The following is Chapter 1 of Healing the Soul in the Age of the Brain by Elio Frattaroli (Viking, 2001). With the permission of the author, it is made available on Serendip in connection with a conversation on Psychonalysis and Neuroscience: Enemies, Acquaintances, Bedfellows?.

A Brief Introduction to the Soul

Now there are some things we all know, but we don't take'm out and look at'm very often. We all know that something is eternal. And it ain't houses and it ain't names, and it ain't earth, and it ain't even the stars . . . everybody knows in their bones that something is eternal, and that something has to do with human beings. All the greatest people ever lived have been telling us that for five thousand years and yet you'd be surprised how people are always losing hold of it.

Thornton Wilder, Our Town

Being There

The first game of the 1993 National League playoffs between the Philadelphia Phillies and the Atlanta Braves was about to begin. My son Gregory and I were sitting high up in the center field grandstands of Philadelphia's Veterans Stadium - two specks of foam in an ocean of restlessly excited fans, swelling against the shores of the AstroTurf playing field. Rooting for the Phillies, we naturally expected to lose, especially against the notorious Atlanta pitching staff, one of the greatest ever assembled.

I don't remember whether we were standing for every pitch as Curt Schilling, the ace pitcher of our own team, struck out the first Atlanta batter. However, I do remember sitting down afterward and calling out loudly, "Okay, Curt, let's get twenty six more of those!"

"Daaad!" moaned an embarrassed Greg, as seven or eight of the fans who were seated just below us turned around, chuckling. Perhaps they were wondering whether it was the voice of optimism or cynicism they were hearing. I wasn't sure myself.

The first two pitches to the second batter were strikes, each punctuated by a thunderous cheer, that subsided and then rose again like a huge wave cresting. When the batter swung and missed for strike three, the wave crashed and exploded into a roar that seemed to lift the stadium with it.

"Okay, Curt, just twenty five more!" I yelled, sitting down once again on the edge of my seat as batter number three walked up to the plate. This time Greg almost smiled, and I caught the amused eyes of a middle-aged couple seated down the aisle a few seats to our right. I felt an immediate bond with them and, by extension, with everyone in the stadium.

With each pitch to the third batter the level of excitement rose even higher, until finally Curt nailed his third straight strikeout and the stadium was transformed. The sea of restlessly excited fans became as one - sixty-three thousand specks of foam vaporizing and coalescing into a single triumphant sound, which seemed to continue unabated through the fourth strikeout, and then the fifth. I know the Phillies had to have batted somewhere in there, but I have no recollection of it.

What I do remember is screaming out, "Hey, Curt! Only twenty two more!" and literally not being able to hear the sound of my own voice. My words were swallowed up even as they left my lips, vanishing into a joyful clamorous tidal wave of sound. But, paradoxically, in that very moment of vanishing I had a sudden, vivid experience of inner presence. I experienced myself as a soundless eddy of consciousness, merging into a roaring unconscious sea. In that moment, I was the very sound of one hand clapping.

The Place Where Experiencing Happens

If I have told this story at all well, then readers who have had the same kind of experience will know the quality of awareness I have just tried to put into words, because they will be able to recognize it from within themselves. But what of readers who have never had such an experience? They may understand what happened as an external event, but can they ever really know what it was like as an inner awareness? To these readers I might say, "Ya hadda be there!" implying that certain experiences cannot be adequately understood unless they are shared. But then, where exactly would a person have to be in order to share my inner experience, to know what it was really like? An interesting question.

Could a person understand my experience, for instance, from having had a similar one at Baltimore's Camden Yards, which holds a mere forty thousand fans? How about at a football or basketball game? Could a person have the same sort of experience while listening to a concert at a symphony hall? How about while doing a circle dance at a wedding, or chanting in unison at a meditation retreat, or walking alone on a deserted beach? Could a person who had never shouted out at a ball game or cried "Bravo!" at a concert understand my experience? Could my son understand it, or the middle-aged couple with whom I felt bonded?

What I am trying to suggest with these questions is that the place you gotta be to understand another person's inner experience is not a particular geographic locale, or cultural institution, or social setting, or even a particular physical body, but rather an indefinable inner place - the place where experiencing happens. This is a metaphori-cal place, like the Ithaca of Homer's Odyssey, or the Rome that all roads lead to. It is a place we must struggle to get to, only to discover that we have been there all along. Even if you have never had an experience quite like mine, you might get to the place where I had it without ever getting up from your chair, and you might understand the experience much better from reading my account of it than the guy in the Braves cap could, who was sitting just three seats away from me at the game.

From Baseball to Psychiatry

As a psychiatrist dedicated to the practice of psychoanalytic psychotherapy, I often feel like a Phillies fan marooned in Atlanta's old Fulton County Stadium, trying to describe to the Braves fans there just what those five straight strikeouts were like. It seems that the psychotherapy I know and love happens in a completely different ballpark from the one where most of my colleagues hold their season tickets. Try asking a psychiatrist, "What do you call the place where experiencing happens?" and nine times out of ten you will get a quizzical look and an automatic answer: "Why, the brain, of course."

I disagree. I think of the brain as a place much like a stadium, where publicly observable, measurable, material events happen - the shouting of phonemes, the throwing and hitting of baseballs, the running of bases, the electrochemical transmission of nerve impulses. The mind, too, may be likened to a stadium, a kind of virtual "field of dreams" where private, unmeasurable, immaterial events happen - thoughts, feelings, images, sensations. But the experiencing of all these events happens in a place utterly different from any stadium. That's what I noticed at the Phillies game, when I couldn't hear the sound of my own voice screaming "Only twenty two more!" As my words vanished into the din, I found myself listening to something beyond the words, beyond even the thought and the elated emotion - to a soundless voice, an inner movement, springing from the still center where all experiencing happens. In the utter privacy of that boisterous public moment, I recognized that I was listening to the soul.

