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Low Blood Sugar Linked to Death Risk for Hospital Patients

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phors of the Mind (Part II)

 by: Sam Vaknin, Ph.D.

Storytelling has been with us since the days of campfire and besieging wild animals. It served a number of important functions: amelioration of fears, communication of vital information (regarding survival tactics and the characteristics of animals, for instance), the satisfaction of a sense of order (justice), the development of the ability to hypothesize, predict and introduce theories and so on.

We are all endowed with a sense of wonder. The world around us in inexplicable, baffling in its diversity and myriad forms. We experience an urge to organize it, to "explain the wonder away", to order it in order to know what to expect next (predict). These are the essentials of survival. But while we have been successful at imposing our mind's structures on the outside world - we have been much less successful when we tried to cope with our internal universe.

The relationship between the structure and functioning of our (ephemeral) mind, the structure and modes of operation of our (physical) brain and the structure and conduct of the outside world have been the matter of heated debate for millennia. Broadly speaking, there were (and still are) two ways of treating it:

There were those who, for all practical purposes, identified the origin (brain) with its product (mind). Some of them postulated the existence of a lattice of preconceived, born categorical knowledge about the universe - the vessels into which we pour our experience and which mould it. Others have regarded the mind as a black box. While it was possible in principle to know its input and output, it was impossible, again in principle, to understand its internal functioning and management of information. Pavlov coined the word "conditioning", Watson adopted it and invented "behaviourism", Skinner came up with "reinforcement". The school of epiphenomenologists (emergent phenomena) regarded the mind as the by product of the brain's "hardware" and "wiring" complexity. But all ignored the psychophysical question: what IS the mind and HOW is it linked to the brain?

The other camp was more "scientific" and "positivist". It speculated that the mind (whether a physical entity, an epiphenomenon, a non-physical principle of organization, or the result of introspection) - had a structure and a limited set of functions. They argued that a "user's manual" could be composed, replete with engineering and maintenance instructions. The most prominent of these "psychodynamists" was, of course, Freud. Though his disciples (Adler, Horney, the object-relations lot) diverged wildly from his initial theories - they all shared his belief in the need to "scientify" and objectify psychology. Freud - a medical doctor by profession (Neurologist) and Bleuler before him - came with a theory regarding the structure of the mind and its mechanics: (suppressed) energies and (reactive) forces. Flow charts were provided together with a method of analysis, a mathematical physics of the mind.

But this was a mirage. An essential part was missing: the ability to test the hypotheses, which derived from these "theories". They were all very convincing, though, and, surprisingly, had great explanatory power. But - non-verifiable and non-falsifiable as they were - they could not be deemed to possess the redeeming features of a scientific theory.

Deciding between the two camps was and is a crucial matter. Consider the clash - however repressed - between psychiatry and psychology. The former regards "mental disorders" as euphemisms - it acknowledges only the reality of brain dysfunctions (such as biochemical or electric imbalances) and of hereditary factors. The latter (psychology) implicitly assumes that something exists (the "mind", the "psyche") which cannot be reduced to hardware or to wiring diagrams. Talk therapy is aimed at that something and supposedly interacts with it.

But perhaps the distinction is artificial. Perhaps the mind is simply the way we experience our brains. Endowed with the gift (or curse) of introspection, we experience a duality, a split, constantly being both observer and observed. Moreover, talk therapy involves TALKING - which is the transfer of energy from one brain to another through the air. This is directed, specifically formed energy, intended to trigger certain circuits in the recipient brain. It should come as no surprise if it were to be discovered that talk therapy has clear physiological effects upon the brain of the patient (blood volume, electrical activity, discharge and absorption of hormones, etc.).

All this would be doubly true if the mind was, indeed, only an emergent phenomenon of the complex brain - two sides of the same coin.

Psychological theories of the mind are metaphors of the mind. They are fables and myths, narratives, stories, hypotheses, conjunctures. They play (exceedingly) important roles in the psychotherapeutic setting - but not in the laboratory. Their form is artistic, not rigorous, not testable, less structured than theories in the natural sciences. The language used is polyvalent, rich, effusive, and fuzzy - in short, metaphorical. They are suffused with value judgements, preferences, fears, post facto and ad hoc constructions. None of this has methodological, systematic, analytic and predictive merits.

Still, the theories in psychology are powerful instruments, admirable constructs of the mind. As such, they are bound to satisfy some needs. Their very existence proves it.

The attainment of peace of mind is a need, which was neglected by Maslow in his famous rendition. People will sacrifice material wealth and welfare, will forgo temptations, will ignore opportunities, and will put their lives in danger - just to reach this bliss of wholeness and completeness. There is, in other words, a preference of inner equilibrium over homeostasis. It is the fulfilment of this overriding need that psychological theories set out to cater to. In this, they are no different than other collective narratives (myths, for instance).

In some respects, though, there are striking differences:

Psychology is desperately trying to link up to reality and to scientific discipline by employing observation and measurement and by organizing the results and presenting them using the language of mathematics. This does not atone for its primordial sin: that its subject matter is ethereal and inaccessible. Still, it lends an air of credibility and rigorousness to it.

The second difference is that while historical narratives are "blanket" narratives - psychology is "tailored", "customized". A unique narrative is invented for every listener (patient, client) and he is incorporated in it as the main hero (or anti-hero). This flexible "production line" seems to be the result of an age of increasing individualism. True, the "language units" (large chunks of denotates and connotates) are one and the same for every "user". In psychoanalysis, the therapist is likely to always employ the tripartite structure (Id, Ego, Superego). But these are language elements and need not be confused with the plots. Each client, each person, and his own, unique, irreplicable, plot.

To qualify as a "psychological" plot, it must be:

• All-inclusive (anamnetic) - It must encompass, integrate and incorporate all the facts known about the protagonist.

