Lately I have become interested in self-reports of mental events, that is, autobiographical or eponymous accounts from the very person who has experienced (or maybe even is experiencing) them. My curiosity has been piqued because recently, I have been called upon to make just such a statement. I have come to the conclusion these reports fundamentally are unreliable, which in turn makes me doubt the efficacy of most forms of cognitive therapy.
There are several things we can say about these reports. First, they fundamentally are different from those given by, say, a psychiatrist, about a patient. Those are behaviorist in orientation, in that they are based on the psychiatrist’s observations about what the patient says, or does, as opposed to what he or she actually may be “thinking.” [I put this in quotes because it is not at all clear “thinking” is the right modality; in fact, it seems quite clear it is not, especially from a Heideggerian perspective. I’m using this term as a proxy, therefore, for whatever kind of occurs-in-the-brain event this is.]
A report from the patient, on the other hand, at least in principle, has more verisimilitude, in that it (actually or potentially) has a closer relationship to the patient’s actual mental state.
Second, neuroscience is not yet at the point where we can look inside a patient’s brain to discern what’s going on. All electroencephalography ever did was capture and depict minute quantities of electricity emanating from nodes on the patient’s skull, such as the occipital nerve and the parietal nerve. It then became possible to discern the presence of brain activity, and to identify distinct waveforms, such as “alpha waves,” into which those impulses grouped.
It was not possible to tell what type of mental event was taking place, or what the patient was thinking. Nor is this possible with more sophisticated technologies such as magnetic resonance imaging (“MRI”), computed axial tomography (“CAT”), positron emission tomography (“PET”), or functional MRI (“fMRI”). (a) MRI only can distinguish pathological tissue (such as a brain tumor) from normal tissue. (b) Same with CAT (but using different technology). (c) PET takes it a step further, and will tell you exactly where in the brain certain neurological events occur. (d) Same with fMRI (but using different technology).
Even the most advanced technologies, then, only tell us “where” some types of mental events take place in the brain. They do not even purport to be able to say anything about their nature, much less the substantive propositional content of any specific thought. Brain scans therefore are useful only when deployed in conjunction with point one (supra) and point three (infra).
Third, we must ask, how does the patient ever acquire sufficient insight or perspective, to render what plausibly qualifies as a report? Any patient-originated report inevitably must be tainted by the patient’s own attitude, interests, outlook and perspective. It is absurd to think the patient might be able to adopt some kind of a “context-free” orientation. That is, one free of, or standing separate and apart from, the patient’s own necessary involvement in the subject matter of the report. In fact, the patient not only is the subject matter of the report, but also, paradoxically, the one giving the report, in the first instance. [Thus, in order to pursue these issues, we need not hypothesize the patient is prevaricating, lying, faking it, or some other category of seems-more-intentional conduct.
This dynamic creates the possibility, at least, the report itself has been influenced, or even corrupted, by the very phenomenon it seeks to explain. The patient is not self-aware of this taking place, which is what makes it so insidious. There are no “red lights,” danger signs, or warning signals. Rather, it occurs because of subtle yet pervasive changes in the patient’s neurochemistry, and even body chemistry. Body chemistry in turn responds to environmental events. “The homeostatic mechanisms that regulate and defend the chemical balance of the body themselves react to changes that threaten health,” Whybrow, P., A Mood Apart 103 (1998).
There are other profound influencers, including: (a) genetics, which frequently correlate with mental illnesses such as depression and mania; (b) the background matrix of life experiences and family and cultural practices, in which all of us find ourselves; and (c) the inherent difficulty of “describing feelings,” that is, labeling and interpreting them for the benefit of others. This is an interactive process that brings into play these and other factors, some of which actually originate with the patient’s counterpart (i.e., in cognitive therapy, a psychiatrist).
I don’t really see a way out of this loop. There can be no question about it – the brain is an organ of the body, not some kind of separate, disembodied, Cartesian “mind.” Because of this, it is vulnerable to anything and everything that happens to the body; and its ailments therefore are susceptible to medical treatment. The main problem right now is, we don’t know enough about brain mechanisms in order to delve into it with the required degree of precision. Compare and contrast: medical science now is able to transplant a human heart, but has not yet been able to transplant a human brain. In principle, the evolution of more sophisticated technology will result in the development of improved pharmaceuticals to treat brain diseases and other aberrations. Which is an objective cognitive therapy never will be able to achieve.