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Exploring Mental Health:
A Working Group

Looking for the Role of Individuals

Participants: Jessica Coulter (BMC student), Laura Cyckowski (BMC student), Paul Grobstein (BMC Biology), Amy Malleck (BMC student), Judie McCoyd (Rutgers, Social Work, practitioner), Linda Slattery (Phil school counselor)

In addition to a relative lack of concern for the interactions between individuals and cultures, considered more extensively in our prior discussion, it was suggested in Models of Mental Health: A Critique and Prospectus that the "medical model" undervalues the active role that internal experiences and individuals themselves play in mental health considerations. The group began exploring these issues, using as a starting point two articles by Eric Kandel, A New Intellectual Framework for Psychiatry (1998) and Biology and the Future of Psychoanalysis: A New Intellectual Framework for Psychiatry (1999) that discuss potential bridges between biologically oriented psychiatry and psychoanalysis.

Kandel outlines the quite significant advances in understanding the brain that are relevant for mental health issues, provides an interesting and useful account of the divergent trajectories taken by psychoanalysis and biologically oriented psychiatry, gives a thoughtful critique of the recent history of psychoanalysis, and suggests that the psychoanalytic tradition could productively link more closely to biologically oriented psychiatry, both by increased awareness of its findings and by returning to a broader "research and scholarship" perspective that characterized its earlier history.

Concerns were expressed about the accessibility of Kandel's writing to people without a significant background in biologically oriented psychiatry (and hence its impact on that community), because of the frequent use of anatomical terminology and other "technical jargon". A second set of concerns related to the definitions of "empirical research", "scientific", and "objective". The issue here is the extent to which "Subjective phenomena do not readily lend themselves to objective empirical analysis", issues of confidentiality in reporting such phenomena, and the degree to which clinical practice necessarily and inevitably depends on clinical "intuition" (because of the enormous diversity inherent in such phenomena?). Kandel speaks of the "need to develop creative ways of studying subjective phenomena" but makes no concrete suggestions along these lines, which seem central to any bidirectional bridge between psychoanalysis/dynamic psychotherapy and biologically oriented psychiatry and, more generally, to any effort to create a broader perspective on mental health that gives greater emphasis to distinctive individual experiences.

In this context, it was noted that people may behave in ways that are not "experienced" by them, an illustrative example being "people with dementia forget that a loved one has just died, yet show all the clinical signs of greiving that anyone else would experience when suffering a similar loss" (see Fogel). The point here is not only that people may act unconsciously, without knowing they are doing so (though it is visible to others), but may even act in particular ways without themselves internally experiencing feelings (in this case "grief") that would normally be presumed to motivate such actions. In this case, the "meaning" of actions may be fully dissociated from the actions themselves. One may act without "meaning" or one may attribute one's actions to "meanings" other than the one's others might attribute to them.

This dissociation seems important both in appreciating the importance of individual experiences and in thinking about how to engage individuals more fully in their own mental health therapies. It calls attention to the important role that one's own "meaning-making" (story telling) plays in human existence and mental status and hence to the role of "metaphor in therapy". Among those who have tried to emphasize this "meaning-making" in a therapeutic context are Jung, George Kelly (in his personal construct psychology), and Robert Niemeyer. It also appears to be the central concept in the work of a number of popular therapists, including Byron Katie.

The issue this raises is whether and how "ideas/meanings" influence behavior (and, presumably) the brain. How is it that "something one said made a difference"? Can we develop a theory related to "meaning-making" and its underpinnings that would help to expand one's understandings of mental health? Judie offered to provide some relevant readings along these lines for our next meeting.

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