Précis of epistemology/Principles of psychiatry

Psychiatry is the medicine of the soul (or the spirit), the science of psychic disorders and their healing, and its application.

The dysfunctions of self-consciousness

Psychic disorders are dysfunctions of self-consciousness. We are conscious of ourselves to act voluntarily on ourselves in an appropriate way, to make good decisions, to give ourselves a good program of life. Psychic disorders appear when we no longer know how to use our consciousness to adapt to this reality that we are ourselves and to our environment.

Psychic disorders always involve emotional disorders, because emotional balance is both a condition and a consequence of the proper functioning of self-consciousness.

Self-consciousness is like a centralized administration in the brain, without a central administrator. An administration must inform itself about itself in order to act on itself, to administer itself. Psychic disorders are like an administration that no longer fulfills its functions because it no longer knows how to administer itself.

Self-consciousness keeps transforming itself every time one makes decisions. It wields great power over internal resources because it is in a central position, like a king in his kingdom. Like all power, it can be wielded for better or for worse. Psychic disorders have an unfortunate tendency to worsen of themselves because the power of consciousness ceases to fulfill its protective function, because it becomes a cause of aggravation of the disorders. The patient makes bad decisions. He chooses goals, beliefs and rules that prevent him from adapting to reality. He gives himself bad programs which lead to an increase in his sufferings.

Healing is always about restoring the proper functioning of self-consciousness, the ability to make good decisions to maintain emotional balance and live well, as much as possible.

Self-consciousness is a very powerful healing tool. By giving oneself a good therapeutic program, good rules, adapted goals, realistic beliefs, one can hope to cure most of the disorders. To be cured, one has to restore the protective functions of self-consciousness by replacing bad decisions with better ones. As decisions wield great power over all internal resources, they can be a very effective remedy.

When we have mental disorders, we are often overwhelmed by a feeling of helplessness, as if there is nothing we could do about our inner troubles. This feeling of helplessness is a factor of aggravation of the disorders: there is enough to go crazy when we say to ourselves that we cannot do anything whereas we cannot remain without doing anything. But this feeling of helplessness is also an illusion that must be dispelled. Decisions are naturally very powerful. As long as we do not lose the ability to make decisions and apply them, we do not lose their power. We feel reduced to helplessness because we do not know how to use our power, not because we have lost it.

The unconscious is produced by repression and denial

Denial is like lying to oneself. We refuse to recognize truths we know or could know. We refuse to think about it. Desires and beliefs are repressed when it would be too painful to become aware of them.

Freedom of interpretation makes denial possible. An interpretation selects the beliefs it deems relevant and obscures the others. An observation which contradicts a desired interpretation may simply be discarded. We repress desires and beliefs by giving ourselves the interpretations that suit us and by refusing those that disturb us.

To know what moves us, we must always interpret the situation to relate the emotions we feel to what we perceive. It is often not difficult to identify the cause of an emotion, and the interpretation leaves no room for doubt. But it is also possible to have many illusions about the causes of our emotions (Gazzaniga 1998). We can attribute an emotion to a cause that did not trigger it. We can deny that we want what we want, by attributing our desire to a cause that has not awakened it.

Repressed desires and beliefs cannot affect us in the same way desires and beliefs that are consciously endorsed do, because they do not benefit from the power of decisions. But they can still have an effect by influencing other desires or other beliefs. One can give oneself honorable ends to satisfy other shameful and repressed ends without even realizing the deception with which one is fooling oneself. One can also ignore repressed beliefs that are the source of other consciously approved beliefs.

When repressed, desires and beliefs cannot be examined by consciousness. We cannot dispute them, criticize them, evaluate them, or reason about their consequences. They can exert their influence unbeknownst to consciousness as if they were the desires and beliefs of another person who dominates us, fools us and manipulates us. “The ego is not the master in its own house." (Freud 1915)

It is not biologically probable that the brain accommodates two competing centralized administrations, one conscious, the other unconscious. Unconscious beliefs and desires therefore have no direct access to control over all of our inner resources. To exercise their power, they must influence conscious desires or beliefs. They are like parasites of consciousness, as if they are harnessing the force of consciousness for their own ends.

