The Psychiatric Soul Train

Nearly a decade ago, psychiatrist Peter Kramer made a big splash with his controversial “Listening to Prozac.” Through descriptions of specific case studies, Kramer displayed to his readers—and there were many—the potential of the popular drug Prozac as an anti-depressant. But, to put it mildly, there is no consensus among psychiatrists—or, for that matter, anyone else—on the efficacy, safety, or propriety of Prozac and other Selective Serotonin Reuptake Inhibitors (SSRI’s) as medication for various forms of depression.

Perhaps no one has released so creative, so audacious, and, ultimately, so problematic a critique of contemporary society’s love affair with psychiatric medication as that offered by Dr. Elio Frattaroli in his new book “Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconscious World.” Frattaroli, a practicing psychiatrist and assistant professor of psychiatry at the University of Pennsylvania, took his A.B. from Harvard in English Literature before going to medical school. On Tuesday, February 19, Frattaroli was in Cambridge and delivered a discussion of his new work in a talk sponsored by the Harvard Book Store.

As its title may suggest, Frattaroli’s book seeks to restore the metaphysical soul as the primary target of therapy in what he sees as an increasingly physicalist psychiatric profession. Frattaroli argues that psychiatrists—and in particularly those trained in the past 15 years—have (to the detriment of their patients) progressively blurred the line between mind/soul and brain. The result has been that “quick-fix” physical and chemical solutions, such as SSRI’s, have come into vogue, while the more involved and more important process of healing the metaphysical soul is neglected. On this front, Frattaroli enjoys referencing the etymology of psychiatry, which derives from the Greek meaning, roughly, “healing the soul.”

All this only begs the question: What, exactly, is the soul, as Frattaroli understands it? Moreover, how is it distinct from the physical brain? In an interview included in the book’s press release, Frattaroli addresses these questions, saying, “The body and brain belong to the domain of outer knowledge. We know about them by seeing, touching and measuring them. Mind, spirit, and soul belong to the domain of inner knowledge. We know about them only through our personal conscious experience.”

Frattaroli’s arguments, then, rest on the premise that most (if not all) mental illnesses usually attributed to the brain are at least in part disorders of the soul. And, because the soul is not chemical or physical, and indeed we can only know about it through our own conscious experience, it is necessary for psychiatrists to approach their work not only as if they are treating a concrete, physical entity with something concrete and physical amiss in it, but rather “by viewing brain chemistry as only one of several competing influences within the whole person-body, brain, mind and spirit...”

Certainly, Frattaroli constructs a compelling case against the use of Prozac as a easy way out; it is undoubtedly essential to cut depression out at its roots rather than merely making its symptoms disappear temporarily. But in order to “heal” mental disorders at their root rather than their branches, do we really need a concept as abstract—and as contradictory to the belief of most contemporary neuroscientists—as a completely immaterial soul?

There is no simple answer to this question. There can be no denying, on the one hand, that the progress of contemporary scientists in understanding the brain continually and inexorably pushes dualistic theories of mind and body further towards implausibility. At the same time, though, neurologists, psychologists, philosophers, and others who study the mind and the brain still have miles and miles to go before achieving anywhere near an adequate, let alone a perfect, knowledge of what goes on inside our crania. For the time being, then, models of some of the more mysterious and difficult to explain aspects of human consciousness like that offered by Frattaroli in his “soul,” (another example would be Freud’s “id,” “ego,” and “superego,”) can serve quite a useful purpose in treating psychopathology—for they provide an abstract and working, if crude and incomplete, model of what we cannot yet understand in any other fashion.

In the final analysis, though, a conception of the soul that is irreducible to physical properties seems naive. It seems that everywhere one looks, there has been a new discovery of how a brain function—a physical, chemical brain function—can account for a cognitive or bodily function that had previously seemed obscure. Frattaroli’s motives are for the best, to be sure. And right now, his concept of “healing the soul” may just be the best way of treating psychiatric patients. But it is difficult to imagine that the concept of a soul will survive the barrage of evidence from neuroscience that can explain the metaphysical in terms of the physical more plausibly with every passing year.

Frattaroli might object that, as Freud put it (in a quote that introduces a chapter of “Healing the Soul”) “If it [a discoverable connection between brain and mind] existed, it would at most provide an exact location of the processes of consciousness and would give us no help towards understanding them.” And yet, it seems that we may concede this point and still not abandon the expectation that a concept of the soul will eventually become irrelevant in psychiatry.

Take, for instance, the case of pain as an example of conscious experience. Distinguished philosopher of mind Jaegwon Kim writes, in the Oxford Companion to Philosophy, that anti-physicalists have adduced the argument that “even if, say, pain should turn out to have a single neural-physical correlate across all organisms and other possible pain-capable systems, how could the painfulness of pain be a neurobiological property? In moving from the mental to the physical, we lose, it has been argued, what’s distinctively mental about mental properties.”

This is certainly a strong point—and, probably, a correct one. But if, as the remarkable progress of neuroscience continually indicates, we can pin down (as Freud conceded might be possible) the exact physical location of mental phenomenon like pain—then why can’t we treat that physical location and thereby alleviate the mental problem? We do not need to rob from mental experiences, as Kim puts it, “their qualitative character, their special accessibility to our awareness, and their privacy” in order to affect and enhance them by chemically altering their corresponding physical locus.

In attempting to carve out a turf for the mental, Frattaroli goes too far in his unqualified distinguishing of it from the physical. But again—until neuroscience progresses much further than it has today, a concept of the soul isn’t such a bad idea—as long as we understand that some day in the future—perhaps the distant future, perhaps not—it will become obsolete.