The terms ‘mind’ and ‘mental’ are messy, harmful and distracting. We should get rid of themEmbodiment. Photo by Denis Sinyakov/ReutersJoe Gough
is a PhD student in philosophy at the University of Sussex in the UK.
Edited bySally Davies
30 August 2021 (aeon.co)
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Someone’s probably told you before that something you thought, felt or feared was ‘all in your mind’. I’m here to tell you something else: there’s no such thing as the mind and nothing is mental. I call this the ‘no mind thesis’. The no-mind thesis is entirely compatible with the idea that people are conscious, and that they think, feel, believe, desire and so on. What it’s not compatible with is the notion that being conscious, thinking, feeling, believing, desiring and so on are mental, part of the mind, or done by the mind.
The no-mind thesis doesn’t mean that people are ‘merely bodies’. Instead, it means that, when faced with a whole person, we shouldn’t think that they can be divided into a ‘mind’ and a ‘body’, or that their properties can be neatly carved up between the ‘mental’ and the ‘non-mental’. It’s notable that Homeric Greek lacks terms that can be consistently translated as ‘mind’ and ‘body’. In Homer, we find a view of people as a coherent collection of communicating parts – ‘the spirit inside my breast drives me’; ‘my legs and arms are willing’. A similar view of human beings, as a big bundle of overlapping, intelligent systems in near-constant communication, is increasingly defended in cognitive science and biology.
The terms mind and mental are used in so many ways and have such a chequered history that they carry more baggage than meaning. Ideas of the mind and the mental are simultaneously ambiguous and misleading, especially in various important areas of science and medicine. When people talk of ‘the mind’ and ‘the mental’, the no-mind thesis doesn’t deny that they’re talking about something – on the contrary, they’re often talking about too many things at once. Sometimes, when speaking of ‘the mind’, people really mean agency; other times, cognition; still others, consciousness; some uses of ‘mental’ really mean psychiatric; others psychological; others still immaterial; and yet others, something else.
This conceptual blurriness is fatal to the usefulness of the idea of ‘the mind’. To be fair, many concepts build bridges: they exhibit a specific, generally harmless kind of ambiguity called polysemy, with slightly different meanings in different contexts. The flexibility and elasticity of polysemy binds disparate areas of research and practice together, priming people to recognise their similarities and interrelatedness. For example, if a computer scientist talks about ‘computation’, they normally mean something slightly different than an engineer, a cognitive scientist or someone chatting with a friend means. The overarching concept of computation links all these conversations together, helping us to spot the commonalities between them.
The problem is that making links like this isn’t always a good idea. Sometimes it spurs creative interactions between different areas of expertise, and offers helpful analogies that would otherwise be hard to spot. But other instances of polysemy lead to harmful conflations and damaging analogies. They make people talk past each other, or become invested in defending or attacking certain concepts rather than identifying their shared goals. This can cement misunderstandings and stigma.
You’ve got to give it to mind and mental: they’re among the most polysemous concepts going around. Lawyers talk of ‘mental’ capacity, psychiatrists talk of ‘mental illness’, cognitive scientists claim to study ‘the mind’, as do psychologists, and as do some philosophers; many people talk of a ‘mind-body problem’, and many people wonder whether it’s OK to eat animals depending on whether they ‘have a mind’. These are only a few of many more examples. In each case, mind and mental mean something different: sometimes subtly different, sometimes not-so-subtly.
In such high-stakes domains, it’s vital to be clear. Many people are all too ready to believe that the problems of the ‘mentally ill’ are ‘all in their mind’. I’ve never heard anyone doubt that a heart problem can lead to problems outside the heart, but I’ve regularly had to explain to friends and family that ‘mental’ illnesses can have physiological effects outside ‘the mind’. Why do people so often find one more mysterious and apparently surprising than the other? It’s because many of the bridges built by mind and mental are bridges that it’s time to burn, once and for all.
The psychiatrist, psychoanalyst and ‘antipsychiatrist’ Thomas Szasz argued that there was no such thing as mental illness. He believed that mental illnesses were ‘problems of living’, things that made it hard to live well because they were bound up with personal conflicts, bad habits and moral faults. Therefore, mental illness was the sufferer’s own personal responsibility. As a consequence, Szasz claimed that psychiatry should be abolished as a medical discipline, since it had nothing to treat. If a person’s symptoms had a physiological basis, then they were physical disorders of the brain rather than ‘mental’ ones. And if the symptoms had no physiological basis, Szasz claimed, then they didn’t amount to a true ‘illness’.
