The Year That Has Passed
Today is New Year's Eve 2023! I have been writing posts on Substack for a couple of months now and have so far written 22 posts covering topics ranging from genetics and psychiatric diagnostics to assisted dying. My ambition is to write posts when I come across something interesting for my own learning and, in that way, share what I've learned for both others and my future self. It seems that this is appreciated, as several colleagues and students are apparently reading the posts. Initially, I was unsure about the target audience, but now I believe it is an educated general audience. The future will reveal how active I manage to be next year.
Concept of Truth
I thought of concluding the year with a brief reflective text on truth in relation to the brain and psyche. Often, when discussing mental illnesses, or even milder mental health issues, people wonder about the reasons behind them. They want to know why things turned out a certain way. Creating a narrative about one's life is part of our narrative self and is essential for good mental health, in my opinion. Perhaps one wants to explain recurring failures in school with an ADHD diagnosis, broken relationships with a personality disorder, or difficulties in keeping friends with childhood trauma. Getting a diagnosis can provide a better understanding of one's well-being and lay the foundation for feeling better. With a clear ADHD diagnosis, one can receive support in school and medication to improve concentration. That being said, you are not your diagnosis! Just labeling a certain behavior or thought pattern without making any changes is meaningless. You are depressed because you are sad and have lost interest in the world.
Today, especially on social media, it's popular to push this to the extreme. People want to explain how they walk or sleep by claiming they have ADHD or attribute stomach pain to traumatic events in childhood. Trauma doesn't even have to be particularly extensive; it could be more about not having had an optimal childhood. The question is, however, who has had an optimal one. If there's something we know, it's that humans are incredibly adaptive creatures. We have managed to spread to all corners of the Earth and live in a way vastly different from our evolutionary past. As long as one's upbringing is not utterly terrible, it will likely be good enough. We humans are resilient!
In the eternal debate between proponents of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT), and for that matter, psychopharmacology, the discussion often revolves around the true cause of a person's well-being. CBT and medication are accused of being too shallow and focused on symptoms, but others argue that PDT is too vague and doesn't provide guidance in daily life. Here, I think a pragmatic approach can be adopted: if it works, it's true. If a certain treatment with certain premises leads to better well-being (both individually and in clinical studies), one can say that the premises are true in some sense. If it applies to SSRIs, it means serotonin is involved in depression, and if it applies to CBT, it means inadequate learning and thoughts have led to passivity. The treatments influence this and lead to improvement. The same applies in this case for PDT, where dysfunctional attachment during childhood may have led the person to have low self-esteem and attribute all setbacks in life as if caused by them.
The Brain as a Simulator
Another important question is how the brain works. Many people have the somewhat naive idea that the brain, along with the sensory organs, functions as a kind of detector. With our vision, we see the world as it is, with our hearing, we perceive it as it sounds, and if only we were rational enough, we could account for the true external world. The problem is that this is not accurate! Just consider the difficulty with eyewitness testimonies. People believe they remember, but what they are actually doing is recalling their modified version of reality. Simply put, the brain (or we) is constantly simulating the external world and comparing what it expects with the information it receives. This can be observed through various visual tricks, where the brain fills in missing information (think about the blind spot in the eye).
Another common example is when an anxious soul feels the heart pounding after rushing to catch the bus, and once on the bus, starts thinking about having a panic attack. This interpretation of introspection leads to more anxiety, which in turn leads to more palpitations. And so the spiral begins. In this case, one can effectively intervene with psychotherapy (CBT) or, for that matter, SSRIs. Both of these are very effective in treating panic disorder.
There are unknown unknowns
As Donald Rumsfeld said regarding evidence of weapons of mass destruction in Iraq, there are things that we don't know that we don't know. The human brain is still a mystery. We have learned a tremendous amount, especially in the last 50 years, but how it truly works is still unknown. Research on consciousness is still in its infancy, and the ultimate question remains: can the brain understand itself?
Happy New Year!
Really like this chapter!