Let me be clear about what I am suggesting here. I believe that humans possess a spiritual as well as a physical dimension, and that there are very real differences between brain, mind, and soul. I think of the soul as the experiencing self, the "I," an ineffable whole that integrates processes happening at four different levels of experience - body, brain, mind, and spirit. In this I disagree radically with the vast majority of psychiatrists today, who are so entranced with the powers of modern medication that they concern themselves with symptoms rather than souls, treating the chemically imbalanced brain, but ignoring the experiencing self.

The Age of the Brain

I believe it should be of great concern to us - as individuals, as a society, and as a culture - that our psychiatrists conceive of personal experiencing as happening in the brain and not in the mind or soul. Current fashions in psychiatry, as in the scientific community generally, tend quickly to become current fashions in our popular thinking - "seep(ing) into popular culture like the dye from a red shirt in hot water" (T.M. Luhrmann [1] ). The fashion nowadays is to use the word mind instead of soul, (to avoid any spiritual connotations) and to believe that either mind or soul is really just another word for brain. This belief - that anything we might call mental or spiritual is really only a by-product of brain activity - is the hallmark of our current "Age of the Brain." It is the basis for the way we answer academic or scientific questions about the mind and mental illness. But it doesn't provide much of an answer for the questions we really care about: Who am I? and What is the meaning of my unique experience as a human being?

To see how our official philosophy answers these ultimate personal questions, consider a few representative pronouncements by an assortment of internationally recognized experts: psychiatrist/neuroscientist Eric Kandel, philosopher John Searle, Nobel laureate biochemist Francis Crick, neurologist/brain researcher Antonio Damasio, former NIMH director, Lewis Judd, and surgeon general, David Satcher: [2]

All mental processes, even the most complex psychological processes, derive from operations of the brain. The central tenet of this view is that what we commonly call mind is a range of functions carried out by the brain. (Kandel, 1998)

[E]verything in our conscious life, from feeling pains, tickles, and itches to - pick your favorite - feeling the angst of postindustrial man under late capitalism or experiencing the ecstasy of skiing in deep powder - is caused by brain processes. (Searle, 1995)

"You," your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules. As Lewis Carroll's Alice might have phrased it: "You're nothing but a pack of neurons." (Crick, 1994)

To say that mind comes from brain is indisputable, but I prefer to qualify the statement and consider the reasons why the brain's neurons behave in such a thoughtful manner. (Damasio, 1994)

[T]he understanding of mental disorders and their treatment requires a new awareness of how the brain functions, how it creates "mind," and . . . how disordered brain creates disordered mind. (Judd, 1990)

[S]cience . . . says that the bases of mental illness are chemical changes in the brain and, therefore physical changes, changes in the basic cells of the brain. That's why I hold that there's no longer any justification for the distinction that we've made between "mind and body" or "mental and physical illnesses." Mental illnesses are physical illnesses. They're related to physical changes in the brain. (Satcher, 1999)

In the pages that follow, I will be arguing that this received psychiatric philosophy of ours suffers from two serious problems that make it hazardous to the health of our culture. First, it is dehumanizing, having a narrowly neurobiological focus that discounts the uniqueness of the individual and the meaning of inner personal experience. Second, it is incoherent, being based on a general misunderstanding of the nature of science and on a more specific misinterpretation of what psychiatric medications actually do.

Missing the Trees for the Soil

Perhaps the most interesting and surprising thing about the five unequivocal assertions listed above is that there is no evidence whatsoever to support them! They are not statements of scientific fact but rather articles of quasi-religious faith cloaked in the language of science. No philosopher, scientist, or psychiatrist even pretends to have any idea how brain processes could possibly produce the mysterious and ineffable experience of human consciousness. Yet the belief that "brain . . . creates Îmind' "- and the general philosophy of "scientific materialism" it reflects [3] - is so strongly held by so many scientists nowadays that it is considered unscientific even to question it. Nevertheless, it is a seriously misguided belief, and I want to emphasize that the reasoning generally used to justify it - captured especially well in the above quote from David Satcher - does not stand up to careful scrutiny.

The reasoning goes that, because the symptoms of mental illness can be alleviated by changing brain chemistry, mental illnesses must really be disorders of brain chemistry - so-called chemical imbalances - and therefore mind (and soul) must really be brain. This line of "neurophilosophical" reasoning is taken so much for granted nowadays that it can be quite startling to realize how little sense it actually makes. We could with equal logic argue that if a tree disease can be cured by changing the chemistry of the soil, then tree diseases must really be soil disorders and therefore trees must really be soil!

In fact, there is no logical or scientific reason not to assume that the soul is a distinct entity, rooted in the brain and dependent on it for consciousness just as a tree is rooted in the soil and dependent on it for life. If we think of the soul as the place where experiencing happens, then brain processes would be a necessary condition (like soil for a tree), but not a sufficient cause, for that experiencing. For mental illness, this would mean that what goes on at the level of the brain can never account fully for the illness as it is experienced at the level of the person; and that even though medication is often quite helpful, it is never a sufficient treatment for an inner crisis of the soul.

If we take this commonsense logic seriously - and I challenge anyone to refute it! [4] - then we must conclude that modern psychiatric opinion is simply wrong. Mental illness cannot be just a chemical imbalance in the brain. Rather, it is a disharmony of body, brain, mind, and spirit within the whole person: an inner conflict of the soul. Such a disharmony may include a chemical imbalance in the brain as one of its elements, but the chemical imbalance itself is not the mental illness, nor does it cause the mental illness.