This argument relied heavily on the idea that mental illnesses are categorically distinct from ‘physiological’ ones. It’s an instance of how the dualistic connotations of mind, associated with certain metaphysical theories of the mental, can be imported inappropriately into psychiatry. Yet many mental illnesses have physiological causes and effects, and even those with no clear physiological cause often warrant medical intervention, because the people suffering from such conditions still deserve medical help.
In contrast with Szasz, I believe that mental illnesses are mental only in that they are psychiatric. Ordinary understandings of the mind, and what is and isn’t part of it, have nothing to do with it. Perception is generally considered to be mental, a part of the mind – yet, while medicine considers deafness and blindness to be disorders of perception, it doesn’t class them as mental illnesses. Why? The answer is obvious: because psychiatrists generally aren’t the best doctors to treat deafness and blindness (if they need treatment, which many Deaf people in particular would reject).
When people talk about ‘the mind’ and ‘the mental’ in psychiatry, my first thought is always ‘What exactly do they mean?’ – which precise meaning of mind and mental are they drawing on, which other area are they trying to appeal to, which bridge are they trying to get me to cross? A ‘mental’ illness is just an illness that psychiatry is equipped to deal with. That’s determined as much by practical considerations about the skills psychiatrists have to offer, as it is by theoretical or philosophical factors. But this pragmatic approach hides itself behind appeals to ‘mental illness’. In many contexts, the term mental tends to bring along inappropriate and stigmatising connotations – showing that the wrong bridges have been built.
Convincing others that your pain is not ‘mental’ might be how you defended the reality of your condition
Imagine that you suffer from long-term, chronic pain. You go to the latest in a series of doctors: by this point, and especially if you are a member of a marginalised group (a woman or person of colour, say), doctors might have dismissed or disbelieved you; they might have assumed you were exaggerating your pain, or perhaps that you were a hypochondriac. After some tests, and some questions, you’re eventually told that your chronic pain is a mental illness, and referred to a psychiatrist. The psychiatrist, you are told, will not prescribe drugs or surgery, but will instead prescribe psychotherapy, also known as ‘talk therapy’, and occasionally, ‘mental therapy’.
You might, quite reasonably, think that this doctor disbelieves you too. You know there is really something wrong, and that your pain is real, but the doctor is here telling you that your illness is mental, and in need of mental treatment. Perhaps they think that you have a delusion, or that you’re lying because of some kind of personality disorder? Convincing friends, family and colleagues – not to mention medical professionals – that your pain is not ‘mental’ might well be how you have defended the reality of your condition. Indeed, The Guardian recently published a series of articles investigating chronic pain, one of which was headlined: ‘Sufferers of Chronic Pain Have Long Been Told It’s All in Their Head. We Now Know That’s Wrong’. In other mainstream pieces on the topic, being referred to a psychiatrist is seen as tantamount to being disbelieved, dismissed or called a hypochondriac. Some advocates appear to argue that fibromyalgia (a condition that causes chronic pain) should not be considered a psychiatric condition because it is ‘real’ and not ‘imagined’.
It’s understandable that you might be annoyed for your condition to be branded a ‘mental illness’. But what about your doctor – what did they want you to take away from that interaction? It might well be that they absolutely believed that you were in severe, involuntary pain, caused by heightened sensitisation of the peripheral nervous system as a result of ‘rewiring’. Pain that results from rewiring of the nervous system is known as ‘nociplastic pain’, recently recognised as a highly medically significant category of pain. They don’t necessarily think you’re lying or delusional. In invoking ‘mental illness’, what they might have meant is only that it might be best treated by talk therapy, and best managed and understood by a psychiatrist.
Despite your legitimate annoyance, your doctor might also be correct. The term mental in the phrase ‘mental illness’ just means psychiatric. Your doctor might know that psychiatrists and psychiatric researchers continue to play an important part in the recognition and study of nociplastic pain. They might be optimistic about the effectiveness of talk therapy, because they know it’s effective at alleviating many of the symptoms of fibromyalgia and chronic pain, perhaps even to reduce the pain itself. They might also have read a recent review that found that talk therapy can be effective as a means of intervening on the immune system – indeed, as effective at reducing the inflammation associated with rheumatoid arthritis as common medications.
