Explaining psychopathologies

My friend, Louis Sass, has said he thinks people attracted to philosophy are at least schizotypal.  Seems a bit confining to me, but explaining oneself and one’s academic colleagues can be challenging.  And it is not just all fun and giggles. Apparently Kissinger said that the reason academic politics is so nasty is that the stakes are so small. I’m inclined to think it’s the reverse; academic politics is so nasty because many academics are the sort of people to fight over very small stakes.

One of the things I have found attractive about cognitive neuroscience is that it gives us a largely new take on what in the world is going on with us.  And it is one free of the dark weapon that Freudian approaches can turn out to use.  In too many people’s hands, Freudian explanations completely epistemically disenfranchise the subject, and then advance demeaning explanations.  People who cannot understand creativity, for example, happily tell themselves that someone dedicated to a project is really self-promoting.  “You may think you were trying to help, but you were really trying to … ” goes a too familiar refrain.  Even feminists who are skeptical about objective truths will be convinced they understand another’s soul.

But cognitive neuroscience invites us to think about the complexity that can underlie a pattern of human behavior. At what points in that complex of person and environment is that problem arising? And the explanation of behavior can be enlightening. Or it can be extremely puzzling.

One thing many cognitive neuroscientists endorse is the view that human beings need to act and react much more quickly than reason can accommodate. (Yes, just as Hume said.) And, simplifying a bit, that need is served in part by structures in the brain that can send send something like alarm signals. The alarms go off very quickly, more quickly than we can think. For example, most human beings get a negative kick when they have visibly hurt someone. Think of scolding a colleague and see their eyes well up. Most of us will stop and back up. Not everyone. I have a friend who will later call you up and start in again, perhaps just to make sure the message got in. It’s a good bet he doesn’t have much in the way of von economo cells in his anterior cingulate cortex, since they provide the kick in human beings.**

I think chimps have some sparse amount of von economo cells, and elephants remain a possibility. But frankly, my dear, most of our animal friends don’t give a damn, though some learn to fake it. (OK, there’s a bit of speculation there.)

And another alarm goes off when norms are broken in most people. If I’m in some supposedly cooperative game with you and I give you a mean share, or you do that to me, an alarm will go off in my anterior insula. And maybe yours too. But not in everyone’s.  A recent article in Science claims to have found a neural marker for borderline personality disorder. And it is precisely a deficit in the anterior insula.

The classic description of BPD people is that they are unstable. They have emotional swings and rages and an inability to establish long term relationships. They also fear abandonment; they are a sort of natural tragedy since their behavior seems geared to bring about what they most fear. Other characteristics include harming themselves; they can be cutters. They apparently go in for splitting; that is, things are black or white, people are good or bad. A friend of mine who was a therapist tells me that they are very manipulative and typically very successful at it.  Some people claim that the BPDs among academics have  very distinctive characterisitics, though others say we’re unlikely to have it (which is one down, anyway).

It is very recent work in Science claims that a distinguishing factor in BPD is a deficit in the anterior insula,  In particular, the BPD participants had no trouble detecting  that they were doing an injustice.  What they didn’t seem to get was when an injustifice  was being done to them.  Or at least they didn’t get the rapid alerm going off.

It is very difficult to understand how a lack of a perception of injustice inflicted upon one would lead to any of the syndrome’s features.  The authors conjecture that BPDs really have severe problems understanding other people, which perhaps brings the marker in closer  to the syndrome.

I suggest there is a whole area for philosophical investigation here.  What is it about norm violation and the failure to detect it that might play an explanatory role in BPD?  We are learning from cognitive neuroscience that traditional distinctions among perception, action and emotion may be quite mistaken and that there is something like affective perception.  We might wonder whether a knowledge of norm violation has a  first and third person variations, some of which are more tied into something like the automatic and instinctive kind of reactions the anterior insula may give us. 

So back to Freud:  what’s the fole of unconscious desires, the id and the ego?  What seems to me to be the highly capitalistic assumption that we are doing what we  want  may be passing away.  Instead, we are products of a much larger complex that includes the environment and our ability to see what is going on.

There is a new science of the self being constructed.  It would be wonderful to have more feminist scholars participating, though the women already in the field are certainly doing their share.

