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From lesion theory of mental illness to Westworld and back

Published online by Cambridge University Press:  02 January 2018

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Abstract

Type
Review Articles
Copyright
Copyright © The Royal College of Psychiatrists 2017 

What is mental illness? This question has challenged psychiatrists for several decades and despite lengthy debates we still do not have a clear answer. Yet we continue to treat mental illnesses and are quite successful at it – there is evidence that our treatments are as effective as those in other medical disciplines. One of the main criticisms of the concept of mental illness is that as there are no observable lesions in the brain, there is no pathology.

This issue came to my mind recently when I was watching the movie Westworld. It was made in 1973 and starred Yul Brynner. The recent TV series has got much attention, yet the 1973 film was more original. It is the first time that the concept of computer virus is referred to in a film, in fact one of the first references to viruses in any medium. What amused me was the shock of the computer scientists and technicians who, seeing nothing wrong with the hardware, could not comprehend how things could have gone wrong. A philosophical doctrine that addresses that issue is called emergentism. It states that as systems become more complex, their behaviour cannot be predicted solely by determining the behaviour of their constituting elements. One cannot approach a computer the same way as a tape recorder. Given the fact that the brain is immensely more complex than any system known to us, the way things can go wrong in the brain could also be more complex than its constituting elements and its physical structure, and colleagues who manage functional disorders can vouch for that. Interestingly, I found that the late Frank Fish had stated the same in his comprehensive psychopathology textbook.

It seems to me that when discussing disorders of the mind, we mainly focus on the disorder parts. Yet we also need to focus on the mind – and for that, we may find an ally in philosophy of mind.

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