• Coherent - It must be chronological, structured and causal.

• Consistent - Self-consistent (its subplots cannot contradict one another or go against the grain of the main plot) and consistent with the observed phenomena (both those related to the protagonist and those pertaining to the rest of the universe).

• Logically compatible - It must not violate the laws of logic both internally (the plot must abide by some internally imposed logic) and externally (the Aristotelian logic which is applicable to the observable world).

• Insightful (diagnostic) - It must inspire in the client a sense of awe and astonishment which is the result of seeing something familiar in a new light or the result of seeing a pattern emerging out of a big body of data. The insights must be the logical conclusion of the logic, the language and of the development of the plot.

• Aesthetic - The plot must be both plausible and "right", beautiful, not cumbersome, not awkward, not discontinuous, smooth and so on.

• Parsimonious - The plot must employ the minimum numbers of assumptions and entities in order to satisfy all the above conditions.

• Explanatory - The plot must explain the behaviour of other characters in the plot, the hero's decisions and behaviour, why events developed the way that they did.

• Predictive (prognostic) - The plot must possess the ability to predict future events, the future behaviour of the hero and of other meaningful figures and the inner emotional and cognitive dynamics.

• Therapeutic - With the power to induce change (whether it is for the better, is a matter of contemporary value judgements and fashions).

• Imposing - The plot must be regarded by the client as the preferable organizing principle of his life's events and the torch to guide him in the darkness to come.

• Elastic - The plot must possess the intrinsic abilities to self organize, reorganize, give room to emerging order, accommodate new data comfortably, avoid rigidity in its modes of reaction to attacks from within and from without.

In all these respects, a psychological plot is a theory in disguise. Scientific theories should satisfy most of the same conditions. But the equation is flawed. The important elements of testability, verifiability, refutability, falsifiability, and repeatability - are all missing. No experiment could be designed to test the statements within the plot, to establish their truth-value and, thus, to convert them to theorems.

There are four reasons to account for this shortcoming:

• Ethical - Experiments would have to be conducted, involving the hero and other humans. To achieve the necessary result, the subjects will have to be ignorant of the reasons for the experiments and their aims. Sometimes even the very performance of an experiment will have to remain a secret (double blind experiments). Some experiments may involve unpleasant experiences. This is ethically unacceptable.

• The Psychological Uncertainty Principle - The current position of a human subject can be fully known. But both treatment and experimentation influence the subject and void this knowledge. The very processes of measurement and observation influence the subject and change him.

• Uniqueness - Psychological experiments are, therefore, bound to be unique, unrepeatable, cannot be replicated elsewhere and at other times even if they deal with the SAME subjects. The subjects are never the same due to the psychological uncertainty principle. Repeating the experiments with other subjects adversely affects the scientific value of the results.

• The undergeneration of testable hypotheses - Psychology does not generate a sufficient number of hypotheses, which can be subjected to scientific testing. This has to do with the fabulous (=storytelling) nature of psychology. In a way, psychology has affinity with some private languages. It is a form of art and, as such, is self-sufficient. If structural, internal constraints and requirements are met - a statement is deemed true even if it does not satisfy external scientific requirements.

So, what are plots good for? They are the instruments used in the procedures, which induce peace of mind (even happiness) in the client. This is done with the help of a few embedded mechanisms:

• The Organizing Principle - Psychological plots offer the client an organizing principle, a sense of order and ensuing justice, of an inexorable drive toward well defined (though, perhaps, hidden) goals, the ubiquity of meaning, being part of a whole. It strives to answer the "why's" and "how's". It is dialogic. The client asks: "why am I (here follows a syndrome)". Then, the plot is spun: "you are like this not because the world is whimsically cruel but because your parents mistreated you when you were very young, or because a person important to you died, or was taken away from you when you were still impressionable, or because you were sexually abused and so on". The client is calmed by the very fact that there is an explanation to that which until now monstrously taunted and haunted him, that he is not the plaything of vicious Gods, that there is who to blame (focussing diffused anger is a very important result) and, that, therefore, his belief in order, justice and their administration by some supreme, transcendental principle is restored. This sense of "law and order" is further enhanced when the plot yields predictions which come true (either because they are self-fulfilling or because some real "law" has been discovered).

• The Integrative Principle - The client is offered, through the plot, access to the innermost, hitherto inaccessible, recesses of his mind. He feels that he is being reintegrated, that "things fall into place". In psychodynamic terms, the energy is released to do productive and positive work, rather than to induce distorted and destructive forces.

• The Purgatory Principle - In most cases, the client feels sinful, debased, inhuman, decrepit, corrupting, guilty, punishable, hateful, alienated, strange, mocked and so on. The plot offers him absolution. Like the highly symbolic figure of the Saviour before him - the client's sufferings expurgate, cleanse, absolve, and atone for his sins and handicaps. A feeling of hard won achievement accompanies a successful plot. The client sheds layers of functional, adaptive clothing. This is inordinately painful. The client feels dangerously naked, precariously exposed. He then assimilates the plot offered to him, thus enjoying the benefits emanating from the previous two principles and only then does he develop new mechanisms of coping. Therapy is a mental crucifixion and resurrection and atonement for the sins. It is highly religious with the plot in the role of the scriptures from which solace and consolation can be always gleaned.

About The Author Sam Vaknin is the author of "Malignant Self Love - Narcissism Revisited" and the editor of mental health categories in The Open Directory, Suite101, and searcheurope.com. His web site: http://samvak.tripod.com Frequently asked questions regarding narcissism: http://samvak.tripod.com/faq1.html Narcissistic Personality Disorder on Suite101: http://www.suite101.com/welcome.cfm/npd

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