I don’t believe that the field of psychotherapy has ever been as “medicalized” as it has become within the last twenty years. Even at the end of the nineteenth century, when the study of neurology and the brain was all the rage, there was still plenty of room for theories of personality and personality change that were specifically derived from philosophy and the arts, and not from the physical sciences.
Freud himself clearly recognized the links of his practice to these disciplines, writing that “everywhere that I have investigated human nature, I find that a philosopher or poet has been there first”. He also argued that it is not necessary to be a medical doctor to be trained as a psychoanalyst, noting that medical training is actually the least desirable professional background for a psychoanalyst because it emphasizes active intervention upon (so-called) “symptoms” rather than quiet attention to the stirrings of the unconscious.
The relationship between mind and brain remains elusive. In my opinion, it is not possible to articulate the nature of their relationship, other than to say that there has never appeared a human brain that did not also produce a mind, or, conversely, a mind that exists apart from a physical brain. But I simply wish to say that the science of psychotherapy is not related in any meaningful way to the physical sciences that study neurons, neurotransmitters, and brain hemispheric activation. It is not the case that I oppose such paths of inquiry, merely that they have little to do with the concept of human “mindedness”. The medical community has attempted to solve this dilemma by collapsing the two categories, making “mind” the equivalent of “brain”. But the two remain categorically distinct, in my view, with one not reducible to the other.
The attempt to medicalize psychotherapy has led to a widespread dismissal of the value of so-called “talk therapy” by medically-trained psychiatrists and primary care physicians. A recent article in a major psychiatric publication questioned the need for psychiatrists to continue to be trained in psychotherapy, noting that the lauded “era of the brain” legitimizes a blanket dismissal of psychotherapy as an unnecessary adjunct to the medical mission of the psychiatric worldview. In its place are substituted a variety of drug interventions, with one or more medications prescribed after a ten or so minute talk with the medically-trained mental health professional.
So, human dialogue, in the context of a safe and confidential relationship of intimacy, is now considered by many within the medical establishment to be a version of a “pseudo-science”, one that is not objectifiable or quantifiable, hence, possibly fraudulent. However, when I listen to a patient tell me of their reaction of being jilted by a lover, struggling with a parent’s narrow-mindedness, or suffering because of a toxic work environment, I do not imagine that I am listening to something derived from the actions of their neurotransmitters. Serotonin and dopamine do not generate meaning, I suggest.
The creation of meaning has traditionally been considered something that transcends the physical realm, although it remains intimately involved with physicality. Meaning is free, in some fundamental sense, from the limitations of time and space which constitute the nature of the physical realm of Being. Hence, our capacity to make meaning of reality is the clearest sign of our fundamental state of existential freedom from the press of immediate conditions and/or circumstances. Can anyone truthfully be said to have located this ability within some dimension of brain activity? I suggest that this is an absurd proposition, and one which cannot stand the test of time.