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Are talk therapy and antidepressants treating the same thing?

Martín Iriarte Fellow
· 5 replies
Psychology & the mind sciencesAnalyticContinentalHilary PutnamU. T. Place#mental-illness#multiple-realisability#psychiatry#therapy
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Its coordinates: 6.14 Philosophy of Psychology

I have been in psychoanalysis for years in Buenos Aires, and like many people here I have also seen a psychiatrist and taken medication. At some point I started asking whether the two were working on the same problem from two sides or on two different problems.

The easy answer is "the mind is the brain, so both change the brain". I am not sure that is an answer. If depression is a brain state, then a conversation that changes it must work by changing that brain state, and the conversation is just an unusually slow drug. But that misdescribes what happens in the room. What changes is that a person comes to understand something about their own desire, and understanding is not a chemical description.

On the other side, if depression is not a brain state but something like a way of being in the world, it is strange that a molecule can lift it.

So I would like to hear arguments. Is "mental illness is brain illness" true, false, or confused? Does the identity theory of Place and Smart help here, or does Putnam's point that the same mental state could be realised in different physical ways cut against it? I suspect the honest answer is that the same condition can be described at several levels and intervened on at each. But I would like to be argued out of my suspicions too.

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5 answers

  1. Priya Raghavan

    Fellow

    I'm a materialist, so I will take the side you expect. I think "mental illness is brain illness" is true but uninformative, in the same way "a novel is ink on paper" is true. A predictive processing view is helpful: depression looks like a system that has learned very confident negative predictions about itself. Medication can change how strongly those predictions are weighted. Therapy can change the predictions themselves by giving the system new evidence. Same system, different handles.

    1. Omar Ragab

      Fellow

      I'd add a caution. "Same system, different handles" is attractive, but, as I understand it, we do not actually have a good mechanistic account of how most antidepressants help the patients they help. We know what they do to neurotransmitters within hours, and patients often improve over weeks. Confident talk about the brain is sometimes ahead of the data.

      Helpful · 1
    2. Martín Iriarte

      Fellow

      Priya, I like "different handles" more than I expected to. My worry is that it makes the patient's own understanding a mere input to the machine. In analysis, the point is not that the system receives new evidence. It is that someone takes up a relation to what they did not know they wanted. Perhaps that is also describable as updating, but something is lost in the translation.

      Helpful · 3
  2. Nirmala Jayasekara

    Fellow

    The Abhidhamma would not let you separate the two as cleanly as the question assumes. Mental factors arise together with a physical basis, and they condition each other moment by moment. On that picture there is nothing odd about a substance affecting a mind or a conversation affecting a body. What would be odd is thinking either is the whole story.

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  3. Elif Yıldız

    Fellow

    Psychology student here. My clinical lecturer would say the levels question is practically settled: we treat at the level where we can intervene. But Putnam's point does bite. If the "same" depression is realised differently in different people, a single drug target was always unlikely, and that fits what you see in practice, where people respond very differently.