Leaving Psychiatry. J. R. Ó’Braonáin. M.D.
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 yet how can this be the case? There are no convincing analogies of emergence the likes of which we are asked to believe happens in the relationship between brain and mind. One could say that the wetness of water is an emergent property from the combination of billions of water molecules. Yet this is a nonsense. Wetness is the subjective sense of a person with a mind who “feels” water. Wetness needs mind. The fluidity of water on the other hand results from the properties of the water molecules themselves and their arrangement at a given temperature and pressure. Fluidity can be understood with a language already contained within a semantics of physical chemistry. Are we to propose that from placing the straws on the camels back, that somehow emerges this alien state of crushing the camel, like a giant phantom hand has appeared in the midst of the straw or come down from on high. And yet the potentiality of the crushing was contained within the mass of each straw, this pitted against the physical carrying capacity of the camel. Something happened for sure yet nothing alien emerged. Or it is like a revolutionary society, which in its emergence is more than the conversation. And yet what is so alien here? Is not the revolution of the same properties of the conversation in the café or the first call to arms? But where in the brain can we find mind, even in its proto or partial emergence?
That having been said, let’s entertain the nonsense anyway, and pit it against our intuitions. Let’s scale up the complexity. Where there were three neurons and two synapses, we now have billions. And so what? From heaping lead upon lead upon lead do we see emerge an ounce of gold? Billions of more of the same is greater mass without effecting an alchemical transmutation of what that mass is composed of. Now it’s in the arrangement they might say, the spatial complexity is the wellspring of emergence. Fair enough. Let us put one train upon a track, then multiply the tracks into an elaborate system of a national railway, with thousands of miles of tracks and hundreds of trains coming and going in extension and recursive loops. And yet we still have nothing more than trains and tracks. Nowhere in all this does the great train God emerge to know itself as something beyond its material and efficient self. Or at least the train God has not acquired a communicative apparatus to communicate its existence to us, and so we have exercised the option to hypothesize its non-existence. Those of a pan-psychic persuasion think every material thing is conscious. Even a grain of rice has a tiny packet of proto consciousness. How a consciousness not conscious of itself can be a meaningful consciousness is for