So you and your doctor might actually agree about the nature of your condition – and yet, you are left feeling understandably let down by your referral to a psychiatrist. Something has gone very wrong here. The problem, I think, is the idea that psychiatry deals with ‘mental illnesses’, disorders of the mind. Indeed, it’s common wisdom that mental illnesses are disorders of the mind, and that psychiatry treats mental illnesses. If you look in dictionaries, textbooks or diagnostic classifications, this is the characterisation of psychiatry and its domain that you’ll find. The key problem is that mind and mental come with associations that are wildly inappropriate when characterising a medical discipline – ‘mental’ can, after all, be contrasted with ‘real’, ‘biological’, and ‘physical’.
What we have is a problem of miscommunication, stemming from the messiness of the ideas of the mind and the mental. The terms mind and mental can be used many ways and can carry many different meanings, sometimes implying a lack of reality, sometimes indicating a relationship to psychiatry – and sometimes meaning something else entirely.
Depression and schizophrenia are no more ‘all in the mind’ than chronic pain
Imagine, instead, that your doctor told you that you had a ‘psychiatric’ illness, but stressed that psychiatric illness is not ‘mental’ in any important sense. Imagine if they told you that you might be prescribed ‘talk therapy’, but emphasised that many conditions that are not ‘in the mind’ are amenable to talk therapy, which can affect almost all of the ‘plastic’, malleable parts of a human being. Imagine, even more optimistically, that people did not generally infer that categorising an illness as psychiatric made it automatically mental, or think that because a condition can be affected by ‘mental’ states such as one’s beliefs or expectations, that it was therefore non-biological or non-physical or ‘all in the mind’.
Not bringing in ideas of the mind and the mental makes for much easier communication. You might go away from such a conversation with your doctor feeling like you’d been believed, and that psychiatry could help you. Yet your doctor has not actually done anything differently; beyond assuaging your concern that your illness isn’t taken seriously, the course of action is otherwise exactly the same. While chronic pain might be psychiatric, it’s not imaginary or non-biological – and the terms mind and mental blur all these things together. The problems of the mind and the mental are not confined to the treatment of chronic pain. It adds to the stigma surrounding other psychiatric illnesses to describe them as ‘mental’ too: depression and schizophrenia are no more ‘all in the mind’ than chronic pain.
As well as reinforcing the stigma around mental illness, the messiness of mental also fuels misguided arguments for radical reforms to (and even the abolition of) psychiatry as a medical discipline. At the other extreme from Szasz’s antipsychiatry views, many people argue for a merger of psychiatry and neurology. This relies on certain philosophical ‘theories of mind’, popular in cognitive science: some people think that the mind is the brain; others think that the mind is the software that runs on the brain, the way that Windows runs on my laptop. This argument relies on the notion that, because psychiatry deals with ‘mental’ illness, it should defer to philosophical views of the ‘mind’ popular in cognitive science. The issue is that the ‘mental’ in mental illness just means psychiatric, which is not what these philosophers and scientists are talking about.
As a result, we should be suspicious of appeals to the mind and the mental in psychiatry. Psychiatric patients certainly don’t need the burden of any extra stigma, and understanding psychiatric conditions is difficult enough without the constant risk of conflation and miscommunication. Without a reason to retain them, we should eject the concepts of ‘the mind’ and ‘the mental’ from psychiatry. And not just there: the concepts are wreaking havoc in cognitive science and psychology too.
Just as psychiatry is meant to be the branch of medicine dealing with mental illnesses, so cognitive science and psychology are supposedly the sciences concerned with the study of the mind. However, psychology and cognitive science do not study quite the same thing. Disciplines such as personality psychometrics are historically a core part of psychology, but only dubiously part of cognitive science at all. Conversely, cognitive science has inherited broader interests in self-organisation, information processing and adaptive behaviour from some of its predecessors, especially cybernetics. The domains of psychology and cognitive science also do not line up with the domain of psychiatry. Perception remains firmly within the domain of psychology and cognitive science, but blindness and deafness are not psychiatric illnesses (again, even if/when they are illnesses at all).
