Wittgenstein calls out crooked mental-health charlatans

While the reply-guys whine that "philosophy isn't practical", bad philosophy twists everything we know about the mind and mental health.

By Matt Perryman

Imagine a person who spent his life collecting rocks. He can identify a rock with the effort it takes you and I to take a breath. He knows that a tree, a puddle of rain water, and a monkey are definitely not rocks. When he goes for a walk, the differences between sandstone, granite, quartz, and dozens of different rocks are as obvious to him as a bright patch of blue sky on a clear summer day.

A good rock-collector might be tempted to apply his methods to other kinds of things. Say he develops an interest in trees, or puddles, or monkeys. The same method works well enough. Observe, catalog, and classify. So far so good.

But then a puzzle appears. A pug-faced stranger in a toga comes along one day and asks odd questions like, “What is time?”, “What is real?”, and “How do we know what we know?”

Real head-scratchers, but our rock collector is undaunted. He knows how to understand things. You observe, catalog, and classify. Simple…

…until he tries it with the concept of time.

The moment he tries to observe time, he realizes he doesn’t have the first idea of what he is trying to look at. The problem is not that time simply floats away, leading to the familiar metaphors of lines and rivers.

No, the problem is that as soon as he turns his attention to the thing called time, there’s no thing there to know. He isn’t even sure what he’s trying to observe — there is no “what”. He can’t begin to get a grip on his quarry, much less analyze and classify it.

Time isn’t like rocks, puddles, and monkeys. The methods that work to understand those things don’t get you anywhere with time.

That is, with some creative license, where Wittgenstein begins the Philosophical Investigations, reflecting on the confuzzlement of St. Augustine of Hippo when confronted with the problem of saying what time is.

Later in that book, Wittgenstein remarked:

A main cause of philosophical disease—a one-sided diet: one nourishes one’s thinking with only one kind of example.

Poor intellectual nutrition is how otherwise bright people end up believing, saying, and doing stupid things. The cutting edges of the mind-sciences are one of the worst offenders, as we’ll see.

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The other day I read an article in The Guardian about a woman who discovered to her horror that mental illness is not a simple product of brain (dys)function.

Here’s the quote of interest:

“Abnormalities in these regions are by no means exclusive to OCD,” Gillan said. “A great many disorders show the same kinds of brain changes.”

I didn’t know this. I thought my brain shared the same abnormalities as everyone else with OCD and that these were the root causes of our obsessions; that we had brains that were measurably different from the brains of people with, say, ADHD or anorexia. I thought this was the definition of “official” diagnosis. Gillan explained that, on the contrary, psychiatric diagnoses are not based on biomarkers, they are subjective constructs.

Where the author is shocked to learn that there are no systematic correlations between brain-stuff and mind-stuff, this is old hat in my world — the world of philosophers who’ve warned for decades (if not centuries) against simplified reductions of mind to matter.

What does “reduction” mean? A technical definition goes something like this:

If some entity x is reducible to another entity y, then y somehow comes before, or is more fundamental or even more “real”, than x.

Reduction of mind to matter means that what appears to us as mental — a belief, a desire, a sensation, consciousness, self-awareness, and so on — is in some way dependent on or a consequence of material properties.

The facts about the mind ultimately depend on the facts about matter.

The “in some way” clause is vague enough to mean a lot of things, though, and by itself it doesn’t identify the problem. The specific kinds of reductionism in question are much stronger and more precise. The article notes a concrete example from the medical industry, referring to

the received wisdom that mental disorders are diseases of the brain with organic, biological root causes; and to the medical language that infused charity campaigns and the media. It was also due to the ideas explicitly promoted by professionals who treated me. One of my CBT (cognitive behavioural therapy) therapists said that OCD is primarily caused by a misfiring amygdala, a structure in the temporal lobe of the brain. Another said that their trademarked therapy could “rewire my brain” in six weeks.

This is not only more precise, it’s also a much stronger reduction of mind to matter. Facts about the brain’s structure and function are the sole true causes of mental illness. This extreme interpretation claims that that all facts about mental functioning are identical with facts about the brain.