Unfortunately, entrenched beliefs tend to be impervious to logic, and so our blind cultural faith in scientific materialism has now brought us to the point where we are willing to accept extravagant and potentially dangerous uses of medication that could never be justified on the basis of scientific evidence alone. The burgeoning use of antidepressants in children is the most glaring example. Very little research has been done in this area, [5] and what research has been done has almost always shown antidepressants to be no more effective than placebo in the pediatric age group. [6] Moreover, at least one antidepressant has been associated with an increased risk of sudden death in children. [7] Most importantly, we know almost nothing about longer-term consequences of modifying the biochemistry of an immature growing brain. [8] And yet the Philadelphia Inquirer reported in 1998 that in the previous year 207,000 children between the ages of 6 and 12 had been prescribed antidepressants - a 43 percent increase from the year before. Also in 1998 a psychiatric journal reported that the prescription of selective sertonin inhibitor antidepressants for children 5 years old and younger had increased 10-fold in four years. [9]

For adults, the trend is equally alarming. As reported in Newsweek on January 26, 1998, the concept of chemical imbalance is now being applied indiscriminately, not only to cases of clear-cut mental illness but to objectionable personality traits as well. [10] The fault is not in ourselves, we are told, but in our neurotransmitters! Any qualities or tendencies we might have reason to dislike in ourselves - anything from shyness to ill-temperedness to scrupulosity to simple irresponsibility - we are now being taught to think of as subtle neurochemical malfunctions that can and should be corrected with medication.

Who Do You Think You Are?

It was psychiatrist Peter Kramer who first popularized the idea of using medication to modify undesirable personality traits. In his 1993 book, Listening to Prozac, Kramer coined the rather chilling term "cosmetic psychopharmacology" to describe how Prozac and other medications can be used to make people feel "better than well" - "to give social confidence to the habitually timid, to make the sensitive brash, to lend the introvert the social skills of a salesman." [11] This apparent endorsement of the idea of "better personalities through chemistry" came alarmingly close to fulfilling the prophecy of Brave New World, Aldous Huxley's 1932 novel about a future utopia in which human individuality has been completely eliminated through biotechnology, behavior modification, and a drug called soma. Soma was designed to keep the populace psychologically mellow and emotionally bland. It was said to have "All the advantages of Christianity and alcohol; none of their defects." "One cubic centimetre cures ten gloomy sentiments." so the slogan went.

In sanctioning the cosmetic use of Prozac to make people "better than well," Kramer seemed to have forgotten the lesson of Brave New World. Although he acknowledged the possibility of moral or ethical concerns about Prozac similar to those Huxley envisioned with soma, Kramer in the end dismissed all such concerns as irrelevant or trivial in the face of what he claimed to be one raw fact:

The capacity of modern medication to allow a person to experience, on a stable and continuous basis, the feelings of someone with a different temperament and history is among the most extraordinary accomplishments of modern science. [12]

This fantastical assertion reminded me of a retort I once received from an eight-year old autistic girl, a student in my classroom at Bruno Bettelheim's Orthogenic School who had been disrupting the English lesson I was trying to teach. After many attempts to deal gracefully with what I felt to be her relentlessly willful misbehavior, I finally lost my temper, stood up glowering indignantly at her, and yelled loudly: "Who do you think you are?!!"

Instantly the meek reply came back: "Somebody else."

According to Peter Kramer, it would seem that I could have achieved the same result - made her feel like somebody else - with far less agita, simply by prescribing Prozac.

Who Do You Want to Be?

I suggest that the desire to become "somebody else" is not something to be encouraged and pandered to, but something we should recognize for what it is: a sickness of the soul, a refusal or inability to accept ourselves as we really are that keeps us ultimately from becoming the person we have it in us to become. Cosmetic psychopharmacology, like cosmetic surgery and cosmetics in general, is based on the popular delusion that it is actually possible to be somebody else; that the soul's sickness can be healed through a quick, superficial "fix." More generally, the entire modern biological approach to mental illness - the so-called Medical Model - fosters the same delusory hope, equating sickness of the soul with a neurological glitch, and promising patients an easy chemical normalization without their ever having to confront the existential crisis that is at the center of their pain. It is time we all recognized this delusion for what it is. There is no quick fix for the soul, no easy procedure for becoming somebody else through a cosmetic alteration in brain chemistry. And it doesn't matter how many scientists and psychiatrists want to tell us otherwise. The science they are preaching is a religion just as unprovable as any other.

A Psychotherapeutic Model of Psychiatry

Lest I be misunderstood, let me emphasize at the outset that I am not at all opposed to using psychiatric medications. In fact, I have found them quite useful and am currently prescribing a wide variety of them, including Prozac, for about half the patients I am treating. However, I am willing to prescribe these medications only for patients I am also seeing in ongoing psychotherapy. Only through a psychotherapeutic process can I get to know the inner lives of my patients well enough to understand in depth not only their symptoms but also the effects that medication is and is not having on them as people. Only through a psychotherapeutic process can I attend to the personal and existential meanings that my patients' illnesses have for them, and discover how these illnesses reflect the disowned needs of the soul.

I take seriously the root meaning of the word psychiatry - from the Greek words psyche and iatreia - as a timely reminder of the larger purpose my profession is meant to serve, a purpose we have sadly lost track of in recent years:

psyche [Greek psyche life, spirit, soul, self; akin to Greek psychein to breathe, blow] 1a : the vital principle of corporeal matter that is a distinct mental or spiritual entity coextensive with but independent of body or soma : soul, self, personality... 1b : the specialized cognitive, conative and affective aspects of a psychosomatic unity : mind; specif : the totality of the id, ego, and superego including both conscious and unconscious components

-iatry [from the Greek iatreia art or action of healing, from iatros physi_cian] : medical treatment : healing [13]

Etymologically, culturally, and ethically, psychiatry means "healing the soul." This is a calling, and a need, that can never be answered simply by prescribing an alteration in brain chemistry. Healing the soul requires a growth-enhancing personal encounter with another human being in a psychotherapeutic process. It requires what philosopher Martin Buber called an I-Thou relationship - a "personal making present," in which one person recognizes the unique individuality of another, and the other flourishes in being so recognized. Unfortunately, with the advent of cosmetic psychopharmacology and managed care, too few psychiatrists remember, if they ever knew, what a psychotherapeutic process is, and too few patients realize that healing the soul through an I-Thou relationship with their physician is a potential treatment option that is no longer being offered them. In the Age of the Brain, psychiatric treatment has been reduced to an exclusively I-It relationship, in which patients are objectified, diagnosed as "cases," equated with their brains (and genes), and treated according to standards of statistical science rather than of personal knowledge.

