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The following is draft essay intended for the teaching of doctors training in psychiatry. It has been used for a number of lectures to general practitioners, psychiatry registrars and psychiatrists.
Contents
IntroductionMetaphorical models are not necessarily medical models.Not to be taken literally, these representations of the psychiatric condition may be symbolic, anthropomorphic, concrete, allegorical, visual or conceptual abstractions. They represent the human imagination sculpting sense from incomprehensible human states.
Metaphors introduce alternative ways of perceiving complex mental constructsrather than necessarily being simplifications or formulations of the constructs. They are derived from medical models, but their primary aim is not necessarily to simulate, to recreate or to provide fertile ground for research or predictions.
The human mind seems to strive for reason, for meaning, for some form of causal model.In its quest for meaning, the human brain has evolved a considerable talent for deriving models of the world around it. What happens when it cannot make sense of the perceptions it receives and ideas it itself develops because they are outside the usual range or contradictory, as occurs in mental disorders, where the brain is malfunctioning?
This is because the brain is the primary organ that decides how we respond to the environment around us (which includes the other people and living things in it as well as the resources in it that enable our survival) and the best way of responding is to develop a model based on experience (both ancestral - which permitted the species the survive - and the life experience of the organism and its family-of-origin
The problem with any model is that it may not keep up with the changing environment.
When the brain becomes confounded by abnormal stimuli, such as feelings and perceptions that don’t fit into a range or pattern that it has experienced before, it may develop anomalous explanatory models.These models may themselves confound the person further if they are novel or unusual or not very good. In such a case, the model may be maladaptive and it seems reasonable for the doctor to try to find a model that is less maladaptive or perhaps even adaptive, promoting behaviours or feelings that are helpful and positive for the person. Some people call such a process cognitive therapy or cognitive restructuring or deconstructing cognitive distortions.
Metaphorical models help the patient find meaning and understanding....to achieve some level of acceptance, to obtain some degree of ease of mind. It may be better to calm a patient and reduce frantic searching for reason or significance, when it is increasing their alarm and agitation. Internal conflict may further stir up the internal storm brewing.
Metaphorical models may assist the patient to gain orientation and move on.The metaphor should enable the patient to progress from a maladaptive paradigm to a less maladaptive one. The process is one of promoting a reorientation towards normalcy. There may be a spectrum to proceed along, especially if the patient is psychotic. How ‘loose’ the metaphor proves to be, then, depends on the patient’s degree of reality orientation.
Metaphors may help the doctor to find common ground with the patientwithout their colluding with a maladaptive paradigm. The closer a metaphorical model that is acceptable to a patient is to an established or sensible medical model, the better, as this will promote the patient obtaining a better insight. The patient and doctor can then work together in the challenge to gain control and mastery over the disorder and the circumstances. The metaphorical model need not be equal to a medical model, but so much the better if it is. It needs to be just palatable enough to the patient that they choose to substitute the metaphorical model for the less adaptive one that they had developed.
Mind Metaphors
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Hardware |
Software {Data processing} |
The software is something that has been neglected and oversimplified in psychiatry up to now.
The brain appears to have pre-programmed software programs, incorporated into the brain by natural selection -- analogous to the 'hardwired' programs in the computer of an arcade game. These have been identified by infant developmental psychologists, such as Piaget, as being present in all new-born babies and increasing in complexity through child development -- so-called physical and developmental 'milestones'. Examples of the pre-programmed skills are crying, sucking and, amazingly, facial mimicking (e.g. tongue poking), from birth. Then develops fear of strangers, avoidance of heights, etc. Most of the programs are present by the age of 7 in humans.
Beck's behavioural model comparing Pavlov’s dogs to the human mind is a simplistic software program -- a nice algebraic formula, where a behaviour that is programmed to be experienced as positively reinforcing leads to more of such behaviour and if the brain experiences it as aversive then it avoids it.
The mental activity involved in processing such linear behaviour is the 'data processing' depicted as flickering lights on antiquated computer screens, from information that has been keyed in from a source, such as a keyboard, mouse, modem or CD-ROM.
A controversial question being debated by evolutionary biologists, psychologists, psychiatrists and neuroscientists is whether the brain software comprises of a few, general, all-purpose programs or thousands of individual modules each programmed to deal with each individual problem {permitting formulation of the most adaptive likely response to an array of complex incoming sensory data}.
These refer to the inbuilt software programs that usher in stereotyped defensive behaviours under specific circumstances, present because they have provided a survival advantage to our ancestors and thus been preserved by natural selection.
For example, depression probably evolved to promote disengagement from and demobilisation within high threat and/or low-resource environments, in response to loss of control over social resources. Social anxiety probably evolved to promote vigilance to one's own behaviours and their impact on in-group others, with social avoidance and inhibition of social behaviour, in response to loss of status or rejection resulting from displays of unattractive social behaviours. Separation anxiety probably evolved to promote vigilance to access and availability of supportive others, with protest and despair at loss of access, in response to loss of access to protective others. Paranoia probably evolved to promote vigilance, distrust and avoidance of or aggression towards those identified as belonging to hostile groups, in response to hostile groups or alliances.
Panic attacks and mild depressive syndromes appear to be psychobiological response patterns that sometimes act like software programs that have been activated by certain key triggers or combinations of factors to usher in a survival mode. How they do this defensive role will be outlined.
The infamous biopsychosocial model proposes that there are precipitating, propagating and protective factors influencing the course of a disorder. It may similarly be possible to speak of ‘recovery factors’, which set in motion the departure of the program and thus recovery from the disordered mental state. There may be internal and external factors operating here. Examples are endogenous hormones, medications, physical exercise, psychotherapies, placebos and so-called non-specific environmental (including interpersonal) factors.
When a mental state is severe or recurrent, there are significant melancholic or psychotic features, or there appears to be underlying contributing medical disorders, it is behaving more like an illness than a defensive strategy. When there is no obvious defensive purpose, and the individual’s level of function is very impaired, this is also likely to be the case. Such disorders may be strategies-gone-wrong -- a dysregulation of a strategy. A ‘strategy disorder’. A bug in the software.
This does not necessarily exclude the bearing that modulating factors or triggers may have on the course of the disorder. In fact, part of the dysfunction of the strategy may be that the brain has become overly sensitive, ushering in the software package without due cause. Alternatively, there may be an insensitivity of the system to the recovery factors, which normally close the program down.
The aetiology may arise from within the organism. Genes are the blueprints coding for the inbuilt evolutionary strategies (just as they code for physical or structural biological characteristics). Whilst some of us might have genetic errors that are inherited or errors that spontaneously arise at the time of conception or during foetal development, which make the development of the strategy disorder very likely, like a time bomb waiting to go off under the right circumstances, usually this is not the case with regard to mental disorders. Most people with mental disorders had genes that make them vulnerable but not pre-destined to develop a disorder.
It is important to understand that what is being proposed is not that genes determine behaviour. Behaviour is determined by the central nervous system's response to the interaction between genes and environment.
The human
mind is a product of the human brain.
