How does mental stability work?

exploring how we can all become more mentally secure -- what's not to like?

 As mentioned, I write posts for the Critical Psychiatry Network (CPN), a group of some 350 psychiatrists around the world – and have recently taken to re-posting these on my Substack pages, as here, with a brief intro. So this one comes from an earlier contribution by my erudite friend, Clive.

The topic under review was life/death, hallucinogens and their connection with various religions – quite a wide brief, but including some interesting comments on the various words we use, and how unstable most things (including words) are. Clive describes how the Dutch word for ‘beath’ is adem, which he says –

“comes from the same Indo-European root as the Sanskrit/Pali word Atman, which is a Buddhist term (500BC) translated into English as self, I, and is what Christians and some others mis-interpret as a lasting soul.Psychiatrists use the word psyche which is from Gk for breath (as well as life, soul, mind). Psychiatrists also use the word mind, which is from Old English gemynd 'memory, thought’, of Germanic origin, related to Latin mens ‘mind’. And this takes us full circle back to Buddhism which explicitly makes clear that the Atman (see above) is nothing more than a flow of memories that is forever changing — hence cannot be re-incarnated any more than you would say the stream of a river or the flame of a candle could be.”

I responded to Clive as follows – so the next question is – is mental stability ever possible? Given the fluidity of words, the flowing of rivers, the flickering of candle flames and the transience of breathing – you pose the question – is anything ever fixed, or stable?

Now, not everyone thinks this is the key question in psychiatry – but I do. And more, I offer a rickety scaffold to justify it. But it does require a couple of leaps – one, to ‘agency’, and the other to insight.

First then, for AGENCY. This is the tricky one – it keeps changing, it is never the same, which makes it easy to dismiss “scientifically”, and hard to establish humanly. But here goes. It may seem hard work, but take my word for it – it is so worth it.

We breathe in and out – but only when we’re alive. Breathing is intimately linked to living – once we’re dead, we don’t. So being alive confers something which isn’t there later on. OK? We don’t have to define it, which is fortunate, since if we did, we’d get lost – but however unscientific, if we once forget that being alive is the most significant thing we any of us ever do, then we are, well, moribund to say the least. 

 And if you ever think breathing is boring, try doing without.

So breathing is something we all do. We don’t think it’s particularly odd, or exceptional. It’s just something we take for granted. Yet we can never ever define it, nor really know what it’s all about, apart from the exchange of two enigmatic gasses, oxygen and carbon-dioxide – without which we’re dead.

So here is something quasi-miraculous, which we don’t question – except to find out if someone is still alive or not. From this, it’s not really such a big leap to ‘agency’. The muscular energy and control we ‘automatically’ expend on breathing is merely one aspect of ‘deciding’. You could refer to it, indirectly, by any number of different words – all are just woolly labels, none definitive, all risk losing what it’s really all about. So you could have – consent, ‘intent’, decisions, choosings, permissions, voting, buying, democracy – all sorts of wonderfully evocative terms – but have a care, because words can so easily play havoc with communication, even though they’re the only things we’ve got to converse with.

 I recall a session I once attended in the House of Lords of all places, where our very own Jo (Dr Joanna MonCrieff, co-founder of CPN) was on the panel. She confronts, or tries to confront, some stony-faced Lancet Psychiatry people, by asking why they don’t allow patients to have ‘agency’. Jo and I accept we all do have it. Lancet type people think they can get away without.

Yet along with breathing, ‘agency’ is one of the most important faculties we have – we do things, we’re agents, we enact, we create. Even Lancet editors cannot get through life without using ‘agencies’. Whoever made it into maturity without consulting at least one of the following? – Estate Agents, Literary Agents, even on occasion Special Agents – these are people we pay to do things. We don’t expect them to work by clockwork, by rote – we expect them to bring something new to the situation that we didn’t happen to be able to do ourselves – buy our house, sell our book, steal our competitor’s secrets – whatever. No sensible person would pay good money if the agent they’re hiring doesn’t do something new, something not done before, something not available to us previously, something sui generis. So ‘agency’ is accepted in the wider social world.

We each of us has the capacity to do things anew, to create situations and events that weren’t there before – like those agents we pay. Else we wouldn't pay them. In fact, in real life it’s so obvious, it’s boring. We do it for ourselves. No real question. Until you get into the higher reaches of psychiatry, when suddenly we all lose all choices, and become robotic chemical clockworks.

Now, once you concede ‘agency’ – however unscientific – once you allow that decisions you make are what they appear – spontaneous, creative, unprecedented – then you have to concede also, that these are things which are not driven by all those machinations that went on before. Something we do, de novo, and do for ourselves. Like the way we breathe. Most unscientific.

But enough on ‘agency’ – you either accept that you have an element of Free Will or you decidedly choose not to – from here on in, we’ll assume you do.

Next, how does this ‘agency’ generate STABILITY? This is where that flash of insight is needed, the leap from ‘intent’, or ‘agency’, to security, indeed to mental peace-of-mind.

Let’s take a nice concrete example, one we can all see, and understand. We breathe out, and this means we can blow air upwards. From which it follows, if we wanted to, we could support a feather in mid-air. It would defy gravity. We could keep it up as long as we had breath in our body. A somewhat pointless exercise – but you’ve got to admit it is possible, it’s feasible, and it’s available to anyone who can breathe. No amount of Scientific Determinism can gainsay it.

Now if we can do this with feathers, the same applies to other light objects. Take a balloon for instance, one filled with air, not helium. Again, by patting this into the air, we could keep it from falling. We could give it some temporary stability up there, where it wouldn't otherwise belong.

Short-lived perhaps, but quite different from that river you mentioned. We can make sure that this particular object remains airborne, if that’s what we decided to do, what we deploy our agency in doing.

Watch the next bit very carefully. We could pat this balloon to and fro. From me to you for example. We could agree that that’s what we wanted to do with our lives. Not terribly enhancing – but you should see what people do with balls, foot-, tennis, golf and all. If you deny we have ‘agency’, then you must condemn all these sports, and their innumerable fans, to pre-determined clockwork purgatory. They won’t like that.

So here we are with our balloon. We have a mutual interest in keeping a heavier-than-air object up. We float it between ourselves, because that’s what we’ve decided to do. This is our very own ‘agency’. It wouldn't happen, unless we wanted it to, or willed it to, or intended it, and so on.

Now in place of that balloon, let’s put an idea, a notion, a concept. How about ‘approbation’? I approve of you – I ask you to approve of me. More, I ask you to do this everytime I wobble. If I feel a little insecure, if a pang hits me – I want to turn to someone, someone reliable, someone trustworthy to come straight back to me, and assure me that we’re in this together. We can keep a feeling, an idea, an approbation going as long as we want, as long as that’s what we decide is important for both of us to do. And as a crowning bonus – this is where ‘agency’ puts the final nail into the coffin of both AI and DSM-psychiatry.

That’s the insight. Does it transmit from me to you? I’ve tried to pat it into the air, so that it travels safely from here to you – but, as usual, there are any number of barriers, pitfalls, contrary gusts. Even so, I happen to think that agency is the key to sanity. What do you think?

 Rock on, until the next seminar.

 Thanx

 Bob.

 Professor Bob Johnson, DSc(hon), MRCPsych, MRCGP, PhD(med computing), MA (Psychol), MBCS, DPM, MRCS, School of Psychology, University of Bolton, BL3 5AB, UK.      GMC num. 0400150

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