Philosophy, Psychiatry, & Psychology

In "antidepressants and the Chaotic Brain: Implications for the Respectful Treatment of Selves," Douglas Heinrichs provides an intriguing justification of individuated and longer term therapy for depressive clients. He does not reject medication as a therapeutic strategy, nor does he question the materialist basis of the traditional medical model. Rather, he offers a physically deterministic account of depression that is at the same time compatible with a sense of human agency and individuality. Heinrichs suggests that human physiology and its psychiatric disorders are better accounted for by the nonlinear dynamics of chaos theory than by the traditional account of neurotransmitter production and reuptake. Because the latter, microscopic, explanation suggests a direct cause-and-effect relationship between synaptic activity and subjective affect, it cannot account for the wide variation of responses to the same medications, nor can it satisfy the client's fears that her drug-induced well-being is not fully hers to control. Chaos theory, he asserts, can provide a better explanation by treating the human organism as a complex holistic system whose patterns resemble a topographical map of probability more than they do a unidirectional vector model of cause to effect. Like the weather, human affect and behavior are physically determined but difficult to predict, and so careful attention to both the individual history of the client and the uniqueness of responses to medication are a necessary part of any successful therapeutic program.

Connected to this theory of nonlinear physiology is Heinrichs's account of autonomy and agency under this rubric. He notes that a psychology based on chaos theory is not only compatible with the notion of free will, it can better explain why the successful use of medication actually increases freedom and autonomy instead of limiting it. It is here that I wish to focus my comments, because his interpretation of free will may give us, to borrow a phrase from Daniel Dennett, a "variet[y] of free will worth wanting" (1984, title page). Free will, in this case, is not a metaphysical ability to act above and beyond our material causes, but is instead a property of the material system itself, namely when that system feels itself capable of greater psychic mobility around the topographical map of probabilistic patterns.

According to this model, our ability to reason, plan, and act on the decisions we make is itself a [End Page 235] part of our chaotically determined neurologic system. When we are healthy, we are able to reason in our best interests and act on those reasons. This is modeled as an ability for the organism to metaphorically "move about" the map of its own possibilities, and more important, to both enter and escape certain states, known as chaotic attractors, into which it is likely to be drawn. "Where" we wind up, psychologically speaking, at any point in time is determined by our own system, and so we may say that in such a case we are autonomous and our choices are made freely. Depression, on the other hand, can be compared to a deep groove in the map, a chaotic attractor that is hard to escape, and so the system quite literally becomes "stuck in a rut." This is subjectively experienced as the tendency for thought processes and activities to fall into negative and self-defeating patterns despite the best efforts of the client to escape these habits. So long as the organism does not have a sense of being "trapped" in an attractor (whether a depressive or, for example, manic or compulsive state), then that organism may be said to be free. Medication and the therapy that accompanies it, so far as it facilitates our ability to escape deep chaotic attractors, promotes our own freedom of will. If a car cannot spin its way out of a ditch, does the tow truck hinder or promote its freedom by hauling it back onto solid pavement where it may again...