Where do we go to from here? One possible direction we could go in, by way of illustrating the landscape that’s opened up by having answered the question what a mind is, how it works, what it’s for, is to ask ourselves, well, then, what about disorders of the mind? What does all of this tell us about disorders of the mind?
Well, I’d like to just give a few general principles about disorders of the mind. It really would be a whole new course of its own to go into this properly, to give the question the detailed answers that it deserves. But I think that we can sketch the thing in broad outline. And the outline goes something like this. If what the mind is there for is to meet our needs in the outside world, and if the way we come to know what’s our needs are, that is to say what our problems are, is through feelings, feelings register for you something’s happening here that needs my attention and that needs attending to in the outside world.
Then there are only two ways in which things can go wrong with the mind, either in terms of its feelings or in terms of what it’s doing in the outside world. When we are born, we really have no idea how to meet our needs in the outside world. So there’s good reason to imagine, and, in fact, if you look at the matter from the outside, it certainly seems that this is the case, that the mental life of a little baby is full of feelings, full of problems. Remembering that that’s what feelings are, that’s how the subject comes to know that there’s something the matter inside. It can’t meet those needs in the outside world.
And that’s why parents, or the adults who look after children, are so important in establishing the foundations of mental health. Parents or caregivers have to teach that little mind how to meet its needs in the outside world, first by meeting its needs for it. And then gradually the baby builds up a picture of, oh, that’s what one does when one feels like this. That’s how you acquire ideas as to how to meet your needs in the world. Eventually, you take over from your parents and you start thinking your own way through your problems.
Please note that once you’ve thought your way through a problem, that is to say actually felt your way through a problem, once you’ve applied your consciousness and said this feels good, this feels bad, let me work this out. If I do it like that, does it work as I recall? When I did it like this, it didn’t work, it didn’t leave me feeling right, et cetera. Once you’ve worked out how to do it, once you really have got a solution, that works. This works for me. I’m going to do it that way. You don’t need to consciously think those things any more. And that’s why and how we gradually render most of our cognitive operations unconscious.
We only have to have in conscious mind those things that we don’t know how to do, those things which present here and now problems for us, surprises.
But life is so difficult and so complicated, obviously there are a great many things that we don’t find solutions to. Especially when we’re little, there are things we can’t find solutions to. How am I going to become a big man, and earn a living, and drive a car, and have a family? How am I going to do that when I’m two? You can’t begin to fathom your way through it. So what we do is in order to be able to focus on those things that we can solve, we have to put things out of mind. We have to, as Freud called it, repress things. It’s inevitable.
But please note, things that you’ve repressed are automatised solutions, this is what I do in that situation, which actually don’t work. So these sorts of solutions, these premature solutions, these prematurely automatised solutions, things we make unconscious, which are not yet fit for the bill, those things are always going to bang into reality and generate new feelings. That’s what Freud called the return of the repressed. That’s what mental disorders are. Mental disorders arise out of us not having the right sort of thoughts, the right sorts of ideas, plans, intentions that actually fit the bill of meeting our needs in life. That’s why we say that mental disorders are, in a sense, emotional disorders.
People go to psychiatrists and psychotherapists with troubles with their feelings. The aim of the treatment then becomes trying to find better solutions, trying to find ideas or action plans that really do fit the bill. That really is all that psychological therapy is about. All forms of psychological therapy are helping the patient to find better ideas that really do meet the demands of the feelings that are arising from within them. In psychoanalytical therapy, it specifically involves having to bring back to mind those memories, those representations, derived mainly from childhood of this is how I’m going to solve this problem that I can’t solve. In other words, it’s allowing you to bring back into mind things which really generated difficult feelings.
That’s what specifically psychoanalytical treatment does. First, you have to make those unconscious things conscious again. And it’s done against resistances. This is not easy. But in the end, now as an adult, with the help of another adult, you’re able to think those things through afresh and then reconsolidate, reautomatise, turn unconscious again, ideas which really do work and do enable you to meet your needs in the world. That’s really all it comes down to. I’ll end though with one final observation, which is, of course, it’s not only by psychotherapy that we treat mental disorders. It’s also by psychopharmacology.
The main difference between psychotherapy and psychopharmacology is that the psychopharmacological approach treats the feelings themselves, not the ideas, the thoughts about how am I going to manage these feelings. Drugs act directly on the upper brainstem structures, the reticular activating system that generates the feelings. I’d like to point out, maybe I’m being a little naughty in doing so, that that is not a curative treatment. That’s symptomatic treatment, suppressing the feelings which are actually trying to tell you something. So the real curative treatment is the psychological therapy, where you find solutions that actually do work so that you don’t need to have those troublesome feelings any more.
But sometimes it’s necessary to have psychopharmacological treatments to damp down the feelings, to make them manageable enough to be able to think them in a psychological treatment. And that’s why so often the best way forwards is to have both drugs and psychotherapy. So that’s a pointer, broad brush strokes, as to where we might go if we were to take this all further and try to understand on the basis of our answer what is a mind, and how does it work, and what is it for, how we might apply that to mental illness. Thanks.