One of my primary purposes in writing this book is to show that this politically sanctioned, neurological vision of Medical Model psychiatry is no more than a shallow philosophical prejudice, without scientific foundation or merit, and to propose an alternative, a Psychotherapeutic Model in which the soul - not the brain - is considered the proper focus of psychiatric attention. I want to reclaim the psychotherapeutic process as the heart and soul of psychiatry, putting psychopharmacology in its proper place as only one of psychiatry's helping hands. More generally, I want to reclaim the soul itself as the most important element of our existence as individuals, as a society, and as a culture.

Whom Do You Trust?

For many of us, our first ideas about the soul came from parents or religious teachers who told us about it when we were children. They may have told us that the soul is the part of us that lives on after death, or that it is what distinguishes us from animals and makes us human, or that it is the seat of reason and moral judgement, or that it is the part of us that is capable of free will. Common to all these traditional ideas about the soul is the belief that it is something spiritual - nonphysical - in human nature. Most of us grew up with some form of this belief in the soul as spirit because, instinctively, unreflectively, we trusted those authorities who taught us to believe in it.

As adults however, we have a greater need to think for ourselves. Rather than automatically and unthinkingly accepting authority, we aspire to form our own opinions and beliefs, based on standards of truth that are personally convincing to us. Yet childish patterns of deference to authority are surprisingly difficult to overcome, so we may find it confusing when the powerful authority of Big Science, speaking through psychiatry's Medical Model, tells us that soul is merely another word for brain. This puts us in the position of trying to form our own opinion while caught between two conflicting authorities. What we had previously thought of as the spiritual essence of our humanity we are now told is merely the echo of neurons firing, with no independent existence or functioning of its own. According to this modern scientific dogma, all our conscious experiences, the way we think and feel - even who we are - is simply a by-product of the way our brains are wired. The idea of personal autonomy, or free will, or forming opinions that are genuinely our own opinions (all these being functions of the soul, as traditionally conceived), must therefore be an illusion, a kind of trick our brain plays on our consciousness.

Yet, ironically, in rejecting the traditional religious idea of a spiritual soul for the modern scientific idea of a neurological soul, scientists and psychiatrists must inevitably appeal to the very higher faculties whose relevance they deny. Their argument depends on our ability somehow to discern that scientific facts are inherently and objectively different - more valid - than religious beliefs. But if, as they insist, all ideas are nothing more than electrochemical impulses in the neurons of the brain, determined only by other such electrochemical impulses, then how could we possibly tell whether one impulse was more valid than another? Imagine, for instance, a brain researcher who proved that the impulses that produce scientific-fact ideas happen in a different part of the brain or have a different electrical pattern from those that produce religious-belief ideas. How could he then tell which kind of impulse was better? Each would be merely an automatic response to a series of other impulses, dictated by a pattern of brain wiring and a set of electrochemical inputs that would vary from person to person. Whether you believed in science or in religion or in genocide, or whether you changed your belief from one to the other, would be a matter of meaningless neurological reflex, not of free personal and existential choice. It would have nothing to do with what is objectively true.

If, however, you believe that you are indeed somehow able to recognize ideas as true or false objectively - the way many scientists seem to think they can recognize mathematical equations as true and religious beliefs as false - then there has to be something autonomous in you (independent of the way your brain is wired) that is able to do the recognizing. Whatever that something is, it cannot be just another electrochemical impulse. Borrowing from Thornton Wilder, we might say that it ain't genes and it ain't culture, and it ain't even brain wiring and neurological reflex, but there is something about human beings that "everybody knows in their eternal."

By this reasoning, all scientific arguments against the idea of an autonomous spiritual soul appear to be logically incoherent - based not on scientific fact but on blind faith in the dogma of scientific materialism. So it makes little sense, if we are going to take our beliefs on faith, to have more faith in the authority of science than in the authority of religion or of our parents. But what if we are no longer content to take our beliefs on faith in anyone else's authority? How then do we go about deciding what to believe? Ultimately we cannot do better than to have faith in our own authority, and base our beliefs on what makes the most sense, and feels most deeply right, to us. Interestingly enough, this was precisely the method advocated 350 years ago by a man who has been called the father of modern science, French philosopher René Descartes.

Descartes's Truth

Descartes's philosophy began with his decision that he would trust no authority but his own experience and would believe only those things for which he could find within himself not even the remotest possibility of doubt. He resolved to systematically call into question every proposition he had ever been taught, or had heard in church, or had read in a book. He would assume to be false everything that was generally accepted as true, until he found a proposition that was, as he put it, "presented to my mind so clearly and distinctly that I could have no occasion to doubt it." [14] Through this method of systematic doubting, Descartes discovered that the only thing he could know beyond all doubt was that he doubted. In his inner experience of himself doubting, he discovered his own soul - the place from which his doubting, and all his experiencing, originated. He captured this profound self-awareness in the famous words Cogito, ergo sum: "I think [in this case, ÎI doubt'], therefore I am."

