The Mind-Body Problem

We appreciate the thoughtful and clever piece on the mind-body problem by Kenneth Kendler, M.D. (1). Too little attention has been paid in psychiatric education and training to the philosophical underpinnings of our field, and we believe that many problems with the way in which psychiatry is both perceived from the outside and practiced from the inside are attributable to a lack of clarity—or simply an absence of thought—on this topic.

It is for that reason that we are troubled by the misunderstanding of the doctrine of eliminative materialism that this dialogue is likely to engender. “Teacher” states that, according to eliminative materialism, “Mental experiences are all epiphenomenal or, as some say, inert” (p. 992). Eliminative materialism, put forth by the philosopher Richard Rorty (2), carries no such implication. Rather, it likens the concept of “mental” events to obsolete ideas, such as Zeus’s thunderbolts. Instead of asserting that Zeus’s thunderbolts are identical to discharges of electricity (lightning), we say that what were once considered Zeus’s thunderbolts are now thought of as electrical discharges. In our current discourse, there are no such things as Zeus’s thunderbolts; they have been eliminated. Similarly, for the eliminative materialist, mind can be seen as nothing more than body (i.e., neural events). Thus, rather than being identified with or reduced to body, mind can be eliminated—at least as far as scientific discourse is concerned. However, just as what used to be seen as Zeus’s thunderbolts can still be lethal, what is currently referred to as mind can certainly be—and clearly is—causally efficacious.

Of more obvious direct import for psychiatry, “Teacher” opines that acceptance of eliminative materialism would imply that “Any psychiatric interventions that are purely mental in nature, like psychotherapy, could not possibly work” (1, p. 998). Attempting to adopt the perspective of eliminative materialism while invoking the Cartesian category “purely mental” is what cannot possibly work. An eliminative materialist would not describe psychotherapy as an intervention that is “purely mental” for the simple reason that the concept of the “purely mental” makes no sense. An eliminative materialist would have no difficulty conceiving of the techniques of psychotherapy as being effective—to whatever extent they may actually be effective—because they are methods of changing the function of the brain. Moreover, there is absolutely no need (and certainly no reason!) to posit the existence of a mental intermediary that transduces the techniques of psychotherapy into changes in brain function.

Nonetheless, Dr. Kendler has done us all a great service by writing this piece, and we applaud him for it.