Objective Mental Health I

Beyond The Realm of Choice

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The psychology student reading this article might be surprised by seeing Alexander's name next to those of Freud and Breuler, as he is often considered a minor author in college courses. His work, however, is far from minor - although his ideas are based on his predecessors, he adopted an Aristotelian approach, giving non-contradictory definitions to his concepts, and revising the work of previous psychoanalysts to rid them of unwarranted assumptions.

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Anti-psychiatry was a movement spearheaded by Franco Basaglia (1924 - 1980), Thomas Szasz (1920 - 2017), and other psychologists in the 1960s. Influenced by Existentialists like Martin Heidegger (1889 - 1976) and Neomarxists like Michel Foucault, these authors  considered the existence of psychiatric hospitals, as well as the use of physical restraints, sedatives, convulsive therapies and other tools for psychiatric treatment as forms of oppressing marginalized individuals in a society. In the USA, the movement has been responsible for the near extinction of involuntary commitment, and the gradual replacement of mental hospitals with home care and halfway houses. This has since led to an increase in homelessness,   acts of terrorism by the insane, as well as their incarceration.

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With all his merits as a philosopher, Leonard Peikoff’s stance on mental health has been rather ambiguous - oscillating between two equally mistaken views. In his lecture on post-modernity and schizophrenia, Peikoff talks about how one’s lack of conscious standards can cause the disease when, in reality, it can only hinder one’s ability to manage a pre-existing condition. When talking about depressive disorder in his personal website, however, Peikoff describes it as a “chemical imbalance in the brain”, completely ignoring the role of one’s choices, habits and environment in the illness.  As I will explain throughout this article, mental illnesses are caused by the interaction between physical, environmental, behavioral and volitional factors - they cannot be caused by a conscious belief, nor reduced to chemical imbalances. 

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An abnormality is simply an existent that strays from the norm - to that which is common, or to a pre-existing set of rules, depending on the context in which the word is used. As Ayn Rand explains in her many critiques to collectivism, the actions, values and beliefs of others are not a proper standard with which to judge one’s own life - the rational identification of one's nature is.

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One can argue that certain mental conditions can be reduced to specific physical pathogens, such as tumors or parasites in the brain. These, however, are neurological problems, and grouping them together with psychological illnesses would be akin to saying the feeling of exhaustion caused by a flu is a mental illness, not a mental reaction to the physical disease.

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It is worth noting that the nervous and endocrine systems are merely those whose interactions are more clearly related to mental phenomena, but this isn’t, by any means, an exhaustive list. The digestive system, for example, is essential to the experience of hunger and thirst, which are mental phenomena, and the extent to which that relationship is mediated by the two aforementioned systems, or independent of them, is still unclear.

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The mind-body dichotomy is the false belief that mind and body are two distinct existents, often with contradictory natures. In Ayn Rand’s more eloquent words:
“They have cut man in two, setting one half against the other. They have taught him that his body and his consciousness are two enemies engaged in deadly conflict, two antagonists of opposite natures, contradictory claims, incompatible needs, that to benefit one is to injure the other, that his soul belongs to a supernatural realm, but his body is an evil prison holding it in bondage to this earth—and that the good is to defeat his body, to undermine it by years of patient struggle, digging his way to that glorious jail-break which leads into the freedom of the grave.” - 1957, Atlas Shrugged, p.138

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With regards to the relationship between mind and body, Ayn Rand disagrees with the vast majority of philosophers, who are either materialists or idealists. Materialists see the mind as a superfluous consequence of the physical factors that give rise to it, whether directly like Behaviorists and their belief that thoughts are mere pre-determined responses to the physical factors that originate them, or indirectly, as in the Marxist belief that our ideas are determined by our economic context. Idealists, on the other hand, believe that the mind has primacy over the physical world - to the Pragmatists the physical world is the creation of a universal mind, while Hegelians and Platonists believe physical existents to be “vessels” for universal ideas.

