Monday, July 28, 2008

The problem with my 'brain and mind' tag - the mind is not in the brain

Blogger supports tagging of posts, though they're called "labels". One of the tags for this blog is Brain and mind.

There's a problem with that tag. No, not the boring old "mind/body" duality stuff. I'm a pragmatic materialist 2.0 (ie reality + emergence), for me the "mind" more or less runs on the body [1].

The problem came to me as I thought about a post I wrote a week or two ago on current models of chronic pain syndromes ...
Gordon's Notes: The pain is all in your head

... The ideas aren't quite as novel as Gawande suggests. I recall fifteen years ago veteran physicians, with lots of experience with intractable pain and chronic fatigue, had begun to think the problems were 'all in the patient's head'. By which we meant, with intentional irony, that the problem was 'malwiring' of the brain.

The good news is, the brain is plastic. We can't easily alter it directly, but we can slowly reprogram it through the mind. That's how the mirror-box therapies Gawande describes work, and presumably that's how exercise therapy works for chronic fatigue syndrome (albeit both imperfectly)...
Ok, I have to also thank my son, who has an extremely tight connection between psyche and soma. I watched a recent shoulder problem wax and wane in proportion to psychic stress, and I realized what's wrong with both my tag and my prior post.

I have too strong a division in my own head between the central and peripheral nervous system. Yeah, sure, everything is connected to everything else so we do need to draw lines, but I think for the purposes of modeling disorders of sensation and perception, including pain, the line should be drawn around the peripheral nervous system -- not around the central nervous system (and not around the body -- that's too broad to be conceptually useful).

Perception and sensation are core functions of mind, and we physicians may err in ascribing them primarily to the periphery or the core.

Yes, I know this seems self-evident when I put it this way. Maybe it is, but I think there's something here. If we truly believed in this model, I think we would approach all management of sensation, whether arising in a broken leg (peripheral nervous system), or my son's sore shoulder (central and peripheral) or intractable itching (central) with an eye to techniques applied both peripherally (set the leg) and centrally (??).

There's something here ... I just need to think about it a bit more.

[1] More or less, without the "oxygen" of social interaction and coherent sensory input it won't run well for long.

1 comment:

alanbooker said...

Thank God that there is someone else who is so fed up with mind/brain thinking.

Just as with the prevalence of computer/brain brain/computer thinking it just shows how little is really known about what constitutes the mind.

The thought that a brain is an enclosed organ that functions like a computer is laughable.

I think you are on the right course with your “central and peripheral” take. I would certainly stretch it much further by suggesting that one might consider the center being you or I and the periphery being the greater cosmos, of course the first thought, for the mind/brain folk would be to search for the place, places if there is some intelligence there, where interface takes place.

Once one has escaped dimensional thinking, wanting to nail everything down, it’s all quite simple.

Now to tusk the “pragmatic materialist 2.0”, “with an eye to techniques applied both peripherally (set the leg) and centrally (a broken bone might be nothing more than a personal wake up call).

Knowing just how complicated and life changing, at least for several weeks, a broken limb can be; might it have more to do with inducing biographical change than splints and casts?

Regards, Alan