Psychotherapy, Biological Psychiatry, and the Nature of Matter: A View from Physics

By Berger, Louis S. | American Journal of Psychotherapy, January 1, 2001 | Go to article overview

Psychotherapy, Biological Psychiatry, and the Nature of Matter: A View from Physics


Berger, Louis S., American Journal of Psychotherapy


Biological psychiatry has marginalized psychotherapy, and it is difficult for psychotherapists to counter its hegemony. The reductionist/materialist position seems incontrovertible and self-evident. An important factor in maintaining this stance is the belief that the physical world is understandable, solid, unproblematic, especially when compared to the realm of the psychological. Developments in quantum and relativity theories, however, cast doubt on that belief They show the fundamental nature of the material world to be problematic, enigmatic, paradoxical, impossible to understand or conceptualize in terms of everyday experience. This insight weakens the prima facie case for privileging the material over the psychological, and alternative (ie., nonneurobiological) approaches to mental health matters should, therefore, be able to compete on an equal footing. However, the materialist-reductionist stance is kept in place by powerful forces and is well defended; rational arguments alone are unlikely to have an impact. This pervasive ideological resistance to rational, often well-founded critiques of physical reductionism continues to be a major impediment to changing the present materialist climate. That resistance has to be addressed before any significant shift in orientation can be expected to occur.

A major concept that has channeled thinking, research, and practices within and on the periphery of the mental health fields is the polarity of the mental or psychosocial against the physical/material or neurobiological. It is the legacy of Cartesian mind/body dualism which is "so marked a feature of our spiritual and moral landscape" (1, p. 6).

While a wide variety of positions and associated practices reflecting differences in the relative weight given to each pole are found among mental health clinicians and researchers, few would quarrel with the conclusion that the positions that privilege the material, neurobiological pole virtually have won the day. As Elliot Valenstein, Professor Emeritus of Psychology and Neuroscience at the University of Michigan reports,

now it is widely believed by most authorities and the public alike that the cause [of mental disorders] is a chemical imbalance in the brain.... Brain chemistry is believed to be not only the cause of mental disorders, but also the explanation of the normal variations in personality and behavior.... Today, the disturbed thoughts and behavior of mental patients are believed to be caused by a biochemically defective brain, and symptoms are not "analyzed," but used mainly as the means of arriving at the diagnosis that will determine the appropriate medication to prescribe. Almost all current chairmen and the majority of the staffs of psychiatry departments are committed to a biochemical approach to mental illness. (2, p.1)

The dominance of neurobiological or biomedical orientation has brought with it a marginalization of psychotherapy. It has even "fueled speculation that one day soon all forms of talking therapy will be obsolete.... [C]onsumers increasingly rely on insurance companies and health maintenance organizations, which prefer cheap pharmacology to expensive psychotherapy" (3, p. 17).

Is this marginalization justified? The answer will depend on one's position on a number of issues, including, for example, how one judges the efficacy of various psychotherapies, what one considers to be the goals of treatment, or what importance one places on simple economic considerations. Another major factor is one's position on materialism or physicalism-roughly, on the premise

that everything in the world is physical, or that there is nothing over and above the physical, or that the physical facts in a certain sense exhaust all the facts about the world. (4, p. 41)

If one believes this premise, one will naturally tend to reduce mental domain to the physical:

Everything mental or spiritual is a product of material processes. …

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