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Traditionally, schizophrenia has been attributed to problems with one's dopamine receptors, in what is known as "The Dopamine Hypothesis". In recent years, scientists have also linked the illness to serotonin and glutamate receptors. Stephem M. Stahl has condensed these hypothesis in this 2018 paper.

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Kolomeets and Uranova found a correlation between schizophrenia and a reduced density of oligodendrocytes in layer 5 of the prefrontal cortex. Sweet, Sampson and other researchers have found a correlation between the illness and reduced dendritic spine density in the auditory cortex. Many other researches point to the same direction - although the causality is unclear, there seems to be a link between the illness and the lower density of certain parts of the cortex.

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The very term “psyche” was coined by the ancient Greeks, whose popular culture was considerably more rational than our own. To them, the psyche was not “the mind”, understood as something distinct from one’s body and physical existence, but a form of “life force”, which denoted, simultaneously, the process of being conscious and the process of being alive - similar to Ayn Rand’s view of consciousness as a biological process. A “psychic” problem, in Greek terminology, does not refer only to an emotional or cognitive issue, but to a problem with the integration of the individual as a whole to his surroundings.
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Ayn Rand differentiates between metaphysical and man-made facts. The first type refers to that which is independent, and outside of the scope of Man’s choice, such as the law of gravity. The second type refers to facts caused by Man’s choice, such as the existence of political systems.

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Cognitive habits are the methods utilized automatically by the individual to identify existence. The term subsumes both perceptual habits, such as the way we direct our eyes in the perception of entities (do we focus first on the shape of an object, or the details of its texture?), and conceptual habits, such as the way we formulate a concept (do we start by keeping its instances’ differences or the similarities in mind?).

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Motivational habits are the methods utilized automatically by the individual to integrate their actions and emotions. The term subsumes both valuing habits, such as the way we adjust our value-structure to new identifications (do we gradually adjust single value-judgements, or stochastically adjust large sets of value-judgements?), and integrative habits, such as the way we adjust our emotions to past events and future expectations (do we visualize discrete possible scenarios which each elicit specific emotions, or contemplate a general statement about the future?).

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    We understand the nature of physical existents with much greater precision than we do their mental counterparts. Centuries before Christ, Greeks and Egyptians already understood many of the basic principles that still guide contemporary physics and biology, yet attributed psychic phenomena to gods and other supernatural forces. Nearly 500 years ago, geniuses like Galileo, Newton and Darwin set themselves on the task of emancipating the natural sciences from faith and mysticism - mental health, on the other hand, was treated even more irrationally than before, with the mad being ostracized or burned at the stake.

    While the natural sciences have developed for over 2000 years, it hasn’t yet been 200 since pioneers like Gustav Fechner (1801 - 1887), Jean-Martin Charcot (1825 - 1893) and Josef Breuer (1842 - 1925) took the first steps towards an objective understanding of the human mind. In fact, one can argue that the field of psychology only rid itself of mysticism generations after its founders - and even its most famous proponent, Sigmund Freud (1856 - 1939) - with the systematic work of intellectuals like Erich Neumann (1905 - 1960) e Franz Alexander   (1891 - 1964). This would put the age of Psychology, as an objective science, at about 80 years.

    As a consequence of this relative youth, the same average individual who understands complex ideas like “gravity” and “natural selection” reasonably well, has very little clarity when it comes to mental health. This is specially true in America, where the science of psychology was introduced by anti-reason intellectuals such as William James (1842 - 1910) and C.S. Peirce (1839 - 1914) - the same Pragmatist intellectuals who, as I discussed in a previous article, championed state-enforced eugenics, and the failed education system in place today.