This is a silly idea, for all its popularity (even among professionals). Most of them believe it because their ideas came from blind acceptance of received dogmas. Few take the time to study the history of their field and its ideas, which leads to intellectual malnutrition.

When Wittgenstein remarked on nourishing our thinking with only one kind of example, this was the kind of case he had in mind. This project to localize ineffable mental processes in definite physical stuff belongs to an old pedigree. Descartes told us that the mind is nothing more than the activity of thinking, quite distinct from any material substance. Locke told us that ideas were contents of the mind, as a plastic toy sits inside a child’s toy-box. The common thread is that mind is something different from the material world known through the senses.

Yet these theories give shape and substance to the mind’s contents. The something may be different from matter, but there is a definite something all the same. Once you can localize a thought or a sensation or a belief or a desire, draw a circle around it and point at it, the shift from an immaterial idea to a material entity is almost trivial.

While the brain-mind connection is now part of the common sense of our culture, the strict reductionism that identifies facts about mental phenomena with facts about the brain is a product of a malnourished diet.

Today’s sciences of the mind are inseparable from the history of the ideas and theories that birthed them. That ought to be fair warning to take notice of just how much philosophical theories influence us — and how these ideas seep down into unconscious “common sense” like poisons leeching into well-water.

Unconscious influences from weird and bad philosophy shape everything, right down to our understanding of thought and language.If we don’t have a clear view of our own thoughts, you almost can’t help but fall victim to distortions in other areas.

Wittgenstein went so far as to say that philosophy is not in the business of offering explanations. The point of philosophy is a kind of perspicuous description that aims to clear away certain confusions. The confusions include those caused by our tendency to read too much into grammar, along with the habit of over-generalizing from a limited set of examples.

Don’t theorize — look and see what is going on. How do we use words? How did we come to use words in these ways? For what purposes? What are people doing when they speak?

One of the more surprising facts is how much Wittgenstein’s ideas have in common with those of Aristotle and St. Thomas Aquinas. This isn’t as strange as it might seem. Aristotle’s method and attitude to inquiry — including what we now divide into “philosophy” and “science” — could be understood as “let’s look and see”.

When Aristotle looked, he saw a stunning assortment of living things that differ in degree, rather than kind. The unique powers of the human animal, which include our powers of speech and our ability to reason, both captured in the Greek word logos, were no different than the bird’s powers of flight or the fish’s aptitude for swimming. There was nothing mysterious or exceptional about our mental processes.

This sounds weird and unfamiliar to us, after a few hundred years of the Cartesian division of mind and the world seeping into the water-table of common sense, but even the recent history of psychology and cognitive science acknowledges the mind’s material embodiment.

Intelligence has a body.

This should be obvious. Every intelligent being has a definite, physical form. Yet the doctrines of computation and information that ensorcell the Silicon Valley glitterati insist on ignoring this trivially obvious fact. Information is disembodied and immaterial, and so is mind.

To be embodied means to have a material body. To have a body means to be in a world, to be practically involved with a world, and, behind it all, to care about the world.

A world is more than the physical environment. Our world is how things show up as significant for us. This involves us in more than physical sensations or cause-and-effect interactions. What shows up includes our complex social relationships, all the accumulated treasures and trash of culture, and the languages that express it all.

Before the computer and the network captured our collective imagination, psychologists and social scientists understood that mind is not strictly personal and private. What we call mind has social, relational, and cultural dimensions. Mental processes come hand in hand with the use of language and the social relationships that language makes possible.

Far from the mythology of mind as irreducibly private, personal, and beyond question, our mental processes are interwoven with the interactions between two (or more) individuals. Instead of speaking of mental states, it would be more accurate to speak first of mental acts.

Mind is a kind of activity, expressed by verbs.

Like any other verb, there is a “public” and “private” aspect. We don’t find anything mysterious about running, jumping, stealing, or drawing, although these each involve a range of mental attitudes and processes along with the physical movement. Shift to a slightly different sort of verb, like thinking, understanding, feeling, wanting, and knowing, and we feel a sudden metaphysical pressure.

