Psychological Concepts and Biological Psychiatry: A Philosophical Analysis: Advances in Philosophical Analysis, vol. 28

Marcus Tullius Cicero (106 to 43 B.C.) defined six mistakes of man:

• The illusion that personal gain is made up of crushing others.

• The tendency to worry about things that cannot be changed or corrected.

• Insisting that a thing is impossible because we have not been able to accomplish it ourselves.

• Refusing to set aside trivial preferences.

• Neglecting the development of refinement of the mind and not acquiring the habits of reading and study.

• Attempting to compel others to believe and to live as we do.

These warnings were valid in Cicero’s time and are valid now. I see them especially in the imposition of the will of managed care programs on health care providers and consumers. I also see their validity in the academic training programs for mental health professionals, whose leaders impose their particular perceptions of science rather than what the author of this book calls “folk psychology” on medical students and psychiatric residents. These programs have an influence on how mental health care is delivered, not only by mental health professionals but especially—and more alarmingly—by primary care physicians, who treat more than half of all patients with psychiatric disorders.

A survey conducted by the Rand Corporation in 1993 found that only half of the general practitioners participating in the study who treated depression spent three minutes or more discussing the patient’s personal problems. This sobering statistic is very scary for all psychiatrists because most general practitioners are so biased toward the scientific, “broken brain” model that, without so much as a standard mental status examination or inquiries into family histories, they prescribe antidepressants and potentially addictive anxiolytics.

I have been doing book reviews since 1971, first for the New England Journal of Medicine, then for the Journal of the American Academy of Child Psychiatry, and now for the American Journal of Psychiatry. Nancy Andreasen, the Editor-in-Chief of the Journal and its Book Forum editor, is my former classmate, a friend, and one of the most brilliant minds I have ever encountered. I had a very difficult time reviewing this book and had to put it aside several times because the author, Peter Zachar, attacks her by name, as he does the St. Louis group headed by the late George Winokur, who was one of my professors.

This book is remarkable for its catholicity of intellectual breadth and the courage of the author in taking on the powerful intellectual forces that dominate the academic scene today. He tells these emperors that they may not be wearing the clothes of wisdom.

Zachar very skillfully builds his case brick by brick by exposing the specious “facts” on which “biomedical and eliminative materialists” build the foundation of their assault on folk psychology. Defining in laborious detail the evidence on which each of those facts is based, like Marc Anthony giving his famous speech praising the “honorable” men who assassinated Julius Caesar, Zachar makes it sound as if he were convinced that the quacks of folk psychology deserve to be hoisted by their own petards.

In fact, so well researched is Zachar’s understanding of the materialists that the reader is best warned to be well versed in semiotics, physics, and philosophy and to have the patience of Job. The fainthearted and those with a less than intimate working knowledge of the Oxford English Dictionary might drop of mental exhaustion by page 294. In this regard, Peter Zachar is very much like Vladimir Nabokov: he is so encyclopedic in his knowledge and so elitist in his rarefied vocabulary that he never bothers to explain a lot of complex ideas or pause to use simple words rather than polysyllabic, arcane, or esoteric neologisms—the way a wiseacre would say “floccinaucinihilipilification” instead of “the action or habit of estimating as worthless.”

What is most sobering and deflating for psychiatrists and other medical professions about this book is that it forces self-examination of our own psyche and motives and our prickly, overdefensive overreaction. The phenomenon described by Zachar was also described by Thomas Maeder in “Wounded Healers” (1). Zachar exposes the ugly misanthrope hiding under those who approach the emotionally troubled from a cold, clinical, biomedical, scientific perspective. Sue Erikson Bloland, the daughter of the great psychoanalyst Erik Erikson, described her father as a very distant, insecure man who pushed his own children away when they needed him most and who eschewed psychotherapy for himself (2). Sir Lawrence Olivier (3) stated that he was most at ease on the stage, where he could wear a costume and a facial disguise like a fake nose, moustache, or beard because they allowed him “the shelter of an alien character” that enabled him “to avoid anything so embarrassing as self-representation.”

When I was in training, one of my “biologically oriented” professors often demeaned psychotherapists as “quacks and pseudoscientists” because “therapy never works.” I asked him whether his misanthropy made him ineffective as a therapist, which would lead him to the conclusion that therapy does not work.

Don’t You Believe It! by A.J. Hoover (4) is a catalog of the 30 logical fallacies most human beings are prone to, including 1) slippery slope thinking, 2) argument of the beard, 3) argumentum ad elenchii or begging the issue, 4) argumentum ad hominem or dismissing a fact because it is espoused by a reputedly stupid or widely known disreputable quack or immoral person, and 5) poisoning the wells or attempting to refute an argument by discrediting in advance the source of the evidence for the argument.

One by one, like dominos, Zachar fells one materialist tenet after another. He even administers a coup de grace for Nancy Andreasen and the Churchlands by reminding the reader that before their more recent, inglorious mutations into scientists they were aesthetically sophisticated Ph.D.s in English literature or philosophy.

Most psychiatrists and other materialist readers will be angered by Zachar’s systematic and efficient dismantling of those who would be known as “scientific.” Zachar shows his true colors—if not his finest moment—by reminding us that psychiatrists really do not need to dumb themselves downward to align themselves with mainstream medicine. Rather, it should be the other way around: the rest of medicine can develop compleat physicians by adopting the psychiatrist’s Shakespearean breadth of interest in understanding the total human condition. Physicians need to be reminded that we treat more than just diseases.

Like Minoru Yamasaki, the architect of the World Trade Center, let us all begin with the end in mind. Yamasaki wrote that those buildings were supposed to be a “representation of man’s belief in humanity, his need for individual dignity, his beliefs in the cooperation of men, and through cooperation, his ability to find greatness” (5). Zachar calls us to a table of dialogue, tolerance, and consensus, not the intolerance and “take no prisoners” attitude of Osama Bin Laden and his goons.

If I know Nancy Andreasen, she will read this book and encourage us to follow Zachar’s call. I hope our materialist colleagues will follow her example and not fall victim to A.J. Hoover’s logical fallacy number 30, pigheadedness, the ultimate fallacy—refusing to accept a proposition even when it has been established by adequate evidence.