Two Perspectives of Mental Distress

ABSTRACT

This article explores an imbalance between two perspectives on mental distress. The Broken Brain perspective sees mental distress as largely caused by discrete mechanical failures of organic brain function. In tension with this, the Symphonic perspective of mind (encompassing, but not limited to, psychodynamic models) refers to a non-local, wholistic and distributed process spread across the entirety of the mental capacity in which mental distress results from the impacts of tragic life experience on the normally functioning mind. While overlapping in some areas, these two perspectives often lead to dramatically different ways of understanding and treating mental distress. While the Broken Brain perspective has had preeminence in recent decades, it is suffering from increasingly serious scientific and clinical obstacles. Conversely, the Symphonic perspective is increasingly supported both theoretically and clinically by emerging scientific evidence as an efficacious, reasonable, and cost-effective treatment approach.

KEYWORDS:

• Philosophical perspectives
• broken brain
• symphonic
• mechanistic
• holistic

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ For example, it was revealed in 2009 that the National Alliance for Mental Illness (NAMI) received the vast majority of its drug funding from drug companies (Harris, 2009).

² The writers of this review article go on exclusively to describe the process of psychosis from a Broken Brain perspective, completely leaving out negative evidence and other theories that also have scientific support. This is in contradiction to the spirit of review articles, which are supposed to offer balanced and thorough overviews of a subject. At the very end of the article Dr. Lieberman discloses he is affiliated with 15 different drug companies. This is even more breathtaking when you realize this article was published in the New England Journal of Medicine, a premier medical journal of the United States.

³ Another often repeated claim is that twin studies of those with schizophrenia supposedly showed a high rate of heredity. Another look at that data has revealed that the authors of these series of papers engaged in a series of statistical inflation techniques to achieve these numbers. If you remove those statistical inflators and use the regularly accepted method of determining heredity, the results are much, much lower – very much in keeping with the argument I have presented here (Ross & Ross, 2018).

⁴ For example, a study from 2019 found an increase in the rate of unexplained death in children prescribed antipsychotics, a class of drug regularly prescribed to children with these diagnoses (Ray et al., 2019).

⁵ This is entirely in keeping with our understanding of other lasting mental phenomena like language. Those who learn English early keep speaking English, those who learned Greek early keep speaking Greek, etc. Changing primary language, including emotional language, is a difficult thing.

⁶ I have found that I can write a short paragraph describing an individual’s history and expressions of distress integrated with my understanding of the problem that is far more helpful to myself, the individual, the family and other professionals than ever using the DSM.

⁷ It was at this point that Whitney’s parents finally began to recognize their role in their daughter’s distress. With great courage, they approached Whitney and began acknowledging their treatment of her. This began a positive transformation for Whitney. I believe it was this capacity for change, as exhibited by her parents, that saved Whitney’s life.

⁸ Broken Brain scientists have difficulty understanding why some people clearly struggle with certain events more than others, and look toward genetics, chemical imbalances, etc. for answers. However, given the mounting evidence around the shockingly high rates of childhood adversity, it is increasingly obvious that this confusion can be more straightforwardly explained through an understanding of childhood and familial trauma (N. B. Harris, 2018).

⁹ I work in a way informed primarily by Donald Winnicott, Wilfred Bion and contemporary field theorists like Antonino Ferro and Guiseppe Civitaresse, combined with ideas derived from the Open Dialogue techniques developed in Finland.

¹⁰ Approximately 20% of those with whom I work continue to take some form of psychotropic medication on a regular basis. While I intend psychotropic drugs to be used for short durations during times of extreme distress and only after an extensive review of their significant risks and limited benefits, there are still occasions in which I believe medications are the best course of action – just far less often than is promoted in the psychiatric literature.

Additional information

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John Thor Cornelius

John Thor Cornelius, M.D., is a medical doctor and psychoanalyst who works in Sacramento, California. He trained as a psychiatrist and worked psychiatrically in hospitals, outpatient clinics and as the medical director of an intensive community mental health program before completing psychoanalytic training. He taught psychoanalysis at the University of California at Davis for many years, is the current president of the Sacramento Psychoanalytic Society and writes and speaks nationally on the intersection of science and psychoanalysis. In his practice he prescribes medications, engages in psychoanalytic psychotherapy, and sees people in many forms of distress, including those struggling with trauma and extreme states.