Unfortunately, Descartes's aphorism has been almost universally misunderstood as a kind of "content-thinking" - a logical sequence of thoughts (mental contents) along the lines of the (rather strained) syllogism "It is a fact that I think; facts exist; therefore I exist." On the contrary, I believe that Descartes' words signaled his liberation from content-thinking, representing not a syllogism, but an epiphany, an epochal moment of illumination. I like to imagine that it happened something like this: Descartes did indeed start out with a program of content-thinking - the systematic attempt to find a factual proposition (a mental content) that he could know to be true beyond any possibility of doubt. As he relentlessly pursued this program, however, it became increasingly clear to him that there could be no such proposition, that all content-propositions of objective fact were open to doubt. Finally, as he banged his head again and again against his self-constructed wall of doubting, the wall suddenly opened and became a window of awareness, through which he could "see" himself doubting. His attention shifted - a kind of quantum shift of consciousness - from content to process, from the endless series of questionable facts to the questioning act itself. With a shock of recognition, Descartes caught himself in the act and existential moment of questioning. In the immediacy of that distilled awareness of himself as consciousness in process, he recognized that he was listening to the soul, the still center and spiritual essence of his personal experiencing. It was this awareness that he summed up in the famous Cogito, ergo sum.

Descartes then proceeded to develop his epiphany into a formal philosophy, which we now call Cartesian dualism. He was so impressed with the difference between his inner awareness of the soul and his sensory awareness of the physical world that he concluded that human nature must consist of two distinct essences: the thinking mind (res cogitans), which is the center of consciousness and is spiritual, not subject to the laws of physics; and the physical body (res extensa), which operates according to the same mechanical laws that govern machines and animals.

Cartesian Dualism and the Mind‑Body Problem

Descartes was by no means the first to articulate a dualistic philosophy - one that conceives the soul (or mind) as an essence fundamentally different from the brain. Dualism has a venerable tradition in Western philosophy going back clearly to Plato, with more obscure origins long before him. Of particular importance for psychotherapy, dualistic philosophy reflects the universal human experience of inner conflict - a tension between opposing needs and tendencies within the self that triggers anxiety, shame, or guilt. This existential condition of inner conflict has been recognized and described by virtually every known religion as an opposition between the Flesh and the Spirit: between the "lower" passions - our bodily appetites and emotional needs for pleasure and power - and the higher desires (our spiritual yearning toward truth, love, and virtue). In this way, dualistic philosophy had been linked with the religious problem of good and evil. The dualism of the Flesh and the Spirit was a way of talking about our inner sense of moral choice between our temptation toward sin and our aspirations toward virtue.

What was truly revolutionary in Descartes's thinking was that he divorced dualism from the religious problem of good and evil, and for the first time treated it in a way that can properly be called scientific - through a carefully described systematic observation of his own conscious experience. Unlike Plato and the many religious teachers who had located the soul in our innate sense of morality, Descartes discovered it in the simple but profound experiencing of self-awareness. We now take as self-evident the distinction between the private inner world of introspective awareness and the public outer world of sensory awareness (including the awareness of our own bodies), but in fact it is only since Descartes that we have become able to recognize this distinction. Descartes shifted the terms in which we think about dualism so that instead of an inner moral conflict between higher and lower passions, we now understand it as a complementarity of inner awareness and outer perception, self and other, subject and object. This shift has been profoundly important for the evolution of Western culture. It promoted the development of individualism - as a natural extension of Descartes's inward focus on the private self - and it established the modern scientific worldview, as an extension of his outward focus on the body and the objective physical world.

However, this progress that we owe to Cartesian dualism has come at a price. In shifting the focus of self-reflective awareness from the conflicting passions of the soul to the distilled consciousness of the mind, it seems that Descartes inadvertently reinforced a somewhat schizophrenic tendency in our human nature - a tendency to avoid the unsettling awareness of inner conflict by divorcing our mental life from our experience of the body. We began to shift our interest and attention from the soul to the mind, using the Cartesian dichotomy as a way of distancing ourselves from our emotional experience, thinking of the emotions as belonging to the body but identifying the self with the mind. In reflecting on the self we began to ignore the passions of the soul and to focus more and more on the dispassionate ideas of the mind. We defined ourselves no longer in terms of what we felt but in terms of what we thought and perceived.

The result of this self-alienating trend is apparent today in every major university psychology department, where course offerings are limited almost exclusively to cognitive science and neuroscience - studying the functions of a detached intellectual mind (learning, language, memory, perception, and reasoning), and the operations of a disembodied electrochemical brain. Rarely is there even a single course that deals in a meaningful way with the human emotions, still less with the experience of inner conflict. More disturbingly, what's missing from our psychology departments is also missing from our collective cultural consciousness. As individuals and as a society, we have lost the moral compass that used to be provided by our awareness of inner conflict. We no longer recognize the "existential emotions" of anxiety, shame, and guilt as signals of moral conflict, central to the life of the soul. Indeed, it now seems that we have lost touch with our emotions, and with our sense of the soul altogether.

Of course Descartes cannot be held responsible for what we have made of his philosophy. Cartesian dualism has perhaps made it easier for us to detach ourselves from our emotions, but it certainly did not create our need to do so. Nor did Cartesian dualism create the so-called mind-body problem. Rather, it simply changed the way we experience the mind-body problem. Before Descartes, we experienced it as an inner moral conflict between the Spirit and the Flesh - the problem of good and evil. Since Descartes, we have come to experience it as the problem of self-alienation - our difficulty being in touch with our feelings and bringing body, mind, and spirit together in a fully emotional experience of ourselves.