The strength of the unconscious comes from the weakness of consciousness. By refusing to face reality, we allow ourselves to be dominated by unconscious forces. The unconscious is not like a foreign power destined to dominate us. Rather, it is the result of a surrender of power, because the consciousness cedes its power to it when it takes refuge in denial.

Denial prevents one from adapting to oneself and gives strength to the unconscious. It is produced by repression. Should we conclude from this that it is always wrong to repress?

It is wrong to repress only if it prevents us from adapting to reality. When repression easily leads to giving up desires that must be given up, it is of course highly desirable. We repress to maintain a good self-image. It is only a mistake if this image is too false, if it prevents us from adapting to the reality that we are for ourselves.

A remark on the unconscious: the theory of the unconscious is here a theory of beliefs and unconscious motivations. We can also reason on the cognitive unconscious: information is unconscious when it is present in the brain without the knowledge of consciousness. This definition poses a puzzle: where are the brain signals that carry the conscious information? And why do these signals become conscious while others remain unconscious?

The fire of emotions

When an effect strengthens the cause that produced it, we are in the presence of a positive feedback loop: even a small deviation from the equilibrium position of a pencil placed on its tip imposes a force of gravity on the pencil which removes it further from its position of equilibrium; in a nuclear bomb, the free neutrons break the heavy nuclei which then release more neutrons; a spark in a flammable vapor releases heat which triggers chemical reactions which in turn release more heat ...

• Panic attack

We feel an anguish that oppresses us and frightens us because we believe that it will kill us, as if the heart or the chest were going to explode. Believing that we are going to die of it makes us more anxious, we are more oppressed and we are confirmed in our conviction that we are going to die of it. In the panic attack, the anxiety itself is terribly distressing.

• Depression

We feel sad and we tell ourselves that this sadness deprives us of a good life and will always do. We will never find happiness or peace because we are only able to be sad. In the morning we anticipate a day of sadness and to think in this way makes us disproportionately sad. In depression, sadness itself is saddening.

• Manic joy

For once we are in a good mood, we feel good, as if we were cured of depression, as if it was a rebirth. This illusion of healing reinforces the joy that we feel. In a manic outbreak, the elation itself is elating.

• Burning of desire

An intense and unfulfilled desire causes pain. The more one suffers from frustration, the more the fulfillment of desire is desirable, in order to get rid of suffering. Intense desire is itself a cause of increased desire.

• Haunting memories

The more a memory arouses emotions, the better and more often it is remembered, because emotions signal what is important. But this can have a perverse effect: it is painful to remember a painful past. The more often we remember it, the more painful it is. The more painful it is, the more often it is remembered.

• Tenacious hatred

Hatred prevents people from enjoying life. We are not even able to enjoy a good time anymore. This permanent incapacity is the main harm inflicted by those who attacked us. Even when they are no longer there to provoke us, the hatred is still there and it eats away at us from within. We have more hatred precisely because we have hatred, because we lost our life before we hated. When hatred is persistent, it is itself a cause of increased hatred. What is most infuriating about hatred is that it infuriates us.

• To be ashamed to be ashamed

If we blush in public, we feel ridiculous and we blush more, to the point that we think of running away. Shame itself can be a cause of increased shame.

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We dramatize when we choose an interpretation that amplifies the emotions. To heal emotional disorders, we must always play down, de-dramatize, as much as possible without ceasing to face reality. A self-consciousness who dramatizes aggravates his or her emotional disorders.

The positive method in psychiatry

The positive method is based on the following principle: we are better off with reassuring thoughts than with distressing ones, provided we face reality.

The positive method is generally ineffective to cure serious somatic (bodily) disorders, but it can still be effective, especially if the disorders are mild, thanks to psychosomatic effects. The production of hormones that regulate the functioning of the body depends on our emotions, and therefore on our thoughts. In addition, the nervous pathways are generally two-way. Since the nervous system innervates most of the body, all of our reactions can also depend on what we think.

The positive method has much more importance in psychiatry. Giving ourselves reassuring and realistic thoughts is part of the proper functioning of self-consciousness. Those who have little or no psychic disorders apply the positive method on a daily basis to overcome their anxiety in the face of life's difficulties. Anxiety disorders (the most common psychic disorders) appear when patients no longer know how to apply the positive method.

In psychiatry, it is very important not to make fun of the positive method. If we despise it, we can only worsen psychic disorders.

