Philosophy, Psychiatry, & Psychology

In "Corporealized and Disembodied Minds,"I outlined a phenomenological analysis of depression and schizophrenia as disorders of lived embodiment (Fuchs 2005a). Drew Leder's apposite remarks point to the open questions left by my paper and give me the welcome opportunity to add some considerations on the mind–body problem, on etiology and therapy. Of course a phenomenological approach centered on the lived body may not be misunderstood as pertaining to merely subjective experiences stored in the transmundane repository of the "mind." Instead of such dualistic assumptions rightly rejected by Leder, phenomenologists favor a systemic or ecological view, which regards mind and world, as well as body and environment, as mutually overlapping, or as poles of a unity (Fuchs 2002, 2005b). Thus, the environment is not a realm of "pure objects," but is constituted as the specific surroundings of the living being; nor is the living being as such an object in physical space, but rather, by mediation of the lived body, always already embedded in meaningful situations.

An ecological notion of life is indispensable for a nondualistic approach to the mind–body problem. For consciousness does not develop in an isolated brain, but only in a living organism enmeshed in its environment. The brain may well be the central organ of the mind, but it is not its "seat". First, consciousness is based on the continuous interaction of the brain and the organism with its neurovegetative, hormonal, immunologic, and proprioceptive processes (Damasio 1999). Second, the higher or cognitive brain functions depend on the dynamic sensorimotor interplay with the environment. The mind is not located in any one place, but distributed among the brain, body, and world, and thus continuously crosses the borders of the skull (Clark 1997). Moreover, research on neuronal plasticity has shown that the brain is not inserted into the world as a prefabricated apparatus, but is structured epigenetically by the interaction of organism and environment in which we move, behave and live with others. From birth on, our mind as well as the correlated brain structures are essentially shaped by social and cultural influences (Eisenberg 1995). Obviously there are nonmaterial powers that have a decisive impact on the configuration of the human brain: language, ideas, models, norms, and world views. The concept of a historical biology (Fuchs 2002) implies the continuous formation and reconstruction of the brain via subjective experience.

In this complementary relationship, there is nothing like "a mind acting on a physical body" or "a brain producing the mind." Instead, the brain acts as a transformer, which may be addressed by input on different hierarchical levels and translates it in both directions: Psychosocial influences on the level of meaning and intentionality are transformed into altered patterns of neuronal activity on the biological level, and vice versa. This means that any process concerning the etiology and symptoms of mental illness is of a biological as well as psychological nature. The translation only runs "top-down" in the one case, that is, from subjective experience (e.g., a [End Page 115] perceived social situation, a psychotherapeutic intervention) to the level of neuronal and biochemical processes, and it runs "bottom-up" in the other case, for example, from pharmacologic effects on transmitter metabolism to modification of subjective experience (Fuchs 2002, 2005b). Neurobiochemical changes become mood changes on the subjective level, but subjectivity in turn influences the plasticity, structuring, and functioning of the brain.

This concept suggests that the simple bottom-up explanation of mental disorders as products of genetic or neurophysiologic determinants is inadequate to the causal complexity involved. Instead we ought to develop etiologic models that are based on a circular causality between organism and environment, with the brain acting as a mediating entity. As a paradigm case, I have elsewhere described depressive illness as a social as well as psychophysiological desynchronization (Fuchs 2001). A backlog in the fulfillment of one's duties, a gap between one's expectations and achievements, or a loss that the individual is unable to cope with, are perceived as a loss of synchronicity and connection with important others and may result in depression. This means that the perceived situation is translated by the brain into...