Descartes, 17th century philosopher, first pioneered the idea of the body’s dualistic nature, better summarised by substance dualism, stating that mind and body are two distinct domains. These subsequently diverge into outer (comprising the body) and inner experience (comprising the soul). Epistemologically, the presence of the word ‘substance’, in philosophical terms, determines an entity that is independent from anything else and has set properties.
Overall, depicting two central units that make up an individual, the first relates to our purely physical form, Descartes envisioned the body as mechanically operating through its components, while the second unit he considered being solely mental- the meta-physical nature of the soul. These combined, generating the fundamentals of a human being alongside the human experience; potentially interacting at times, they remain autonomous and possess various different properties. Descartes presented various arguments for this ideal, starting from his stance on ‘indivisibility’, suggesting that due to the mind not being able to be divided into segments, unlike the body, they must be distinct substances, “when I consider my mind, that is to say myself insofar as I am only a thinking thing, I can distinguish no parts”[1](Meditations, 1641).
The connecting factor between mind and body selected was the Pineal gland, attributing its singular and central conformation to its ability to direct the flow of spirit from mental to physical. Interestingly, Descartes coined the idea of an intersection between the formerly proposed division, examining a possible correlation which currently still struggles to be acknowledged; however, we can now state with certainty that the Pineal gland is in no way spiritually attuned.
Cartesian dualism therefore set the boundaries within medicine early on, segregating mind-related problems to body-related ones; erasing any potential overlap between these. Hence, medical practitioners have faced a dichotomy of choice: treating the body or mind, independently of each other. Although the apparently innocuous nature of such division might have been overlooked through the advance of what we now call modern medicine, the current significance placed on mental disorders has heightened the interest in the topic. In fact, despite the developments on the ‘outer’ dualist domain, the same evolutive process has not occurred for the ‘soul’ domain. Currently, the boundary is still present within medical specialisation: physician or psychiatrist? This is further reinforced by the planning of consultancy, appointments and expert opinion; no overlap between the mental and physical ever occurs within hospitals as the patient enters the door, symbolically labelled ‘body’ or ‘mind’.
Conversely, when the correlation between a corporeal state and a mental reaction is instead acknowledged, the second is simply described as a conscious response of the medical state that the patient is in. The example used by Dr Andrew Budson in The Inflamed Mind can further elucidate on the frequent phenomenon: Mrs P (a patient treated by Budson) was previously diagnosed with rheumatoid arthritis, beside her physical pain, a secondary question on the woman’s mental state arises. The reported, classical symptoms of depression that affected Mrs P where hoped to be treated efficiently, resorting to psychotherapy and antidepressants. Dr Budson’s idea was instantly debunked, “depressed? Well you would be too, wouldn’t you?”[2], he was told. The potential association between her condition was discarded as a conscious response to the bad news of an arthritis diagnosis, not posing the dilemma on whether the depression had emerged physiologically, thanks to the inflammation caused by her disease directly affecting the brain.
This assumption of a conscious experience when dealing with mental states further perpetuates the stigma related to mental disorders, boosting the culture of shame which surrounds the talk and presence of such diseases. This conscious underpinning which is assumed in Major Depressive Disorder (MMD), other than concluding that the patient is responsible for their condition, also urges a sentiment of responsibility to cure or better the situation independently, better summarised in the following framework- if the problem arises from my own mind, it is within my power to control and treat.
In accordance, the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), rejects the diagnosis of depression in the occurrence that the symptoms are, “attributable to the physiological effects…of another medical condition”[3]. An MMD diagnosis was therefore revoked for Mrs P, leading her to live her mental and physical condition concurrently, while the medical world only acknowledged one of the two.
As prefaced, the tangible aspect of medicine has been critically examined and studied over the years, predominantly thanks to the physical presence of the disturbance in the patient. Adversely, the presumption that an element becomes respectable in medicine only if traceable, still permeates the disciple.
From a humanitarian stance, Cartesian dualism is seen as one of the principal factors in the mechanical treatment of patients, also given by the inability to respond to concerns that patients have raised. An seen the inability to respond to Mrs P’s ‘why?’ regarding her psychological condition, any solution proposed was an educated guess to explain the symptoms as consequences to the realisation on their declining physical health.
Ultimately, diseases are currently identified by clinico-pathological correlation, clinical assumptions that are then reinforced by findings such as the diagnostic checklist published in the DSM-5; leading to a completely dispassionate approach towards patients. A possible solution raised between experts was the introduction of subjective evidence, aiming to firstly eradicate the mechanical attitude which has developed, while bridging the gap between the independence of mind and body diseases. The acknowledgement of some form of interdependence, which is likely to be even greater than we can currently envision, would most likely fade the cemented lines of Cartesian dualism.
Thank you!
Eva Schilton
[1] https://www.alevelphilosophy.co.uk/handouts_religion/DescartesDualism.pdf, Michael Lacewing, ‘Descartes’ arguments for distinguishing mind and body’, Routledge Taylor & Francis Group, accessed 10/10/23. [2] https://www.bookbrowse.com/mag/reviews/index.cfm/book_number/3854/the-inflamed-mind, Jamie Chornoby (2019), The Inflamed Mind, Book Browse, accessed 11/10/23. [3] https://www.psychiatry.org/psychiatrists/practice/dsm, (2013), Diagnostic and Statistical Manual of Mental Disorders, 5th edition ed. Arlington, American Psychiatric Association, accessed 11/10/23.