Nevertheless, there is a widespread current opinion that the mind-body problem was actually Descartes's invention - Descartes' Error as one book called it - [15] an unfortunate and unnecessary split he imposed on our way of thinking about ourselves. I disagree. Based on my experience of the psychotherapeutic process, I am convinced that the mind-body problem is inherent in human nature. We may experience it either as an inner moral conflict or as self-alienation, but both elements are always present to some degree. In fact they are closely related. Self-alienation results from a defensive need to detach oneself from the disturbing awareness of inner conflict. This link between moral conflict and self-alienation was actually quite well known to Western culture long before Descartes. It is poignantly represented, for instance, in the story of Oedipus, who tried to detach himself both geographically and emotionally from the disturbing prophecy of his forbidden passions, and then gouged out his own eyes when he was finally forced to "see" himself as he really was. Shakespeare's Hamlet, too, expressed the need to detach himself from the torment of his conflicting passions in his suicidal soliloquy (written 40 years before Descartes's cogito): "Oh that this too, too solid flesh would melt."

Listening to the Soul

We might say, then, that in equating the soul with a detached self-reflective consciousness, Descartes encouraged our already universal tendency to split ourselves off from the disturbing experience of inner conflict. Yet in doing so, he also pointed the way to resolving this inner split, by teaching us how to use that self-reflective consciousness to pay attention to our inner lives. This is the great achievement of Descartes's method and the basis for the psychotherapeutic process of healing the soul. The idea is to focus our self-reflective Cartesian consciousness not on our thought processes but on our emotions - especially on anxiety, shame, and guilt. By allowing ourselves to have a full conscious experience of these painful emotions, we can discover for ourselves, beyond any possibility of doubt, that they always point to an experience of inner moral conflict. If we then examine this conflict further, experiencing both sides of it more fully, we discover that it always involves some degree of self-alienation, a need to disown, repudiate, or otherwise push out of awareness important elements of our emotional lives - precisely those emotions that, when we begin to feel them, will provoke anxiety, shame, or guilt in us. As we become more conscious of these previously repudiated emotions, we also become more accepting, less alienated from ourselves, because we discover that however disturbing our passions may be, and however destructive they may feel, there is always something in them that is life-affirming and growth-enhancing - a baby with the bath water.

This entire process of self-reflection - paying careful attention to one's conscious experiences of anxiety, shame, and guilt, and then to the deeper layers of disowned, less conscious emotions they point to - is the heart of the psychotherapeutic process. I believe it is the heart of a fully human life as well. It is what I call listening to the soul in its most complete form: not the detached awareness of the soul as pure consciousness that Descartes emphasized, but a richer, more engaged awareness of the soul as authentic self - an ineffable mixture of pure consciousness and personal passion - captured in the full experiencing of conflicted emotion.

What Are We Really Experiencing When We Experience Ourselves?

The psychotherapeutic practice of listening to the soul reflects the principle that it is primarily in our awareness of feeling, not thinking, that we can discover who we really are. From this perspective, the value of Cartesian dualism has been to promote awareness of the inner life. Its weakness has been in missing the importance of the inner experience of emotion. [16] If we distinguish, as Descartes did, only between the mind as a center of detached awareness and the body as a center of mechanical physiological activity, then we cannot account for the kind of complex states of inner moral and emotional conflict that are experienced in a psychotherapeutic process. To do this, we need to expand the simple Cartesian dichotomy of body and mind - in which mind is considered synonymous with soul - by considering the soul as a complex entity, the center of the whole person, the experiencing self. We can then think of the experience of felt emotion as one in which mind and body, spirit and flesh, come together in a more or less integrated experience of the soul. We can understand the experiences of inner conflict and self-alienation as dis-integrated experiences of the soul in which our capacity to feel is restricted.

This is essentially the understanding that Sigmund Freud proposed in his model of the soul as a three-way interaction - either harmonious or discordant - between the id, ego, and superego. Actually, Freud's meaning is better conveyed by translating his original German terms (das Es, das Ich, das †berich) into their proper English equivalents: the It, the I, and the I that stands above, referring to processes of the body, the soul, and the detached, self-reflective mind. As Bruno Bettelheim has pointed out, the more familiar Latinate terms are really mistranslations that have reinforced a mechanistic caricature of psychoanalysis in the English-speaking world. [17] They have obscured the way Freud's ideas are grounded in personal, emotional experience, and have fostered a false impression of the psychotherapeutic process as a kind of intellectual game, a putting together of misplaced mental contents into a cognitive map, like a jigsaw puzzle. In this way Freud's method, like Descartes's, has come to be misunderstood as an application of content-thinking. On the contrary, as I will illustrate in Part Three, Freudian psychotherapy is a formal method of listening to the soul, aimed at catching oneself - the I - in process.

The Danger of Scientific Materialism

Considering that the mind-body problem is ultimately the problem of inner conflict, it is hardly surprising that Freudian psychotherapy and Cartesian dualism should be misunderstood and discredited nowadays in much the same way. The pervasive doctrine of scientific materialism - the assumption that mind and soul are merely by-products of brain activity - makes it all too easy to persuade ourselves that there is no mind-body problem, no inner conflict or self-alienation, and therefore no need to examine the inner life of the soul in psychotherapy. I believe that the unchecked influence of this materialist philosophy is destructive to Western culture. By discounting the inherent dualism of our inner experience, it fosters and provides a rationalization for a dangerous tendency to denial - not only the denial of inner conflict, but potentially the denial of our inner life altogether. As Martin Buber has put it, "The personal life, the ever-near mystery, once the source of the stillest enthusiasms, is leveled down." What this has led to in the Age of the Brain has been a politically endorsed, corporately sponsored psychiatric drug culture that now threatens to destroy the practice of psychotherapy altogether. The rationalization (explicitly or implicitly) goes like this: "Descartes was wrong. There is no mind-body problem. Mind, soul, and brain are really all the same thing. Therefore, why spend years focusing on your inner life and trying to heal the soul in psychotherapy when medication can get you there so much faster and better?"

