When I set about becoming a writer in my twenties, I felt I needed to understand the nuts and bolts of language. I compiled lists of words and learned their etymologies. I broke down the sentence structure of books I admired in the hope of discovering a particle physics behind their greatness. One day I came upon Tolstoy's response to an accusation that he used language in an ordinary way. "You don't need beautiful bricks," he wrote, "to build a beautiful building."
When I entered the field of psychology, I felt I needed to understand the inner workings of the brain. The 1990s promised that we were edging ever closer to Freud's dream of uncovering a "nerve" basis of the psyche. The DMH demanded "evidence-based practice," looking to a reductive medical model imported from the physical sciences. In county clinics, I watched psychiatrists educate patients by referring to diagrams of the brain, pointing out how ADHD arises out of deficits in frontal-lobe processing and PTSD from dissociation of limbic areas from higher cortical regions. I struggled to memorise the specialisations of brain areas. I learned about myelination and action potential and absorbed Daniel Siegel's definition of mental health as brain integration.
But psychotherapy seemed to me to happen on a different dimension. Consider the case of a 20 year old client who came to me with "presenting problems" of ADHD and a strange phobia toward motes of dust. He demanded to know exactly what was wrong with his brain and how I could fix it. It turned out that behind the urgency of his desire for a "brain" explanation was a fear that his symptoms proved that he had been cursed by God for his thoughts and behavior. If only his problems could be understood as physical instead of moral. My client lived at home, under the rule of a father who followed a dogmatic religion and discharged his anger by violently punishing family members for violations of biblical rules. My client's greater difficulty turned out to involve separating out his anger at his abusive father from the much-valued spiritual beliefs he had inherited from him. His phobias and impulsiveness persisted, but as we felt our way toward a larger understanding of who he was, they mattered less. Patients often initially ask for concrete brain-oriented explanations, but they tend after awhile to reject attempts to wrap a species template over their unique adaptations to the world. The natural course of therapy seems less reductive than expansive, moving from symptoms to meaning to narratives of the self in relation to the world. If our subjective experience boils down to chemicals squirting through the brain, why this fundamental human quest for expansive explanations?
Roger Sperry, who won the Nobel prize for his work with split-brain patients, provides the most credible hypothesis. In his view, feelings, ideas, values and other mental states are emergent properties of the physical brain, irreducible entities that depend on but cannot be explained in terms of their interacting parts. Furthermore, these mental states exercise a controlling influence over the physical components that give rise to them. In this model, "mind is in the driver's seat in the brain, in command over matter."
The notion of the whole exerting "downward causality" on its parts is best understood as happening in two mutually influencing dimensions. Imagine a rolling wheel. Its molecules obey all the usual laws of molecular physics. But if we consider the fate of those molecules through space and time, the rolling wheel is a more important controlling factor. Furthermore, we could no more predict the rolling wheel by considering its molecules than we can understand the meaning of this sentence by examining the individual words and letters that comprise it or understand a person's thoughts, feelings and ideals by analysing the play of neurons in his brain. This is not to say that medication, which intervenes on the level of the brain, has no place in treatment, only that it will never make the kinds of higher-order changes that emerge when two minds connect in the service of one -- not until we invent a pill that understands people.