恶人谷

Time to End Mind-Brain Split
Ronald Pies, M.D.
Ronald Pies, M.D., is a professor of psychiatry at SUNY Upstate Medical Center and a clinical professor of psychiatry at Tufts University School of Medicine.

A June 22 editorial in the Boston Globe speculated on the causes of a young child's severe emotional difficulties. The child, who had been diagnosed with bipolar disorder, had apparently died after an overdose of medications. "Might family dynamics, rather than a chemical imbalance," the editorial asked, "have caused the behavioral problems that led to her diagnosis?"

It is understandable that editorial writers would seek to identify the "cause" of a child's behavioral problems in the binary terms of "mom or molecules?" "dad or dopamine?"

Sadly, some in our profession have contributed to this either/or way of thinking, despite efforts of many psychiatrists to develop a unified theory of mind and brain. Indeed, in her book, Of Two Minds, anthropologist Tanya Luhrmann exposed the split between so-called biomedical and psychodynamic psychiatry―very roughly, between those who conceptualize "mental illness" in terms of brain chemistry, and those who understand it in terms of unconscious conflicts and existential choices. This "molecules or motives" dichotomy is the sad legacy of the philosopher Rene Descartes, who argued that a nonmaterial soul inhabited an essentially mechanical body. This dualism persists in various forms throughout our literary and scientific culture. Even attempts to unify mind and body with terms such as "psychosomatic" or "biopsychosocial" have had the unintended effect of perpetuating this split.

In contrast, the emerging school I call "psychiatric naturalism" asserts that there is no mind-body split. Every activity of what we call "mind" is nothing over and above the workings of the brain―a view compatible with the "monism" of philosophers like Baruch Spinoza and William James. Naturalism does not dismiss the critical importance of our beliefs, motives, and conflicts―much less the enormous influence of what the Globe calls "family dynamics." Psychiatric naturalism merely asserts that all these factors are ultimately represented and resolved in the crucible of the brain.

It follows from this that any "input" to the brain from interactions with friends or family has immediate and long-term effects on brain structure and function. Conversely, a pathological change in brain structure or function―say, from a brain tumor or bipolar disorder―can have profound effects on one's relationship with friends and family. So the Globe editorial's speculation that a child's behavioral problems might be the result of "family dynamics, rather than a chemical imbalance" (italics added) presents us with a false dichotomy.

There is no reason to rule out a complicated, cyclical interaction between family dynamics and brain function. Families with loved ones suffering from bipolar disorder, schizophrenia, or other serious brain disorders will attest to the profoundly disruptive effect these conditions can have on families. Conversely, there is evidence to suggest that pathological family dynamics can exacerbate the course of serious psychiatric illnesses. Thus, our approach to those suffering with these conditions needs to be unified and comprehensive: we need to help the brain heal by addressing all the "inputs" that affect its structure and function. In many cases, this will involve the use of psychotropic medications (there's that Greco-Cartesian term "psyche" again). But in virtually all cases of serious psychiatric disorders, we also need to address a patient's familial and personal issues. This means that some form of "talk therapy" (often including family therapy) should almost always be a part of comprehensive psychiatric care.

In his book, The Brain That Changes Itself, psychiatrist Norman Doidge, M.D., details fascinating new discoveries in "neuroplasticity"―the ability of brain tissue to repair and heal itself, with appropriate treatment.

Contrary to the old notion that the brain is "hard-wired" and largely immutable in the face of injury or trauma, Doidge explores ways in which the brain can actually change its own structure and function. This has practical implications in the treatment not only of stroke victims, but in those who have been victims of traumatic events. Medication may play a useful role in the treatment of these conditions, but so may psychotherapy. Erik Kandel, M.D., and his colleagues have observed that "There is no longer any doubt that psychotherapy can result in detectable changes in the brain." In many cases, appropriate medication may reinforce the brain changes brought about in psychotherapy. In the treatment of major depression, for example, evidence suggests that the combination of antidepressants and psychotherapy works better than either treatment alone.

It is time to move beyond the warring camps of biology versus psychology, brain versus mind. The best scientific evidence suggests that the brain is the mediator and organizer of all our complex experiences. When brain function goes awry, we must look to all the ways in which we may help the brain―and the person―begin to heal.

在大多数心理疾病或问题上，一个广泛存在的根源之一（注意不是全部的根源）是害怕被别人进行道德审判。人都喜欢道德审判别人（这个我自己也免不了，就不算是居高临下地说话了），只有经过专业训练的治疗师和医生才能时刻抑制审判的欲望而适当地治疗患者，缓解对方的焦虑和自责和羞愧。所以这个安全而隐私的环境极度重要。很多人跑到网络上吐苦水，其实也是被这个anonymity 而吸引，结果还是淋到一头的审判，对自己人格和道德价值的审判。

很多人跑到网络上吐苦水，其实也是被这个anonymity 而吸引，结果还是淋到一头的审判，对自己人格和道德价值的审判。

但是就算心理医生又能有什么办法吗，一是忍不了离婚，忍的了就原谅他，装做什么都没发生过，还有什么别的选择吗？莫非心理医师会让人更心理舒适地接受现实？

可是这种事往往最有效的是时间．．．所以很多人会选择让时间消化一切．

有时候人有心理疾病，自己却并不意识到，旁人也很难看的出．

或多或少总会粉饰一下吧，如果心理想的事不是特别高尚的时候？心理医生如何只听求诊者的一面之词，就能准确地把握整个事情其实是什么样子的，求诊者的真实想法又是什么呢？

作为外国人在国外求诊，如果对这门外语把握的不是很精准，一些微妙的思想表达不出来，精神科医生能否完全领会患者的意思，又用比较好懂的陈述来给患者进行治疗？

你以为你撑不住了其实都是脑子做祟只要撑下去都撑的住大家都是这么撑过来的你也能撑过来。

这一点绝大多数人都做不到，要有这方面的天赋加上一定的训练。

我试过一个公司提供的，还是个国际公司在中国的contractor, 水平之低，简直还不如我自己。