fit together, not merely a three columned list of spare parts sitting on the shop floor.
To all this the reader may counter, with a pragmatic refrain, that the psychiatrist does not need to know or even conjecture on what the mind is in order for its praxis to be meaningful. All that matters is if treatment and diagnostic formulation “works” (I have included diagnosis as something that “works”, as diagnosis has as much utility as treatment in the psychiatric ritual, it is a shared fantasy that “treats” the psychiatrists and the patients anxiety not knowing what illness they “have”). The psychiatric pragmatist may state that in times past all physicians may have administered a perfectly suitable remedy without any knowledge at the time of what it chemically was and how it physiologically worked, and the patient none the worse for it. They might cite the example in our own day of general anaesthesia, where it remains only dimly known of how it works (where dim is a charitable overestimate). And fair enough. If one wishes to be rendered unconscious and insensate to avoid what would otherwise be agony at the surgeon’s blade, then who cares how this is to be achieved, and who cares how the sevoflurane or propofol interrupts the mystery of consciousness. This theoretical question is only of interest to the philosopher, and not at all when the philosopher is prepped for surgery. Such an analogy between general anaesthesia and psychiatry would be misplaced however, as general anaesthesia has no claim or calling to be anything other than a wholly self contained pragmatic exercise. It entirely explains itself by its success to bring the patient to deaths door and back again, and does not attempt couch itself in any greater narrative of the human condition.
Psychiatry on the other hand necessarily asks grander questions and pretends to have grander answers into mind and its maladies. In its pretences it tells people who they are in their symptoms and the relation between normal and abnormal, and in its omissions cannot avoid the charge of assuming what the patient is not (as spiritual beings for instance, the cohort of believers run roughshod over in the above quoted guideline elsewhere purporting to have sought and respected submissions from a broad audience with broad values and beliefs). It really does matter if the patient asks what mood is, and is told mood relies upon a harmony of certain neurotransmitters and that indeed good mood is an epiphenomena of the operations of these neurotransmitters. Or alternatively is depression inwardly directed anger or the outcome of laziness or not living up to expectations? It really does matter if the patient is told their addiction is a “highjacked” reward pathway or alternatively more a moral matter or distraction against life's meaninglessness with neuroscience having little of substance to offer to the question. It really does matter if we posit the unconscious to exist at all, let alone it being the warzone from which bursts forth our anxieties. It is only in begging the question towards a philosophical pragmatism (see chapter to follow) that these and countless other questions do not matter.
The current chapter, perhaps to be the shortest in the book, hardly addresses a survey of what the mind is or is not. Nor is it a survey of C.D, Broads taxonomy of mind as consciousness or an answer to Chalmers “hard question” of the same (i.e. the explanation for consciousness itself as the ground upon which all mental operations must stand and be experienced as mind in either noun or verb). Nonetheless I’ll take a stab at a defence of a radical agnosticism with respect to mind. Should I be correct, it will make of psychiatry forever a speculation longing to become the place it can never arrive. And if that is the case, psychiatry sits upon a level playing field with the pastor or wise grandmother as to what maketh the man (or woman).
Brain and Mind
Take a garden variety neuron. One neuron is first excited into activity by another, and so do we begin with the second or the first? But the first is also excited by another, and so on ad infinitum back to some embryological point where somewhere some first neuronal pair was excited to act. Thus our entry point into the brain is arbitrary. And so we are back to the garden variety neuron at an arbitrary space and time in the adult brain. A starting point of excitation for neuron 2 might be, in the simple case, a neurotransmitter floating around in the fluid space between neuron 1 and neuron 2. And the neurotransmitter might form a loose chemical bond with a protein in the seething semi fluid membranous coating that wraps around the neuron and is its cellular “skin”, this membrane being the place within which this protein “receptor” is to be located. This loose chemical bond results in a changing of the receptors structure, the change in structure being entirely explained on first principles to be a physical event, much as a door is explained by where the hinges are located and from where the force is applied when the wind slams it shut or swings it open. For the moment we are imagining neither a mind forcing its will upon the neuron or a hand forcing a will upon the door. This is a change in receptor structure that might, once again in the simple case, result in the receptor becoming a channel or loch through which flows positively charged sodium ions. Why do they flow in and not out? Actually they flow both ways, yet the nett flow is in one direction, this the result of random movement of a physical thing and an initial imbalance in concentration either side of the membrane. The original state of separation of charge and concentration imbalance across the membrane of various ions is driven in large part by other subcellular machinery whose operations can also be explained on the basis of one chemical bobbing up against another, changing the shape of it and so on, the principle chemical unit in this case being a little molecular machine that pumps sodium out and potassium in, in a ratio the resultant of which is more electrical negativity on the inside of the membrane at rest. The events of neuronal activation are similarly entirely explained by basic physical and statistical principles at play. The fact that the positively charged sodium ion is not at a temperature of absolute zero permits motion. The differential concentration either side of the membrane predicts the statistics of bulk nett flow (from high to low concentration). The second law of thermodynamics explains the same (the increase in disorder if energy is not applied to increase order, in dissipating a concentration gradient) and so on. The state of affairs can collectively be readily explained by calculations of both the Nernst and Goldman Hodgkin Katz constant field equations. Should enough sodium enter into the cell to alter the electrical state of the neuron to the requisite threshold, there will be another species of sodium channels responsive to changes in the electrical milieu whose shape will also change, so called voltage gated channels. These will conform into an open state and more sodium will float on in, this sodium diffusing sideways within the neuron, the resultant being more electrical change and more sodium influx propagated along with length of the nerve (so called depolarization and propagation). At the terminus of the nerve the voltage change will activate yet another species of little intramembranous proteins bobbing around like icebergs in the semi fluid sea that is the cellular membrane. These admit calcium ions which in turn come to activate a chain of events that allow for a change in shape of an internal scaffolding within the neurons terminus such that vesicles (little bubble like structures) containing neurotransmitter fuse with the membrane of the neuron itself, releasing the transmitter into the space between neurons to float on over to interact with neuron 3. To imagine vesicular release, imagine a lava lamp where the bubble within the tube is hollow, contains a chemical transmitter substance, and releases it to the outside world if allowed to partially fuse with the glass of the tube, in this case with the outside of the tube composed of the same substance of the bubble and not the glass of the tube in our analogy. The released transmitter will float around between neuron 2 and neuron 3, perhaps resulting in activating the latter when enough quanta of transmitter arrives at its destination. There also will be subsequent processes returning the neurons 1 and 2 to the state of rest and excitability, returning initial charge separation and vesicular separation from the membrane, and refilling the vesicle with transmitter.
The above is the most basic model, explained in the most basic terms faithful to the physicality of the system. Nowhere in all these happenings is anything like that which we know to be the case in our being aware, in feeling and thinking and in directing our intentionality inwards and outwards. Where in all this is the spontaneous emergence of the language of consciousness and mind and persons, let alone the raw beingness of consciousness and mind?
The reader may make the obvious objection. They might say that two or three neurons does not a brain make, and that consciousness and mind is the “emergent” product of complexity.
And