    From the left, we are bombarded by Post-modernist and Neomarxist intellectuals, who echo Michel Foucault’s (1926 - 1984) view of mental illness as an oppressive social construct - a preposterous idea that crumbles when we observe the very intimate suffering of a patient afflicted by delusions, or the monumental failures of the anti-psychiatric movement  . From the right, views range from the old-fashioned mysticism that attributes mental illness to demons and evil spirits, to the pseudo-scientific moralism of those who try to treat homosexuality and the healthy use of drugs as problematic.

    On top of the politicization of mental illness from both the left and the right, there is something even more insidious: materialistic scientificism. Common among Positivists, Pragmatists, and even some Objectivist intellectuals like Leonard Peikoff, psychiatric materialism tries to reduce mental illness to neurological and hormonal problems. On one hand, it completely ignores the role of philosophy and personal choice in one’s mental health and, on the other, it often reduces the very study of brain physiology to statistical analyses.

    This is the first article in a two-part series aimed at fighting the main myths surrounding mental health, by explaining the nature of Man’s mind, and the main factors involved in its proper functioning. I will talk about the relationship between mind and body, as well as the role of environmental and social factors on one’s mental health. Lastly, I will explain how the ideas and habits adopted by an individual influence their mental health.

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What is Mental Illness?

    The first thing to keep in mind is that abnormalities are not mental illnesses.  The purpose of an individual should be his own flourishing and happiness, not his adequacy to collective standards, as unanimous or “natural” as they might seem. An unusual behavior, such as the sexual attraction to one’s own sex, is just that - statistically unusual. The sexual attraction to children, on the other hand, causes suffering to the individual, as well as to his possible victims, and that is what makes it pathological.

    Destructive behavior by itself, however, is not necessarily a sign of mental illness. The German Nazis, for example, brought unfathomable destruction to themselves and, most importantly, to their millions of victims - but Nazism is not a mental illness. They chose to do what they did by consciously adopting evil values. In contrast, and individual who, in the middle of a delirious episode, takes another life, does not do so by choice, but precisely because he has lost the ability to choose.

    It is worth noting, however, that pathological behavior, i.e. destructive, non-chosen behavior, is not a mental illness, but a symptom. An individual is not crazy because he talks to his fridge - he talks to his fridge because he is crazy. What exactly, then, is mental illness? What causes pathological behavior?

    Mental illness is the partial or total loss of one or more mental faculties. Man is able to execute several mental processes - we can perceive the world around us, integrate these perceptions into a cohesive narrative, issue value-judgments, plan and coordinate our actions, etc. These faculties are not superfluous, but essential to our survival and flourishing - and their emotional consequence, happiness. The loss or hinderance of one or more of these faculties to the point where the pursuit of happiness becomes impossible constitutes a mental illness.

    Lastly, it is important to note that mental illnesses are not diseases, like AIDS or COVID, which are caused by a specific pathogen.  They are syndromes - a set of symptoms caused by multiple causes, none of which are sufficient or essential on their own. Every mental faculty is a result of the complex interaction between multiple factors, and any imbalance in these interactions can distort or extinguish the resulting faculty.

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Physical Factors: The False Mind-Body Dichotomy

    The first type of factor is physical. Every mental process is mediated by physical processes, from the chemical reactions inside a single cell to the multiple interactions in the nervous and endocrine systems.  Despite the marginal influence of our experiences on our physical structures, they are essentially determined by our genes. A malnourished child, for example, might not fully develop its brain - but the development of one’s brain is not dependent on the details of their diet. It doesn’t matter whether someone ate tomatoes or potatoes in their childhood, as long as they acquired the nutrients necessary for the development of their brain according to their genes.

    Contrary to the claims of determinists and materialists, these physical processes do not define the mental acts or the contents of an individual’s mind. However, our physical structures are not some type of “general hardware”, able to run any and every “program” - contrary to what idealists claim, the mind is not independent of the physical processes that mediate it. These views are the two sides of the mind-body dichotomy, which has been properly identified and refuted by Ayn Rand.

