleep deprivation on the brain, thereby informing you further of your client’s mood, resilience and mindset?
The role as a psychotherapist is not to diagnose or to pathologize, but how comfortable are you in broadening your initial client assessment to encompass what’s going on for the person in their overall health?
Descartes & Newton – Dualism & Monism
The mind body question is the understanding what the relation between the mind and body is, or more precisely, whether mental phenomena are a subset of physical phenomena or not. French mathematician and philosopher Rene Descartes was instrumental in addressing this very question with the famous “I think, therefore I am” declaration. This offered an explanation of two separate but co-existing entities or substances, the mind and matter. This is now known as Substance Dualism.
Fellow mathematician Isaac Newton’s Laws of Physics, which emerged soon afterwards, offered an opposing view to Descartes – everything that can exist can be measured and calculated and therefore everything in the world can be reduced to matter. The mind is purely a cause of the brain and a body mechanical system. This is now known as Monism.
Some of our psychiatrist colleagues of whom may refer patients onto us for therapy may work from this paradigm – indeed in current allopathic medical training, everything about a human can be explained in terms of their physical body systems (e.g., brains, hormones, neurotransmitters) and is inherently Monist – i.e., only allowing for physical measurement. This same belief is demonstrated when a psychiatrist gives a patient medication, i.e., a change the patient’s brain chemistry will cause a change in the patient’s mood. However, such strong reductionism, which is fair to say has done well in the traditional sciences of chemistry and parts of physiology, has not fared so well in the new sciences of psychology or neuroscience and can lead us to conclude is clearly hopeless in psychotherapy! Afterall, there are no mathematical descriptions or laws of physics for the mind.
Most recent contributions to this debate have been made by neuroscientist Dr Antonio Damasio based on his in-depth study of mid-century philosopher Baruch Spinoza’s “The Ethics”. Along with his own current scientific research, study and debate, Damasio argued that the key neurophysiological insight of our time is “The division between reason and passion, or cognition and emotion (an opposition that goes all the way back to Aristotle), is from a neurological point of view, a fallacy”. This has led us to a new paradigm to view the debate – that of Functionalism.
Functionalism attempts to allow perhaps a more integrated allowance between the mind and brain / body.
Damasio speculates that emotions and feelings are crucial to the evolution of consciousness and, along with it, a sense of self. His theory is both elaborate and counterintuitive, involving a chain reaction that begins when an emotion (defined as a change in body state in response to an external stimulus) triggers a feeling (the representation of that change in the brain as well as specific mental images). In other words, feelings do not cause bodily symptoms but are caused by them: we do not tremble because we feel afraid; we feel afraid because we tremble. Even more provocative is his Spinozist conclusion, that the mind's primary focus is the body.
Functionalism allows for two different pathways to psychiatric illness. For example, is it helpful to ask whether a client develops depression with a normal brain that was “mis-programmed” perhaps through faulty rearing, or, because there is a structural abnormality in his brain? At present, this is still the most popular theory about the mind-body problem among many philosophers.
Conclusion
Once again, let us come back to the question at hand, the Mind Body Question. Are you working from a dualist or a monist perspective? As a professional who is trained to work with the ‘Mind’, is it necessary to be one or the other? As general medical science and overall healthcare evolves and becomes more personalised, I wonder if referring back to this question frequently will also contribute to developing and evolving the practice of psychotherapy, and in turn, further contribute to this ongoing question.
Kiera McCormack is a Counselling Psychologist in private practice, and a Psychotherapy Doctoral candidate at Dublin City University.
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