Our Spirits, Our Selves

If we were to look without the blinders of materialism at the current craze for psychiatric drugs, we could see it easily enough as a symptom of a sick culture seeking to anesthetize itself from the inherent pain of human existence any which way it can: through cosmetic psychopharmacology or cosmetic surgery; through alcohol, drugs or gambling; through promiscuity or violence; through mindless television or mindless cults. The menu of choices is extensive, but instead of anesthetizing us from our pain, each choice in the end leaves us feeling emptier and more uneasy.

This uneasiness we feel, in our culture and in ourselves, is a manifestation of the mind-body problem, the impulses of the Flesh in conflict with the needs of the Spirit. Yet in the Age of the Brain, our official philosophy tells us there can be no such problem because there really is no Spirit. Believing this makes it easier for us to ignore the pain of our sickness, by eliminating the very concepts that would allow us to name it. But in thus denying the soul a forum for expression, we are left with the persistent aching of the soul's unnamed and unmet needs. These needs embarrass us, so we prefer to keep wearing the philosophical blinders that allow us to pretend the needs aren't there. We could take off our blinders, and in fact the cure for our sickness requires that we do so, but something stops us.

Fear of Consciousness

To understand this predicament, it is useful to go back to the beginning - not the historical but the emotional beginning, the inner source of our uneasiness and embarrassment about the soul. There is a story about this beginning in the Bible - just where we would expect it, in the book of Genesis.

Consider the story of Adam and Eve's expulsion from Paradise not as divine revelation but as one of those universal myths that express the deepest truths of the human condition. Seen in this way, the story tells of the birth of human consciousness. Before the Fall, Adam and Eve were conscious, but not self-conscious. There was no sense of alienation, no inner conflict to disrupt their primal state of oneness and harmony. They lived in the place of Descartes's epiphany, but without the shock of recognition. They then ate from the tree of the knowledge of good and evil and became self-conscious; that is, aware of themselves as separate individuals, alienated from each other, from God, and from the world around them. They had lost their state of primal oneness and had thereby attained a state of separate individuality, only it was an individuality in a world of dualism and discord, a world of both good and evil. In the language of the poet William Blake, they had left the world of childhood innocence and been launched into the fearful world of adult experience. And how did this new adult self-consciousness first dawn in them? Through shame and anxiety, the hallmarks of inner conflict: "Then the eyes of both were opened, and they knew that they were naked; and they sewed fig leaves together and made loincloths for themselves." (Genesis 3:7) [18]

They were ashamed; that is, they were aware of being alienated, not only from each other but, more importantly, from themselves. Their eyes had been opened to a new knowledge, a feeling-awareness of good and evil within themselves, crystallized in their experience of sexual desire. They were now in a state of inner conflict over this new self-conscious sexuality. They needed to hide from it and from themselves, covering it up. And then they became anxious, afraid of what God might see in them:

"They heard the sound of the Lord God walking in the garden at the time of the evening breeze, and the man and his wife hid themselves from the presence of the Lord God among the trees of the garden" (Genesis 3:8).

So the myth of the Fall tells us that the dawning consciousness that makes us human is the awareness of inner conflict, the knowledge of good and evil within ourselves. This "fall" into consciousness occurs through an act of willfulness (eating the forbidden fruit), an assertion of self. Significantly, it can occur only after Adam is aware of a separate "other," in the person of Eve. Thus, the shame and anxiety of inner conflict involve an awareness of an internally alienated, willful self in sexual relation to an externally alienated (separate) other. Another way of putting it is that the emerging awareness of self - the dawning of human consciousness - contains both the painful awareness of selfishness and the painful envy of otherness, each experienced as a driving force in sexual desire.

No wonder we fear consciousness! In the light of consciousness we can see that our sexual desire involves both an envy of our partner's otherness (man's envy of the feminine; woman's envy of the masculine - universal elements of the desire to be somebody else) and a selfish need to control, punish, impose or intrude on that otherness. This we would prefer not to see (to have the God within us - the I that stands above - see) in ourselves. We would rather think that our sexual desire is an expression of love, as of course it is. Yet there are times when we cannot help but notice that our desire is not only loving (perhaps not even primarily so), but envious and selfish as well. Then we become like Adam and Eve, ashamed and anxious because we recognize that selfishness and envy subvert the full possibilities of love, the I-Thou relation (represented by God in the story). This is the knowledge of good and evil, the shameful awareness of the soul in its ineluctable state of inner conflict.

We Do Have Choice

I realize that my highly condensed interpretation of the story of Adam and Eve is likely to raise more questions than it answers. I do not mean it to imply that sexual desire is the only emotion that can evoke an experience of inner conflict. As Freud suggested, sexual conflicts are universal, and they operate at the deepest, most intimately personal level of the soul. But as I will describe in numerous clinical examples throughout this book, inner conflict can also revolve around anger, sadness, dependency, pride, or any other emotion that triggers anxiety, shame, or guilt in us - any emotion that threatens to make us more conscious of something we would rather not know about ourselves.

The fact that consciousness is such a threat - that each one of us has crucial aspects of our inner life we would rather not know about - should give us pause. The reason Socrates and the Delphic oracle had to admonish us to "Know thyself," is that they realized we would all, in a way, prefer not to. Personal consciousness is a burden and a responsibility that human beings have always been greatly tempted to avoid. Nevertheless, as Genesis tells us, this burden of consciousness is part of the human condition from which we can run but cannot hide. The more we try to deny our experience of inner conflict, the more it tends to assert itself in the form of psychiatric symptoms.

The Medical Model of psychiatry contributes greatly to this problem by catering to our fear of consciousness. It teaches us to think of anxiety, shame, and guilt as meaningless neurological glitches, and not as urgent calls to self-reflection. It denies the relevance, and even the existence, of inner conflict and discounts the usefulness of psychotherapy as a process of healing self-awareness. Instead, it promotes the pharmacological quick fix, neglecting the deepest long-term needs of the soul. The price of this neglect is one that neither psychiatry nor society can any longer afford to pay.

