What follows is a temporary, but necessary diversion into ‘grand theory’. Necessary, because any approach to mental health that isn’t compatible with a theory of human behaviour in general doesn’t stand a chance. (Those stuck in the insular world of psychiatry and clinical psychology please note). I’ve included references this time, just to give pause to those tempted to come down on me ‘like a ton of bricks’!
I have an evolving definition and explanation for what mental distress (disorder or illness, mild or severe) is. It shows itself as a misplaced fear of others. Personal relationships breakdown, followed by an inability to form and maintain new ones. The sufferer becomes progressively more emotionally and cognitively isolated (which may or may not involve physical isolation too).
Madness results from our failure to constantly update and modify the mental map of the world we have in our brain. If we do not ‘test’ our predictions, beliefs, dreams, thoughts, internal dialogue, fantasies, hypotheses, plans, ideas about how the world is, and what the people within it think and feel, our map becomes rapidly out of date. If we act with an out of date model of the world - we will look mad to others, and they will treat us as mad. If others don’t share a large part of our model of reality we are emotionally and cognitively isolated. Though none of us ‘see’ the world as it really is, we all rely on making a more or less accurate map; by sharing we come to have a more complete understanding than we could ever achieve alone. The ability to doubt and live with uncertainty, and hence know that we must constantly test our vision of the world - is sanity. To control and fix our view is the first step on the road to disaster. And of course the only way to maintain an unchanging outlook is to isolate oneself from any evidence that might contradict it. If we fail to observe (insufficient data) or misinterpret (wrong theory) then the map becomes more out of date. If our prediction disagrees with the experiment it is wrong. An unmodified and out of date model of the world is one where our thoughts and feelings are anchored in the past, hence our predictions of the future may be hopelessly wrong. Mental disorder is emotional and cognitive isolation to varying degrees.
Emotional reactions always come first, from what our five senses are telling us in the present moment, only afterwards do we attach thoughts. If we attach thoughts that come from the past, then we are operating with an out of date model of the world. So often we are not aware of what, in the present moment is ‘cueing’ our emotions and reproducing redundant thoughts. It is natural to be in a meditative state and to focus on the present moment. When the mind drifts away the discipline is to learn to let go, again and again. It is the opposite of taking control. It is about allowing decisions to make themselves, of not worrying about an unknowable future and refusing to get involved in hopes and expectations. The goal should be greater mental awareness of others, at the same time as being more physically relaxed. A full-time activity done with the eyes open. Meditation is not a set of skills that once acquired, can be called on at leisure; for one’s inability to operate in the world, based on the learning made in past relationships, will always return unless such skills are continuously practiced. Unwanted emotions and thoughts from the past will always ‘crash-in’ - meditation is a continuous process of letting go. The myth of self-control leads most to imagine that without it, mayhem and moral collapse will ensue. In practice, the need to manage others falls away and you become a better companion!
The best introduction to meditation I have come across, as a way of operating throughout the day, is to be found in Harrison (1994), and can be read along with his articles on how the core skills have been extracted from their religious context (Harrison 2005-). Sue Blackmore goes further, much further, by placed meditation techniques in the context of human cultural and biological evolution, and how we have evolved the very idea of a ‘self’ (Blackmore 2000:219-246). It’s possible to move towards a resolution of the contradictions of modern life, and the mental distress they give rise to, by developing both an evolutionary perspective and by being aware of the promise of social neuroscience (deCharms 2008, Goleman 2007, Ramachandran 2009). If you view daily life as evolution by natural selection, from minute to minute as well as on a timescale of the last 180,000 years (since we became homo sapiens with our full range of mental capabilities and capacities), see the biological and social as evolving in parallel and feeding back on each other (though at very different rates), then other kinds of questions and explanations suggest themselves (Oppenheimer 2004, Dawkins 1989, Blackmore 2000, Stevens & Price 2000, Nesse & Williams 1996, Nesse 2006).
We have lived out ninety-five per cent of our history as hunter-gathers, moving through and living from the environment. The last eight to ten thousand years, since we have sought to transform the environment (with the invention of agriculture, ideas of ownership and permanent settlement), has been an exceptional, perverse, untypical and abnormal period. Our point of reference for mental wellbeing should be the pre-agricultural world, where we evolved to be nomadic, as part of groups (‘bands’) of no more than about one hundred and thirty people, consisting of relatively close genetic relatives. You cannot ‘know’, as in feel an emotional attachment for, more than about that number of people.
Empathy (the ability to feel what others feel) and a ‘theory of mind’ (knowing how others think) derive from humans almost unique ability to imitate using the ‘mirror neurons’ of the brain, and give the capability to identify with, and be accepted by your group! (Blackmore 2000, Ramachandran 2000, 2003:97-131, 2006, 2007, 2009) If these abilities are blocked by life experience, then you become isolated from the people you are genetically most attached and attracted to. The last eight to ten thousand years has seen the construction of a world containing mental illness. And the culmination is the development of mental health workers, with the normal human capacities, who then try to empathise and share the ‘theory of mind’ of the unhealthy! This leads to the maintenance or reproduction of mental distress. Therapists should be leaders, mentors and role models to whom a client can apprentice themselves, and should not try to connect or catch the habits of the ill. As clients we must imitate the mentally healthy. Three out of four people don’t have a mental health problem during their life times.
And it’s not ‘faulty’ genes either, it is because we did our early learning with very close genetic relatives to whom we are automatically attached. Problems arise as a result of conflicts between the quality of our learning and our attachment to the person from whom we learnt. If you were separated from your close genetic relatives, your learning may well have been exceptional, but your life may become a search for those you are instinctively attached to. Equally you may search the world in vain for a ‘soul mate’, because it is so unlikely in modern society that you will ever meet that person, from the edge of your natural ‘group’, with whom you have a relatively close genetic attraction. It never was nature or nurture - but the ways in which your personal learning, your own cultural evolution, conflicted with the demands of your own biology. Your genes will determine to whom you are attached and attracted to, but it is with your learning that mental disorder is created and maintained.
References
Blackmore, S (2000) The Meme Machine Oxford University: Oxford
Dawkins, R (1989) The Selfish Gene Oxford University: Oxford
deCharms, C (2008) Christopher deCharms looks inside the brain TED conference presentation Feb 2008
Harrison, E (1994) Teach Yourself To Meditate Piatkus: London
Harrison, E (2005-) articles for Nova Magazine available at http://www.perthmeditationcentre.com.au/articles/index.htm [10.1.10]
Nesse, R.M (2006) response to the ‘2005 Edge Question’ in Brockman, J (ed.) What We Believe But Cannot Prove Pocket: London
Nesse, R.M and Williams, G.C (1996) Evolution and Healing: The New Science of Darwinian Healing Phoenix: London
Oppenheimer, S (2004) Out Of Eden: The peopling of the world Robinson: London
Ramachandran, V. S (2000) MIRROR NEURONS and imitation learning as the driving force behind “the great leap forward” in human evolutionhttp://www.edge.org/3rd_culture/ramachandran/ramachandran_p1.html [19.7.08]
Ramachandran, V. S (2003) The Emerging Mind Profile/BBC: London
Ramachandran, V. S (2006) ‘Mirror Neurons And The Brain In The Vat’ response to the 2006 Edge Question at; http://www.edge.org/3rd_culture/ramachandran06/ramachandran06_index.html [3.6.09]
Ramachandran, V. S (2007) Self Awareness: The Last Frontier http://www.edge.org/3rd_culture/rama08/rama08_index.html [6.1.09]
Ramachandran, V. S (2009) The neurons that shape civilisation TED conference presentation.
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