Zadok Paper S100 Winter 1999
The Nature of Humans-Mind and Brain; Body, Soul and Spirit
by Alan Gijspers

Psychology and psychiatry

The Greek word for mind is nous whereas the word psyche is Greek for soul. Thus psychology could be regarded as the study of the soul rather than the mind and psychiatry as the study of diseases of the soul rather than diseases of the mind. Actually, the Hebrews probably would not have made such a distinction, preferring instead to talk of a person's inner being, the real essence of the person, without distinguishing mind and thought from other psychological functions like emotion, cognition, perception, memory, language, learning, development, personality and so on.

Sigmund Freud inferred normal psychology from the study of neurotic Viennese heiresses. Initially, Freud was a neurologist who dabbled in hypnosis to discover unconscious processes. In the sense that he described the actual clinical experience of real patients, he stands firmly in the tradition of descriptive clinical science; however, his postulated mechanisms of psychological processes have largely been dismissed by more reductionist scientists. Even so, the Freudian concept that events in the past need to be discovered and exposed is still a very prominent counselling strategy. The clinical psychiatric spectrum of his patients were largely neuroses, hysteria, anxiety and phobias.
Organic psychiatry has a different source. These practitioners tried to deal with the 'really mad' conditions. These could be divided into two. There were those with obvious organic brain disease, with particular neurological features at autopsy such as general paralysis of the insane (the end result of syphilis infection of the brain), alcoholic dementia and senile dementia, and there were those without obvious pathological features but who were expected to have more subtle neurological conditions. These included manic-depression and schizophrenia.

Initially, the only form of treatment for these poor people was the asylum. Early this century Electro-convulsive Therapy (ECT) was discovered to be particularly useful for schizophrenia and severe depression. Psycho-active drugs are a relatively recent discovery from the 1950s. Along the way patients were also subjected to neurosurgical approaches (the crude cutting of large bundles of nerve tracts) in an attempt to cure particularly distressing behaviour.

Since ECT, drugs and neurosurgery have had such a profound effect, are psychiatric diseases just diseases of the brain? Are they just a chemical disorder and hence can they just be cured by a rearrangement of chemicals or by a rearrangement of nerve bundles?

Unfortunately, it is not that simple. There are other psychiatric conditions which do not fit so neatly into such an organic schema. For instance, personality disorders, defined as an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture,14 does not fit well into an organic category, nor does post-traumatic stress, grief and so on. Particularly intriguing are the psychosomatic disorders (now called somatisation) in which the person expresses their psychological distress through physical symptoms like pain. For these patients, psychological counselling is much more appropriate than drugs. The current campaign against tranquillisers, especially the benzodiazepines, is a witness to this.

There are some neurological diseases whose biochemistry is starting to be elucidated. Thus we know and can test for the gene responsible for Huntington's Chorea and define the nature of the subsequent brain injury. These conditions are genetic defects which lead to premature brain deterioration. They are biochemical disorders, well characterised but as yet not well treated. Their definitive treatment will in the end be a biochemical solution. This is pretty obvious in some conditions, suspected in schizophrenia and hotly debated in the field of addictions.

Can we draw an analogy between these diseases and all behavioural problems? Are there no bad people, only mad people with neurological rather than psychological problems? The law recognises insanity as grounds for diminished responsibility for some crimes and hence a defence in a criminal trial, but other conditions are subject to the full penalty of the law. Somehow in real life we live with this distinction between brain conditions in which patients have no control over their behaviour and other anti-social conditions for which people are held to be responsible.

To: The paradox of addiction

Alan J. Gijsbers MBBS FRACP DTM&H PGDip Epi, is Specialist Physician at Turning Point Drug and Alcohol Centre and at the Department of Drug and Alcohol Studies St Vincent's Hospital. He is a Visiting Physician at the Epworth Hospital, a Senior Lecturer in Clinical Medicine at the Department of Psychological Medicine Monash University and Senior Fellow at St Vincent's Hospital Clinical School, University of Melbourne. He also contributes to a Dual Diagnosis Clinic at the St John of God and St Vincent's Collaborating Centre consulting on people with both Drug and Alcohol and Psychiatric Disorders. He is a fellow ISCAST and editor of their national bulletin. He also somehow manages to be a husband to his wife, Lois, and a father to three children.