Where is the bright line between the activities of drawing or writing and the activity of thinking? The point of the question, by the way, is not to trigger a parrot-like regurgitation of your unthinking common sense beliefs. Ask yourself instead why you believe you can draw that line and from where you received that belief.

The activities expressed in verbs are quite unlike the Cartesian thinking-stuff in another way. A Cartesian thought is non-physical. It happens nowhere, at no time. Which is another way of saying that a thought could belong to any mind, at any time or place. Thinking is universal.

Mental acts, like any other activity of a person, occur in a definite time and place, and this is a crucial detail:

This is what I think is wrong with the medical model: a failure to understand mental health in context. An assumption that a disorder is a “thing” that an individual has, that can be measured, independent of subjective experience. The trauma model can be just as reductive, turning healing into an individual consumer journey and ignoring the environmental conditions in which wounds form. This has empowered professionals to decontextualise distress from the lives of those who experience it; to create pseudo-specific taxonomies of mental disorders.

Read that last sentence closely. By medicalizing the mind, the mental-health industry strips away all context of mental activity. What matters is not what you think and experience, in your situated contexts of living. What matters is the impersonal, if not universal, factors of neurobiology that truly explain your mental condition.

An embodied mind, situated in a context, won’t be fully explained with even a robust scientific theory of the brain. Despite the cultural obsession with all things brain-related and the tens of billions of dollars of annual funding, neuroscience is a young science. All the “scientists discover” and “experts say” headlines create the impression of a powerful, if not settled science, when the truth is much uglier. The field can’t agree on some of the most basic concepts and assumptions. Any sweeping pronouncements are premature (and that’s the best case).

There is a long way to go before the science fiction scenarios of neuro-hacking and brain implants and strong forms of AI become even theoretical possibilities—if they are possibilities at all.

The puzzle of whether we can squeeze the blood of mind from the stone of dead matter is one thing. The ethical concerns are another.

Allen Frances, lead editor of the DSM-IV manual that once guided psychiatric diagnosis, warned some years ago of the practical consequences of medicalizing the mind:

Frances warned that the new DSM, with its emphasis on early intervention, would cause a “wholesale imperial medicalization of normality” and “a bonanza for the pharmaceutical industry,” for which patients would pay the “high price [of] adverse effects, dollars, and stigma.”

The faddish obsession with all things brain might convince you that neuroscience is on equal footing with physics, and the relationship between brain and mind is as obvious as Newton’s laws of motion, but the real state of things is much different. There are no stable, reliable, law-like relationships between what happens in the brain and what happens in the mind.

It is impossible to even talk about a mental illness without factoring in the subjective experience of the patient. Consider that we’re only interested in brain function to the extent that we believe it may cause some suffering to an individual. That suffering is why some brain part gets labeled as defective or dysfunctional. Without the very real experience of suffering, there is no way to diagnose an abnormality (not least of which because there is no clear ideal of normal).

Leaping from a very real experience of suffering to a correlate in the brain is a leap too quick and too far.

The price of this leap is a buffet of undesirable outcomes. All the resources invested in brain theories and new drugs, and by every measure mental health is getting worse across the board. People now refer to themselves, without irony, as “seeking dopamine” and having “misfiring amygdala”.

The central thesis of this newsletter is that the more our machines become life-like and human-like, the more we come to understand ourselves as mechanisms. The monster becomes mechanical, leading to madness.

This is not an ethically-neutral transformation—we distinguish between human beings and machines not only as a matter of mere knowledge but as a practical question of what ought to be done.

Studying the brain in order to understand the mind seems straightforward, obvious, even simple (if not easy). The brain is a physical object, and we know how to study physical objects. The attitudes and methods are familiar from our civilizational project of technology, poking and prodding the natural world to give up its secrets.

The question to ask is, does an easy fit with technology and its practical goals make it the correct approach?

All the interest and the money makes it seem so. I am skeptical. I believe you should be skeptical.

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Matt Perryman

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