An example of the application of the positive method in a particularly painful situation: “Father, forgive them, for they know not what they do." (Luke, 23:34)

Healing by the thought

The Buddha (the awakened one):

"He insulted me, he beat me, he defeated me, he stole me". Do they attach themselves to these reproaches: there is no appeasement for their hatred.

"He insulted me, he beat me, he defeated me, he stole me". Do they not attach themselves to these reproaches: appeasement for their hatred.

Certainly, in this world never hatred appeases hatred, but absence of hatred does : eternal law.

(Dhammapada 3-5)

Interpretation is part of perception. The perception of reality therefore depends on our decisions. As reality exists for us only from its perception, we make our own reality when we choose our interpretations.

The Buddha awakened when he understood that he was the creator of his perception of reality, like a dreamer who wakes up realizing that he has dreamed.

The perception of reality does not depend only on our decisions. We are not free to invent perceived reality in the same way that we are free to invent any fantasy. We must take into account the testimony of the senses and introspection.

The perception of reality can be more or less adapted to what is not dependent on us, to the external or internal reality that we have not decided.

When we suffer from psychic disorders, it is not reality alone but the perception of reality that causes pain. Since we choose our perception, we ourselves are one of the causes of our own suffering. But that does not mean that we are doomed to inflict perpetual torment on ourselves. By replacing a perception which destabilizes by one which gives balance, we can hope to cure the majority of the psychic disorders.

The interpretation of reality depends on our presuppositions. We give ourselves schemas, systems of presuppositions, which determine our expectations and our ways of perceiving. Psychic disorders are very generally caused or aggravated by early maladaptive schemas (Young 2003). Replacing inappropriate schemas with better ones is always a good therapeutic program.

Emotional troubles make us feel overwhelmed by our emotions. As we do not control their triggering we feel invaded by internal forces against which we believe we can do nothing. But it is an illusion. Emotions depend on our interpretations. By voluntarily controlling our interpretations, we can gain mastery over our emotions. Through thought, self-consciousness is powerful enough to appease or extinguish the fire of emotions.

Psychic health is always about making good use of one's self-consciousness in order to live well. We must give ourselves a good life program. No ethical thinking, no healing.

Three fundamental errors of psychoanalysis

• Dramatize when it is necessary to de-dramatize.

To speak of the Oedipus complex about ordinary emotional disturbances of infancy is to turn minor problems of everyday life into tragedy. This can only aggravate the troubles.

• Denigrate the power of self-consciousness.

To cure psychic disorders, one must always restore the natural powers of self-consciousness. Making people believe that we are dominated by unconscious forces against which we can do nothing, or almost nothing, can only prevent healing.

• Postulate the existence of natural self-destructive impulses.

All natural impulses are self-protective. Natural selection does not allow life forms to evolve when they tend to self-destruction. When self-destructive tendencies appear, it is always a dysfunction of our natural tendencies, not a fatality imposed by Nature.

Forgiveness

When we do not know how to forgive, we cannot regain our calm before having revenged ourselves, we can no longer appreciate life, we make ourselves incapable of enjoying the present moment and loving, we condemn ourselves to suffering, we become mad with anger and rage. We then feel revenge as a necessity, to restore our ability to appreciate life. When we do not know how to forgive, the first annoyance that arises is enough to make us incapable of living well.

Revenge is one of the major causes of crimes.

We do not forgive only for the good of those to whom we forgive but also for our own good, to keep our balance, so as not to be eaten away by hatred and criminal tendencies.

The effectiveness of prayer

Those who do not know prayer believe that it is based on superstition: as if there was a good Lord who was going to grant our wishes, as if we believed in Santa Claus.

Prayer can be very effective because it is a way of acting on oneself. By praying we come to endure what would otherwise be unbearable, and it is not necessary for that to believe in Santa Claus. A rationalist believer does not renounce reason when he prays because he is not asking for the impossible. Saying "Lord, help me not to sink" helps not to sink. Prayer is a way to restore inner balance.

Faith can heal psychic disorders. It is a natural psychological effect. For believers, faith is a gift from God, and natural effects are part of divine wisdom.

A psychology which does not understand the meaning of prayer is necessarily bad psychology, because it ignores fundamental truths about the nature of the spirit.