THE MIND
Introduction
The ‘mind’ is a concept to explain human internal (mental) experiences. Historically, Descartes’ mind-body dualism postulated that the mind and the body are two separate entities. However, the separation of mind from body is not scientifically supported, nor is it helpful for accurately understanding humans and predicting behaviours. Nonetheless, we are faced with limitations in medicine that require psychological concepts and psychiatric medical diagnoses. For example, ‘consciousness’ is a psychological concept describing human awareness and experiences, and ‘major depressive disorder’ is a psychiatric diagnosis describing a group of these experiences (e.g. dysphoria, anhedonia, etc.).
This is not so different from physical medical diagnoses. Prior to detailed understanding of anatomy and physiology, and the advent of investigations (e.g. imaging and blood tests), physical diagnoses were based largely on patients’ reported experiences and observations. For example, Hippocrates, the Father of Modern Medicine, defined lower respiratory diseases through groups of symptoms (e.g. pain, breathlessness, and even specific odours). Although some of his theories of physiology were not accurate, he was able to provide treatments that were effective. Since then, knowledge of anatomy, physiology, and medical investigations have developed substantially, although have many limitations.
Despite these developments, many of the physical diagnoses are made through understanding a person’s experience. Where medical knowledge has insufficiently developed, doctors rely on patients’ reported experiences, our own observations of the patient, and collateral information from people who know the patient. Many of these diagnoses sit between physical and psychiatric medical diagnoses. As knowledge advances, some diagnoses previously considered psychiatric, move into the realm of physical understanding. A good historical example of this is neurosyphilis (previously termed ‘general paralysis of the insane’) and more recently NMDA-R encephalitis, see Brain on Fire.
Dr JJ’s Principles of Psychiatry
Psychiatry is a subspecialty of medicine first coined in 1808 by German physician Johan Reil, which created a definitive split from neurology. Modern psychiatry is guided by research and diagnoses outlined in the DSM-5 and ICD-11, which are diagnostic manuals delineating the symptoms of each mental illness (e.g. major depressive disorder, schizophrenia, etc.). These manuals, guidelines, new research, and clinical experience are what guide all psychiatrists. Nonetheless, there can be differences with regard to underlying principles, models, and approaches that each psychiatrist uses.
Dr JJ uses a combination of models, which is intended to optimise the use of evidence-based treatments, while taking into consideration the preferences and individual characteristics of each patient. Often in psychiatry (and medicine in general) individual characteristics are overlooked in favour of a standardized patient. Although this can make it simpler for doctors to make decisions, the downside is that patients sometimes have negative experiences. This leads to poor therapeutic alliance, lack of confidence in the doctor and treatments, and ultimately poor outcomes.
Being a subspecialty of medicine, Psychiatry is largely focused on treatment with medications and procedures. This approach can have powerful results in many cases, but some diagnoses are lifelong or have insufficient treatments. These limitations fuel Dr JJ’s approach to psychiatry which places a high importance on lifestyle psychiatry and psychological approaches for managing mental health. A good example is demonstrated by a meta-analysis (conglomeration of studies) which found that quitting smoking tobacco leads to improvements in mood and anxiety that are at least as large as taking antidepressants (if not larger). Similarly, there are ‘food and mood’ studies that show equally impressive outcomes from improved diet. Patients themselves see these benefits, but sometimes struggle to change habits (as do many people).
“Psychiatry is often termed ‘mental health’, contrasted with other areas of medicine that manage physical health needs. However mental health goes beyond psychiatry, for example people experience subclinical symptoms (i.e. symptoms that affect them, but do not meet diagnostic criteria). Understanding subclinical symptoms and other factors (e.g. psychological, lifestyle, and social) are important for optimising mental health outcomes.” – Dr JJ
Dr JJ’s Principles of Psychology
While psychiatry is based in medicine and largely focused on treatment, psychology is more broadly focused on understanding human behaviours and mental experiences. For example, Dr JJ was simultaneously involved in three research labs investigating various psychological domains including cognition, language, and mood. ‘Psychology’ was first coined in the 1500s, although psychological concepts were present in ancient civilizations around the world. Until the advent of scientific experimentation, psychology was a philosophical domain and often understood through religious (the soul) and supernatural (demons) conceptualisations. Modern psychology is based in rigorous scientific research that is testable and reproducible.