The domains of psychology and cognitive science also include capacities that you probably don’t mean to invoke when you talk about ‘the mind’ in normal life. For example, there are cognitive models that cover the way organisms survive via homeostasis (maintaining stable internal parameters in the body such as heart-rate and blood temperature) and allostasis (adjusting those parameters and behaviour depending on the context).
There are also ways of mapping immunity in cognitive terms. In the 1960s and ’70s, the work of the US psychologist Robert Ader uncovered a surprising feature of the immune system. He trained rats to avoid a harmless sweetener by administering it alongside a sickness-inducing chemical called cyclophosphamide. When testing that the training had worked, by administering just the sweetener, the rats began to die. The more sweetener, the faster they died. This was a mystery. It turned out that cyclophosphamide is an ‘immunosuppressant’, a chemical that turns off the immune system. The immune system had ‘learned’ to turn off in response to the sweetener alone, and this left the rats vulnerable to normally harmless pathogens in their environment, which killed them. In other words, Ader discovered that the immune system is amenable to classic Pavlovian conditioning.
Should we count the immune system as ‘mental’ because it’s psychological and cognitive?
This led to the creation of ‘psychoneuroimmunology’, an area that involves, among other things, psychologists who study the immune system. Later research uncovered many more exciting facts about the ‘wiring’ and signals that link the immune system and the brain. The immune system responds in complex ways to stress and trauma – an imbalance in the immune system is associated with several trauma-related psychiatric illnesses, such as post-traumatic stress disorder and borderline personality disorder (both of which are often linked to trauma). The immune system also plays important roles in controlling social behaviour. For example, some scientists believe depression could sometimes be a side-effect of your immune system reducing your social motivation in order to minimise the risk of spreading disease; the idea is that your immune system has been triggered into possessing an erroneous ‘belief’ that you are infectious.
Sticking to the construal of cognitive science and psychology as studying ‘the mind’ creates a misleading impression of what these disciplines are up to, and raises potentially pointless questions such as whether we should count the immune system and its capacities as ‘mental’ because it’s psychological and cognitive. Once again, the bridges built by mind and mental have proved unhelpful. Psychoneuroimmunology has had a hard time gaining widespread acceptance, especially among immunologists. In large part, this is because it is widely counted as a form of ‘mind-body medicine’, a term that applies to as much chicanery and overblown self-help as it does to legitimate medical research. The bridges built between a kind of sloppy holism, con artistry and psychoneuroimmunology owe much to mind and mental, and have done little to help the disciplines they supposedly serve.
It’s much better, instead, to talk of psychology as the study of the psychological, and cognitive science as the study of the cognitive. This might seem circular, but it only reflects the fact these disciplines are in charge of discovering their domains, and that we simply don’t know enough yet to say exactly what those domains should be in totally independent terms. No-one has any trouble describing physics as studying the physical, and the idea that it’s the study of fundamental laws of motion and contact has long since been abandoned.
When we see the concepts of mind and mental doing such harm, we have good reason to get rid of them. Rather than talk about ‘minds’ and ‘the mental’, we would be better off discussing the more precise and helpful concepts relevant to what we’re doing. The good news is that they already exist for the most part, and work perfectly well once their connections with mind and mental are broken. Psychology has psychological, cognitive science cognitive, and psychiatry psychiatric. Outside these areas, there are many, many more – consciousness, imagination, responsibility, agency, thought, memory, to name but a few. Feminist work on relational autonomy and the relational self, and historical precursors such as Homer provide promising avenues for developing conceptions of people that don’t call on the notion of mind – notions according to which people are coherent wholes, not because they have some unifying inner core, but because of the way they, their relationships and their environments conjoin.
The conclusion is that there is no such thing as a mind, and nothing is mental – even though you and I both think, feel, believe, desire and dream. Whenever you come across the terms ‘mind’ and ‘mental’ – especially when they bear a lot of argumentative weight – you should wonder what they actually mean, and ask yourself what equivocations are hiding below the surface.
To read more about ‘the mind’ and ‘the mental’, visit Psyche, a digital magazine from Aeon that illuminates the human condition through psychology, philosophy and the arts.
Philosophy of mindMetaphysicsPsychiatry and psychotherapy
