The book i’m reviewing is ‘Humanizing Madness – Psychiatry and the Cognitive Neurosciences’ by Dr Niall McLaren. Dr Niall McLaren is described as having been the ‘world’s most isolated psychiatrist’ when he worked in the Kimberley Region in Western Australia. Dr McLaren is straight talking and so his ideas are presented clearly. This book is a presentation of his biocognitive theory which sets out to explain human experience and cognition.
In the first part of the book, Dr Mclaren moves elegantly through the different theoretical models including the biological model, behaviourism, mentalism, the biopsychosocial ‘model’ and classic dualism and discussed why he thinks they cannot provide the answers that psychiatry needs. This section shows McLaren’s profound breadth of knowledge and understanding of the issues that create the limits of psychiatry.
However, before moving on, I would like to make a point about the biopsychosocial model. The biopsychosocial approach is a practical one. When a psychiatrist sees a patient with needs in a number of areas, it is not unreasonable for the psychiatrist to refer to a colleague (e.g. a social worker with a knowledge of sociological theory) when appropriate. There are two reasons that I mention this.
(1) The first one is that it is not necessary for the psychiatrist to have a working sociological model (for instance) for practice but instead it is important to recognise when to call on someone with that expertise to take management forwards. The emphasis is on knowing where things are, rather than necessarily having a working integrated theoretical model.
(2) This leads me neatly onto the next point which is the difference between theory and practice. It would of course be nice to have an integrated biopsychosocial model. By this, I mean a model which we can follow from the genes all the way through the manifestation of behaviour in a cultural context. Indeed it seems essential to psychiatry to have such a model. Nevertheless, psychiatry is a practical as well as theoretical discipline. Whilst theoreticians debate the merits of one model over another, patients in the real world require help. There are a number of approaches that are utilised in this instance. There are approaches based on medical, psychological or social theories (e.g. the monoaminergic hypothesis of mood disorders). There is the empirical approach. Drug A works in this instance. It is not clear why it works but it does and it works effectively. There are also the unmeasured aspects of service provision (e.g. the relationship with the doctor and other members of the care team).
Therefore I would distinguish between the biopsychosocial ‘approach’ and the biopsychosocial model, unless of course it is a model of practice.
Dr McLaren then goes onto discuss his biocognitive model which is presented in a descriptive form which, I think, serves as the higher level framework in which to organise the finer details of this theory. The concept is a brilliant one and has been arrived at both through the process of acquiring clinical acumen and exploration of philosophical texts relevant to psychiatry. He also invokes the works of the brilliant 20th century genius Alan Turing, whose towering achievements have perhaps not reached an appropriate level in the cultural ‘psyche’. McLaren’s model differs from epiphenomenological explanations of inner experience by identifying such experiences as the physiological outcome of the cognitive hardwiring. He also emphasises a postclassical interpretation of mind-brain dualism through the device of symbolism – that is that the neuronal firing patterns can be described both symbolically and in terms of their physical state (e.g. potential, frequency of firing etc). It is the symbolic representation which is irreducible.
In the final part of the book, McLaren then goes onto to apply the theory to different psychiatric conditions. However he also offers clinical insights into these conditions. Within the last section, there is also one point of discussion. Perhaps there might never be a simple theory that could account for psychiatric conditions because of the very diverse and vast nature of such conditions. Therefore McLaren, in my opinion, focuses on some of the most common psychiatric conditions and again offers a framework perhaps for understanding the more common causes of these conditions although some of these suggestions are perhaps too simplistic. For instance I would support the existence and importance of dissociative conditions although adding that the concept would benefit from improvements in formulation.
McLaren’s biocognitive model and exposition is a brilliant work which sets the scene for the formulation of this model which can be tested. McLaren’s approach is similar to that of Winnicott with a similar utilisation of clinical accumen in combination with theoretical construction and an ability to identity focal points for debate. Indeed I wonder if the creation of a regulative fiction (which I interpret in McLaren’s case as the generation of a complex internal construct involving philosophical enquiry so as to reach a better understanding of the external world) is another method of creating in science and one which is ignored by the scientific establishment without the armour of numbers. If we take this a step further, perhaps Einstein’s ‘regulative fiction’ was such a success precisely because it’s end formulation was the testable E=MC2, rather than the story of how this was arrived at. Similarly for Kekule’s dream-induced structure which was reducible to a chemical formula. The only question is whether a theory of mind/brain will ever become accepted if it isn’t expressed in symbols. In any case, I look forward to the development of McLaren’s biocognitive model.
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