    Mind and body are not two distinct existents interacting with one another, but two aspects of the same existent - they can be conceptually abstracted from one another, but are not metaphysically distinct. Thought is an aspect of the physical processes that mediate it, and vice-versa - the act of thinking is the act of directing these physical processes. In more concrete terms, it is not a hormonal change or the execution of certain synapses that causes a happy memory, nor the memory that causes these processes - the act of remembering is the act of executing these processes.

    As an example, let’s look at schizophrenia, which can best be defined as the loss of the faculty of distinguishing between external and internal reality. There are several physical factors correlated with the illness, from the high sensitivity of one’s serotonin and dopamine neuroreceptors   to the low density of the upper layers of one’s cerebral cortex.   In spite of the correlation, however, none of these risk factors are defining. Some people are born with all of them, and live completely healthy lives, while others develop severe schizophrenia in the absence of any.

    Why?

    Because every single person can lose that specific faculty, under the right circumstances. If you take a completely healthy individual and deprive him of sleep for several days, he will start to hallucinate, become delusional, and lose his sense of individuality - classic symptoms of schizophrenia. Every faculty is subject to different forms of stress - to a partial or complete loss in case of problems with the resources needed for its maintenance. Our physical structure determines the level of stress we can endure before we lose our faculties, but not the level of stress to which we are subject to.

    A good analogy is thinking about our physical constitution as a car - it is the means we use to get from point A to point B. A person born with the neuro-hormonal equivalent of a Panzer can drive through any troublesome road, and does not need to be a particularly skilled driver - it’s so resilient, it will only break down under very extreme circumstances. Someone born with the equivalent of a BMW will function even better than the first individual, if driving on a well-maintained road, but must avoid holes because, although it is more efficient, it is also less resilient. In contrast, someone born with the equivalent of a 3-wheeled VW Bug needs to be an exceptional driver to reach their destination, and avoid any troublesome roads. The most severe cases of brain tumors and genetic abnormalities equate to a car without wheels or an engine - driving is physically impossible, regardless of the driver’s skill or the road’s condition.

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Environmental Factors: Life as a Dynamic Process

    If our physical makeup is a car, our environment is the equivalent of a road. Life is a process of constant interaction between an organism and its environment. Whether we’re talking about food, light, heat or mental stimuli, to live is to interact with our surroundings, identifying and utilizing the available resources to promote our own existence. Resources, however, are never a “perfect fit” for the organism, and their very use brings about certain costs.

    Drinking water from a river will quench our thirst, but it will also introduce bacteria and other undesirable entities into our bodies - we actually have entire systems dedicated to deal with these entities, such as the excretive and immune systems. This cost-to-benefit analysis is an essential part of every life-form, and varies not only with the nature of the organism, but also with the options available to it.

    A person’s physical and psychic structures define their objective relationship to the existing resources - certain needs and restrictions that must be met to ensure their proper functioning. Milk, for example, is an ideal source of fat and protein to some, while others have a lactose intolerance - which, in turn, varies from a mild indigestion to severe pain and nausea. The same is true of mental stimuli. The same battlefield tension that triggers Post-Traumatic Stress Disorder in some, is pleasing - and even addictive - to many professional soldiers.

    It is important to note, once again, that mental illness is not a social construct. Societies can incorrectly normalize certain pathologies, or treat healthy behaviors as if they were pathological, but opinions, however popular, do not change facts. In medieval Europe, for example, many delusional episodes were treated as mystical experiences, and the suffering from depressive individuals was considered normal, while homosexuality - a harmless behavior - was considered pathological. Human life depends on objective faculties, and it is the loss of these faculties, and the consequent loss of the ability to live, that defines mental illness. With that said, and individual's political and economic context is essential in defining his environmental trade-offs, and, therefore, his mental health.