**Much of the work on von economo cells has been done by John Allman at Caltech.

9 thoughts on “Explaining psychopathologies

  1. Yikes!! I found this entry a little shocking. I am surprised you are assuming the validity and soundness of psychiatric labels. There is a lot of feminist literature critiquing them, especially the category “bpd.” This extremely insulitng label is most often applied to women who have experienced chronic familial abuse. Judith Herman has argued, for example, that this “disorder” should be seen as a form of post-traumatic stress disorder. I came accross a woman recently who had been given the label bpd. It was hard to communicate with her because she was so deeply caught up in connections with tramautizing relations; yes she had lots of relationship problems and problems with forming healthy bonds–not suprisingly. A paper of mine was published on this topic. nicandr4@aol.com

  2. I’ll certainly look at your work; thanks so much. And thank you for the way you’ve raised the question.

    I have absolutely no negative associations with psychiatric labels, though I have extremely negative associations with most psychiatric approaches to mental disability.

    I’m really puzzled by the idea that “borderline personality disorder” is somehow a bad label, but “post-traumatic stress syndrome” is OK. I wonder if it is because the second doesn’t get ANY MORE the sort of highly demeaning (in my view) explanation that is given by too many psychiatric approaches to the first. I think the approach outlined in the Science paper is easily understood as at least compatible with seeing close associations between the two.

    So you could see this post as appropriating the terms. Further, if we approach mental distress is a very different way, we might even think we’re using the terms in a different sense.

    Now, having said that, it is of course possible that we could find BPD a kind of invention, as Hacking has proposed of multiple personality disorder. (I’m not saying he is right, but just that that’s a kind of approach.) Or we might see it eventually as arguably as many view a lot of cases of depression: a reaction to a very bad positioning imposed on women. Or…well, I’ll read your paper. It’s very surprising to find any sort of biological marker, and if someone wants to push on that, there isn’t much I can say. Among other things, I doubt we should expect diagnosis to track a real syndrome. It may be the cases explored were of some sort of sub-set..

  3. If you’re interested in the topic, you might ‘google’ for different takes on the research on BPD. All the pop accounts I’ve looked at catch the idea that BPD might be a matter of perception rather than motivation or ‘will.’

    I haven’t seen a report that questions the reality of mental distress syndromes, nor ones that question fMRI readings, so they all agree with assumptions you might want to question.

    Here’s one:

  4. Hi, I–Andrea Nicki–am an expert in the field of philosophy of psychiatry and did a postdoc in this field. I refer you to my paper “The Abused Mind” published in Hypatia in a special issue on disability. I have another paper that was accepted for a journal exactly on the topic of the mpd controversy. Further, Susan Sherwin at Dalhousie has explored the issue of “false memory syndrome.” There certainly are many philosophers who maintain that “personality disorders” are valid and tenable categories; but this is really unfortunate and is a prime example of what can happen when philosophers do not draw on other disciplines in their theorizing; which is to produce very meaningless theory and in this case theory that harms women and is actually vampiric.

  5. Ps. The science article is interesting, though. People with “bpd”–complicated ptsd–will have difficulty knowing when someone is doing an injustice toward them because they have received continual invalidation of their experiences in childhood. They know on some level that a person is mistreating them but they have trouble affirming this–they have been taught that all their sensations and feelings are wrong. Perhaps this kind of study will promote empathy toward people with “bpd” while understanding that “bpd” is an insult to a personality that had little choice in how it developed.

  6. An, thanks so much for all the additional input. I’ll certainly look at your work and think about what you are saying. I think we are looking at different parts of a very important problem. I did neglect the social dimensions of the diagnosis of BPD. It certainly can be an excuse, a way of containing, institutionalizing and more. That’s really important and I wish I had said at least a bit about it. I expect your work will give a more textured take on it than I could.

    I was looking more at what ensures therapeutically after a diagnosis. I think there is growing recognition that locating the cause of painful mental disfunctioing in motivations is too often wrong, pointless, damaging, etc.

    I think what is emerging from the last decade or two or research is that people in acute mental distress may well be dealing with a different world from the one the non-distressed are dealing with. To the extend that the acutely distessed person has experiences many of us are spared, the changes in such a person removes them from any sort of easy judgment others might make on their motivational structure. It appears, for example, that trauma can break down the ability most people have of containing miscellaneous signals and warnings; it is as though the surivial of those going through acute trauma depends on their having some awareness of all the signals from their enviroment. Such a person who is flooded with input isn’t “doing something to themselves” or anything remotely like that.

    Hope this makes sense.

  7. Sounds right. I think definitely the trauma survivor has trouble honing in on ways to get certain needs met. Yes and seeing it in this way takes the blame off the person for her challenges and difficulties.

  8. Wicked post, very interesting blog, congrats!

    Lately I’ve been wondering whether self willing slaves could perceive it – that they are enslaved – (but fake otherwise) or not…

    Apparently there is more to it… I’ll be definitely reading more on the neural markers and this disability to create or perceive alarm signals.

    joão david

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