With regard to providing treatment, psychologists primarily use psychotherapy (talking therapy, which is contrasted with pharmacological treatments prescribed by psychiatrists). Since Dr JJ is both a psychiatrist and a psychologist he takes a balanced approach. There are numerous psychological therapies with high levels of evidence for treating mental illnesses. Dr JJ’s preferred psychological therapies are cognitive behaviour therapy (CBT) and psychodynamic psychotherapy.
Although CBT is a specific treatment it is also an umbrella term that encapsulates a multitude of therapies. The behavioural aspect of CBT originated in the early 1900s with Pavlov’s dogs (classical conditioning) and was later complemented with research by B.F. Skinner (operant conditioning). Aaron Beck is considered the father of CBT; in the mid-1900s he combined newly developed cognitive therapies with concepts of behaviour therapies. Beck himself was a psychiatrist and had identified maladaptive cognitions in people with depression. Behaviour therapies were useful for treating anxiety disorders, but insufficient for treating depression. Prior to the advent of CBT Beck was using Freudian psychoanalysis, which is the foundation for psychodynamic psychotherapy, Dr JJ’s other preferred therapy. These therapies are termed ‘insight oriented therapies’ with reference to identifying unconscious processes, usually relating to early life experiences.
“Research on psychological therapies (and other types of treatments) demonstrates that outcomes are significantly improved with good therapeutic alliance (i.e. the patient and doctor agree on treatment goals and treatment choice). Dr JJ also uses a supportive psychotherapy framework to improve therapeutic alliance. Additionally, other important psychological therapies he promotes are the ‘third-wave CBT’ treatments. This includes therapies such as mindfulness, acceptance and commitment therapy (ACT), and dialectical and behaviour therapy (DBT). The purpose of third-wave CBT is to be mindful of the present and accept our experiences, rather than always trying to change them. This approach is beneficial in modern societies since people are busy with family duties, work, and planning for the future such that their minds are often not in the present moment. It’s as if they’re flying through space without paying attention. This leads to Dr JJ’s experiences in astrophysics, a discussion about The Universe.” – Dr JJ
Learn More about the Mind
Below are the latest articles on The Mind written by Dr JJ. Please feel free to leave a comment, ask a question or exchange thoughts with Dr JJ.
The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults
The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adultsResearch article by Jeremy C S Johnson; Gerard J Byrne; Anita M PelecanosBackgroundOur aim was to...
Takotsubo cardiomyopathy in the context of major neurocognitive disorder and multiple risk factors
Takotsubo cardiomyopathy in the context of major neurocognitive disorder and multiple risk factors *Research article by Johnson a,b Jeremy C.S., Byrne a,b Gerard J.A. a Older Persons’ Mental Health Service, Royal Brisbane & Women’s Hospital; b Discipline of...
A retrospective analysis of biochemical and haematological parameters in patients with eating disorders
A retrospective analysis of biochemical and haematological parameters in patients with eating disordersResearch article by Leanne J. Barron1,2*, Robert F. Barron3, Jeremy C. S. Johnson4, Ingrid Wagner5,6, Cameron J. B. Ward6,7,11,12, Shannon R. B. Ward7, Faye M....
Electroconvulsive therapy for psychosis in a patient with a traumatic brain injury
Electroconvulsive therapy for psychosis in a patient with a traumatic brain injury *Research article by Jeremy CS Johnson and David A Ward Royal Brisbane and Women’s Hospital, Herston, QLD, Australia Overall content Medline database, we found case reports of patients...
QT-prolonging agents with risk of torsades de pointes
QT-prolonging agents with risk of torsades de pointes*Research article by Jeremy CS Johnson and Gerard JA Byrne. Brisbane, QLD. Extract Dear Sir We appreciate the review by Berling et al., which was a useful reminder of the potential risks of torsades de pointes (TdP)...
Assessing the effectiveness of pharmacotherapy for obsessive-compulsive disorder
Assessing the effectiveness of pharmacotherapy for obsessive-compulsive disorder *Research article by Jeremy C S Johnson, James G Scott, Naomi Jess. Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia (JCSJ, JGS, NJ); The University of Queensland Centre...