Art of Psychiatry Society

July 2013 book: The Examined Life by Stephen Grosz

All grades of psychiatrist were round the table on July 9th, despite the sizzling heat outside.  For some, Grosz’s work was a distillation of 25 years’ therapy into an honest, simple tome: “What I’m describing here isn’t a magical process,” says Grosz of psychotherapy, “It’s something that is a part of our everyday lives – we tap, we listen”. Nicely put. And yet, for others round the table, there was something unnatural about this tapping.

“Which genre does it belong to?”, one member cried, holding aloft a stick of satay chicken. A forensic consultant sipped his orange juice and replied, “these are a series of case-studies”.  This suggestion did not hold under scrutiny. The histories are mere pages long, some even lacking patients. For example, the chapter ‘Going Back’ concerns his odd gift to his father: a holiday to Eastern Europe, and thus to a childhood marred by Nazism. Even in the more patient-focused chapters, things seem rather well-wrapped for clinical realities.  The first, ‘How we can be possessed by a story that cannot be told’, is about a mendacious patient who fakes his own suicide to upset Grosz. But then the ending is more Grimm than grim: he marries, settles – lives happily ever after. Some of us loved the strong presence of the therapist’s own life and humanity, loved also the subtle, jargon-free exploration of dreams. Others yearned for more warts, more confusion, and more obvious use of psychological technique. Orange juice was exchanged for glasses of viticulture from the warm South, as we approached something like a conclusion.

For all their allure, we agreed that there is a tension in Grosz’s tales, between clarified fact and coddled artifice. This is alluded to in the fly-notes, which describes the cases as “aphoristic”, an original thought expressed in memorable form. None other than Hippocrates was the originator of the aphorism, with his famous maxim on medicine: ars longa, vita brevis (the life so short, the art so long to learn). Fairy tales are also a kind of aphorism. And thus with Grosz: his studies are so short, the point they make is so clear, so elegantly put across, that some readers perceived hints of the artificial behind the seeming reality of his tales.  Does this too-neat packaging of clinical truths matter? Perhaps not. Grosz is clear about his project, quoting Isak Dinesen who said: “Any suffering can be borne if it is put into a narrative.” He has done just this – indeed, done it beautifully with each case-tale. More than artful, perhaps even bordering on Art itself, these histories drew excited comparisons from works of poetry to the musical studies of Bartok. In the final analysis, we raised our collective glasses to Grosz, only to find our glasses empty. Well, such is life – and having examined it thoroughly, we closed our books.

Ben Robinson

September 2013 book: The Myth of Mental Illness by Thomas Sasz

And so to philosophy… We dived in headfirst and found the waters, well, rather murky. Consciousness Explained is Daniel Dennett’s 1991 book on the most difficult conundrum facing philosophy and science today – the phenomenon of consciousness.

As a group, we started by thinking a bit about this. How would you study it? How would you define it? Hang on, what actually is it? The more we thought about it, the more difficult it seemed. Thankfully, despite our guest expert falling ill on the day of the event, we had a great turn out to make (ahem) light work of this weighty topic.

Consciousness Explained is divided into three parts. Dennett uses the first section to outline his project, method and goals. Here he introduces ‘heterophenomenology’, his ‘neutral’ method aimed at getting clear on what the phenomena that need to be explained actually are. The second part develops his model of consciousness, the ‘Multiple Drafts Model’, which he contrasts with the ‘Cartesian Theatre’ which it is so hard to think oneself out of. This is presented as an empirical theory, drawing on evidence from evolutionary theory as well as Artificial Intelligence, neuroscience and cognitive psychology. The third and final part focuses on the philosophical challenges that consciousness poses in the form of some entertaining thought experiments.

Dennett aims to ‘break the spell’ of our way of thinking about consciousness which makes consciousness seem unexplainable. He does this by providing an alternative way of thinking – an alternative set of metaphors.  Few people would claim to be Cartesian dualists – to believe that the mind is made of a completely different kind of stuff than the body – yet we seem to fall into the trap of imagining consciousness as something that is played out in the brain for another observer in the brain: as if the light waves that impinge on our retinas are transduced into neural signals only to be transduced again for our real selves to ‘see’. This manifests as much in scientific as lay thinking about consciousness. His alternative metaphor is the ‘Multiple Draft’: the self exists rather as a scientific paper exists – circulating in multiple drafts – with no final, authoritative version.

Discussion focused on the book and its wider implications e.g. the mind/brain divide, the implications of materialism, is consciousness an epiphenomenon? (we thought not), is there a social definition of consciousness as opposed to individual? (we got stuck on that one!), whether Dennett believes in free will or not? (yes he does). Artificial intelligence and Turing’s famous Test came up, – a machine indistinguishable from a human being. Could a robot have a mind? What about philosophical zombies? Zombies are similar to us in appearances and behaviour but, supposedly, lack subjective conscious experience. Sadly, the zombie discussion didn’t go very far as the group were sceptical (probably rightly) about the contribution that fantasy zombies could make. It did, however, lead us to the one of the key difficulties: qualia. Qualia are the subjective ‘feel of things’, what it’s like to feel pain, to smell fresh coffee. Labelled elsewhere as ‘the hard problem of consciousness’, how can these be explained?   Dennett attempts to show how the whole way of thinking in these terms is a ‘mess’, ‘best walked away from’.

Philosophy often uses thought experiments (such as zombies) to help with complex problems like this. So we thought we’d give that a go with Frank Jackson’s famous thought experiment Mary’s room. Mary is a sci-fi colour expert in the future kept in a black and white room for her whole life. Mary has never seen colour although is world expert on colour red (she knows everything! Refraction, chemical components, wave-length, subjective reports from others). One day she is released, she steps outside and sees a red-rose. Does she learn something new about the colour red? Intuitively, you might think yes. Not our group, hardcore materialist Maudsley Trainees that they are! A straw poll saw ‘no’ as the majority – albeit a narrow majority – view. They were quite happy to do away with qualia but still felt that Dennett hadn’t fully convinced them with his theory.

Well-written, witty, direct and peppered with useful footnotes and anecdotes, Explaining Consciousness was, nonetheless, an ambitious and challenging book and choice for our group. The grand project of the book and the value of philosophy in shaping ideas and questions for modern scientific exploration of consciousness were widely remarked on. The study of subjective conscious experience and the ideas of what the mind may be seemed so relevant to our practice that we wondered why the MRCPsych Course hadn’t touched upon it. Consciousness is an area the book group will return to.

The next meeting of Reading the Mind will be on Tuesday 20th September at 6pm in Seminar Room 2, Institute of Psychiatry. We will be reading Opening Skinner’s Box by Lauren Slater – an interesting run through ten of the 20th century’s most relevant psychological experiments. See you there!

Dr Lisa Conlan, ST6 Psychiatry Trainee and Simon Harrison, ST4 Psychiatry Trainee