Monday, December 19, 2005


A vacation and a recent conversation gave me opportunity and motivation to consider again what I learned on psychiatry. I think the big thing was that Axis I disorders are real. I used to be highly skeptical of mental disease, a byproduct of my stern upbringing. (Which was in itself a result of my Germanic heritage, according to the absolute best teacher I have ever had.) But my views have softened somewhat. I've seen and treated PTSD, MDD, and Bipolar I and II. They are real, and the chemical imbalances which cause them are treatable. Axis II disorders besides retardation I am still a bit skeptical of. They may also be real disorders, but the symptoms are often merely those of someone with poor self-discipline.

I'm thrown back, in considering all this, to that core discomfort of mine: the mind. As science attempts more and more to elucidate the nature of consciousness, that "awareness of awareness" that sets us apart from mere animals, the answers are progressively more uncomfortable to someone with religious convictions. If depression is merely a deficiency of serotonin, what is religious ecstasy? If epileptics seem to have religious visions as a part of their seizures, is the depth of our own convictions merely chemical? William James pointed this out an hundred years ago. Was he right?

So is there a "ghost in the machine"? Is there, somewhere, a point at which progress will stop, and we can say there is something more, something beyond what can be demonstrated with neurotransmitters in a lab? That point may be far in the future, as neuroscience is still in its infancy. Still, the scientist and the mystic within me wait with trepidation.

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