Time to move beyond the mind-body splitBMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7378.1433 (Published 21 December 2002) Cite this as: BMJ 2002;325:1433
The “mind” is not inside but “out there” in the social world
- Patrick Bracken, senior research fellow (, )
- Philip Thomas, senior research fellow
- Centre for Citizenship and Community Mental Health, School of Health Studies, University of Bradford, Bradford BD5 OBB
Descartes distinguished between the res cogitans and the res extensa. The former referred to the soul or mind and was said to be essentially “a thing which thinks.”1 The latter was the material stuff of the body. It was characterised primarily by the fact of extension: it occupied space and was therefore amenable to measurement. In recent years neuroscientists and cognitive psychologists have argued that this ontological separation of mind and body is no longer tenable.2 The former maintain that mental functions can be fully explained by brain science. The latter make the case for a distinct psychological realm but one whose operations, like those of computer software, are measurable and open to scientific investigation. The res cogitans is illusive no longer. We can map it, scan it, and explain its functions in biological or computational terms.
These ideas have become dominant in medical circles and, in some form or other, have become articles of faith for most doctors, psychiatrists, and psychologists. Contemporary philosophers such as Paul and Patricia Churchland and Jerry Fodor offer support for this position. 3 4 Many philosophers disagree, however, and point out that, although it claims to get us beyond ontological dualism, this doctrine really keeps alive the essential features of Descartes's philosophy. In particular, it continues his epistemological separation of inner mind from outside world. It also fails to recognise the problems involved in regarding the mind as a “thing”—Descartes's res.
For these reasons, we argue that this doctrine represents a limited understanding of human reality and undermines our ability to comprehend fundamental aspects of human suffering. Medicine requires a different approach if it is to move beyond the problems of Cartesianism. At the heart of this debate is the question of meaning.
Human beings exist in a meaningful world. When we use terms such as “mind” and “mental” we are referring to some aspect of this world. But this is not something internal, locked away inside a physical body. Think of a painting by Picasso: the famous “Guernica,” perhaps. How do we understand and appreciate this? The type of pigment is important, as are the brushstrokes used. So too are the colours and the shapes of the figures. But to understand what the painting means and the genius of its creator we reach beyond the canvas itself to the context in which it was created. This entails historical, political, cultural, and personal dimensions. Without engaging with its context, we could never appreciate “Guernica” as a work of genius. Its meaning does not reside in the pigment or the canvas but in the relation between these and the world in which it was created and now exists. Similarly, we will never be able to understand the various elements of our mental life such as thoughts, beliefs, feelings, and values if we think of them as located inside the brain. Trying to grasp the meaningful reality of sadness, alienation, obsession, fear, and madness by looking at scans or analysing biochemistry is like trying to understand a painting by looking at the canvas without reference to its wider world. The philosopher Wittgenstein and his modern followers argue that “mind” is not inside but “out there” in the middle of a social world.5 We agree.
We also agree with philosophers from the European continent who have warned against treating human experience as just another thing in the world. People who are influenced by Heidegger understand human reality as being in the world in a way that is fundamentally different from the way other things are in the world.6 We bring meaning to the world that we inhabit: we construct our world as we live in it. Humans have a certain way of hearing, seeing, and smelling the world, a certain way of experiencing space and time. We bring colour and sound to it. It is difficult for us to imagine what sort of world “opens up” to a fruit fly, a fish, or a bat. We are simply not “in” a world that is separate from ourselves. Rather, we allow a world to be by our very presence and through our physical bodies. But these also depend on the sociocultural context in which this opening occurs. Heidegger used the composite term “being-in-the-world” and argued that human reality is not a “thing” at all but is better understood as a “clearing,” a site in which a meaningful world is revealed. One of us has recently used this framework to explore the question of trauma and its sequelae.7
Conceptualising our mental life as some sort of enclosed world residing inside the skull does not do justice to the lived reality of human experience. It systematically neglects the importance of social context.8 Signs are encouraging that psychiatrists are becoming interested in philosophy.9 But the rest of medicine also needs to get beyond the legacy of Descartes. For this, medicine will require a deeper relation with philosophy.
Competing interests None declared.