Organism and mechanism

The philosophy of biology can contribute to critical psychiatry. I came across Daniel Nicholson's PhD thesis on 'Organism and Mechanism' online.  He quotes from Francis Crick, who said that "The ultimate aim of the modern movement in biology is to explain all of biology in terms of physics and chemistry” (p.9) As Nicholson points out, it's often assumed, as in Jacques Monod's book Chance and Necessity, that "organisms are machines, albeit ones cobbled together by natural selection" (p.13).

However, organisms have a capacity for self-regulation. To use JS Haldane's definition of Claude Bernard's principle, "all physiological activities have as their ultimate objective the preservation of the organism's internal environment. ... [T]he continuous dynamic coordination and regulation of the internal environment ... is responsible for the distinctiveness and irreducibility of living beings" (p. 56). Organisms, unlike machines, are self-organising and self-reproducing. As Nicholson says, “No  machine  is  made  of  parts  that  are constantly  replaced  by  the  machine  itself,  yet  this  is  precisely  what  occurs  in  an organism” (p. 125). Mechanistic understanding of life should therefore be abandoned.

This fundamental difference between organisms and machines applies across the spectrum of the complexity of life, from human mind to blade of grass, to use the quote from Kant about the absurdity of hoping for a Newton of the genesis of but a blade of grass (p.33). Critical psychiatry’s challenge to the technological or mechanical paradigm (eg. see previous post) is no different from that in biology of opposing mechanicism by organicism.

The gap in causality in neuroscience

In a JAMA Psychiatry viewpoint, Amit Etkin suggests that brain neuroimaging risks creating ‘Just-So Stories', internally consistent explanations that have no basis in fact. Nonetheless, he still seems to believe that direct experimental manipulations can overcome this challenge.

The problem is more fundamental. Generating massive amounts of data from neuroimaging of the brain, which is only looking at part of a person, misses the point that whole persons have intrinsic purpose. People cannot be investigated as machines in the same way that their brains can be when they are considered in isolation. No wonder there’s a gap in neuroscientific explanation.

Is cognitive remediation therapy in schizophrenia merely placebo amplification?

I went to an open-minded talk this lunchtime by Professor Dame Til Wykes about therapy for cognition in schizophrenia. She was prepared to consider the negative evidence for effectiveness of treatment, although she was clear that NICE should include cognitive remediation therapy (CRT) as an evidenced-based treatment in its schizophrenia guideline, which it doesn't do at present, as CRT improves cognition and reduces disability in schizophrenia (eg. Wykes et al, 2011).

Til Wykes was honest about her interest in CIRCuiTS (Computerised Interactive Remediation of Cognition - a Training for Schizophrenia), a web-based computerised CRT, which doesn't seem to be freely available on the internet. What worries me is that the cognition therapy industry may be based on an artefact. Let me explain.

If clinical trials are not double-blind, positive findings may merely be a self-fullfilling placebo amplification. The hypothesis that unblinding in clinical trials for antidepressants produces artifactual placebo amplification is controversial (e.g. see previous post). This should be less controversial for psychological therapies, such as CRT, as trials cannot be conducted double-blind (see eg. another previous post). At the most, an attempt may be made to single-blind the assessors, but disclosures by patients do occur, even if participants are told not to reveal their allocation, thereby breaking the blind. Such bias could explain the small-to-moderate effects found in meta-analyses of cognitive remediation.