Fortunately, there is an alternative: a Psychotherapeutic Model of psychiatry, whose primary purpose is healing the soul. Where the Medical Model is driven by the fear of consciousness, the Psychotherapeutic Model takes this fear as the central focus of therapeutic attention. Where the Medical Model thinks of mental illness as a chemical imbalance in the brain, the Psychotherapeutic Model understands it as a limitation of consciousness, resulting from an inner conflict of the soul. This difference between the Medical Model and the Psychotherapeutic Model is of fateful consequence, not only for the mental health of psychiatric patients but for the spiritual health of our culture as a whole; not only for the scientific standards by which mental illness is defined and treated, but for the ideals and values by which we all find meaning in our lives. To illustrate what I mean by this, and to suggest what is at stake in the choice that confronts us, perhaps the best way to begin is with a story.

[1] . T.M. Luhrmann, Of Two Minds (New York: Alfred A. Knopf, 2000), p.20.

[2] . Eric Kandel, "A New Intellectual Framework for Psychiatry," American Journal of Psychiatry 155, no.4 (April 1998); John Searle, "The Mystery of Consciousness," New York Review of Books, Nov. 2, 1995, p. 60; Francis Crick, The Astonishing Hypothesis: The Scientific Search for the Soul (New York: Simon & Schuster, 1994), p. 3; Antonio Damasio: Descartes' Error (New York: G. P. Putnam's Sons, 1994), p. 251; Lewis Judd, from a speech as reported in a Sandoz Pharmaceuticals newsletter for psychiatrists, Peer to Peer, vol. 2 (summer 1990), p. 10; and David Satcher, from an interview on PBS Newshour, Dec. 13, 1999, discussing his just released, first-ever surgeon general's report on mental health.

[3] . Webster's New International Dictionary, 3rd ed., defines materialism as "a doctrine, theory or principle according to which physical matter is the only reality and the reality through which all being and processes and phenomena can be explained." The phrase scientific materialism involves the additional, quite erroneous, belief that materialism is the only philosophy that is consistent with the evidence of modern science.

[4] . To refute it, you would have to prove - not simply assume - that brain processes actually do cause consciousness. In Chapter 15 I will propose a thought experiment to demonstrate that this is impossible in principle: that no matter how far neuroscience advances, it will never be able to prove that brain processes cause consciousness.

[5] . In a recent Psychiatric Times article ("Meeting Advances Surgeon General's Recommendation on Children's Mental Health" Volume XVII, issue 7, July 2000) Arline Kaplan reported that "Although children and adolescents receive many of the traditional treatments for mental disorders, much of the research on psychosocial and pharmocologic treatments has been conducted on adults, with results extrapolated to children". For most prescribed medications, including psychotropics, there are no studies of safety and efficacy for children and adolescents. ÎDepending on the specific medication, evidence may be lacking for short-term or, most commonly, for long-term safety and efficacy,' the surgeon general's report said. Î...[T]he combined effectiveness of pharmacological and psychosocial seldom studied.'"

[6] . S. Son and J. Kirchner, "Depression in Children and Adolescents" American Family Physician, November 15, 2000; and B. Geller, D Reising, et al "Critical review of tricyclic antidepressant use in children and adolescents." Journal of the American Academy of Child and Adolescent Psychiatry May, 1999; 38(5):513-6.

[7] . J. Biederman, R. Thisted, et al "Estimation of the association between desipramine and the risk for sudden death in 5- to 14-year-old children." Journal of Clinical Psychiatry 19951 56:87-93.

[8] . In a recent JAMA editorial ("Psychotropic drug use in very young children," Vol.283 No.8, February 23,2000) Dr. Joseph T. Coyle wrote that "there is no empirical evidence to support psychotropic drug treatment in very young children and ... there are valid concerns that such treatment could have deleterious effects on the developing brain." A Time magazine article from May 31, 1999 ("Escaping from the darkness," Volume 153, No.21) reported on "[t]he lack of science about the effects of these drugs on childhood development," quoting Peter Kramer: "ÎAnyone who thinks about this problem is worried about what it means to substantially change neurotransmission in a developing brain. We don't know if these kids would compensate on their own over time and if by giving them these medicines we are interfering with that compensatory mechanism.'"

[9] . Karl Stark (Inquirer staff writer): "Medication of children is surging..." The Philadelphia Inquirer, Sunday, January 18, 1998; and K. Minde "The use of psychotropic medications in preschoolers: some recent developments. Canadian Journal of Psychiatry, 1998;43:571-575.

[10] . Sharon Begley, "Is Everybody Crazy?" Newsweek, Jan. 26, 1998, pp. 50-55; and Jerry Adler, "My Brain Made Me Do It," p. 56. Both articles were prompted by the 1997 book, Shadow Syndromes, by John Ratey and Catherine Johnson.

[11] . Peter Kramer, Listening to Prozac (New York: Viking, 1993), p. xv.

[12] . Ibid., p.195.

[13] . Unless otherwise stated, all definitions in this book are from Webster's New International Dictionary, 3rd ed.

[14] . René Descartes, "Discourse on the Method of Rightly Conduction the Reason," In E.S. Haldane & G.R.T. Ross, trans., Philosophical Works of Descartes, vol. 1 (New York: Dover Publications, 1955), p. 92.

[15] . Damasio, Descartes' Error.

[16] . In fact, Descartes did ultimately recognize and try to correct this weakness in his philosophy. His last work, The Passions of the Soul, focused entirely on the emotions.

[17] . Bruno Bettelheim, Freud and Man's Soul (New York: Alfred A. Knopf, 1982).

[18] . All biblical quotes are from the New Revised Standard Version.

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