    Someone with a considerable lactose intolerance has no reason to drink milk in a modern capitalist society, where resources are plentiful. If that same person is exiled to a hellhole like Venezuela, however, that same glass of milk will become very desirable, very quickly, despite its side-effects. The courses of action available to the individual are essential to his physical and mental health, and are strongly influenced by his social context. The environment’s role can be perfectly illustrated by an old-fashioned psychiatric concept, now unduly dropped due to PC culture: relative stupidity.

    Relative stupidity is a borderline condition of mental retardation. If the individual suffering from this condition lives a life that does not require a lot of intellectual activity, such as that of a small farmer in a rural area, his intelligence suffices, and he is able to support himself financially, socialize properly, and live a happy life. However, if the same individual is to live in a large metropolis, where the very act of walking down the street subjects him to a plethora of stimuli, his life will be drastically different. He will not be able to provide for himself through the available jobs, which are more complex in nature, and will likely be marginalized in his social interactions, inevitably becoming depressed.

    Mental illness can thus be properly conceptualized as a “psychic allergy” to certain stimuli, or even an “existential allergy”    to certain conditions and activities. The individual’s physical and psychic constitution determines their “allergies”, but it is his insertion in situations with which is is not equipped to handle that causes suffering and pathological behavior. In certain cases, the illness is absolute - being incapable of basic logical integrations or social interactions is the equivalent of an allergy to water or air. Most cases, however, are relative, and treatment consists less onf medication and invasive procedures, and more of finding an adequate routine, and planning one’s life according to their nature.

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Psychic Structures: The Relationship Between Past and Present

    If our body is like a car, and our environment like a road, what exactly is the driver? Simply put: our rational faculty. There is, however, an essential difference between the habits and skills we’ve developed throughout our lives and our choices in the present. A driver makes several decisions throughout his journey, but they are conditioned by the skills he’s developed in the past. Someone who has just started driving, or who developed vices throughout his learning process, is not subject to the same choices as a professional pilot.

    As a biological faculty, consciousness is a dynamic process. The content of our minds is constantly changing, both in response to new perceptions, and to the choices we make. This dynamic process, however, gives rise to relatively stable psychic structures - previously made, conscious and subconscious associations, which cannot be immediately altered.

    Subconscious associations include conditioned reflexes, emotional (pre-conceptual) associations, and automatized mental habits - many of which were passed down to us by our parents and educators, or developed independently during childhood, before we are able to properly judge our actions. Changing these associations requires significant time and effort. Conscious associations include the concepts we use, their definitions, and the philosophy that integrates them. Although we can change our definition of a single concept rather quickly, fully integrating that change in our entire world-view often also takes time.

    Those who are somewhat familiar with Austrian economics can find a good analogy in the market process. The market is also a dynamic process, made up of the constant value-judgements of every individual, and the resulting actions and trades. This dynamic process, however, leads to the development of certain static structures, such as supply-chains and capital goods, which can only be altered in the long-term. Although they are a human creation, the short-term existence of these structures is akin to a metaphysical fact,    which we must adapt to. Similarly, these psychic structures are the means we create to integrate our innate physical constitution to the resources available, but they often create their own needs, which must be met during the time it takes to alter them.

     Someone with a physical pre-disposition to depression, for example, must pay more attention to the way in which they structure their thoughts, developing several cognitive     and motivational     habits. These habits, in turn, might make some situations more stressful - and excessive stress is one of the environmental factors that trigger depressive episodes.

    Mental illness can thus be conceptualized as equivalent to the physical pain that comes from carrying a weight. Our physical makeup is like the composition of our bones and muscles; our environment is the weight itself; and our mental habits are like our posture. Weak bones and muscles can be compensated with a better posture, or lighter weights. All three factors influence one another, and their interaction defines the end-result.

    But if our physical makeup, our environment, and the habits we acquire are so important to our mental health, and are all outside our direct control, what exactly is the role of our choices? What is the relationship between mental illness and free will? How does the philosophy we adopt influence our psychic wellbeing? This is the subject of the second part of this series.

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