Introduction: Objectivity and Subjectivity, Erklären and Verstehen
The subjective nature of the mental phenomena which are the object of psychiatry is still puzzling to researchers in neuroscience. It is seen as a limitation that will eventually be overcome by more sensitive or accurate analytic techniques. A wider perspective of how mental phenomena fit into the physical world could help us recognizing this attitude as a particular manifestation of a more general difficulty. A difficulty that philosophers have identified as the mind/body problem; which is, the problem of how subjective mental phenomena can be integrated into a comprehensive scientific understanding of the world. How can subjective experiences be explained within the framework of a unified conception of objective reality? This appears to be such a vexing problem, because of the general tendency to assert that the only way of describing things "as they really are" is by seeking an objective account of their existence. Objectivity, then, is seen as the hallmark of reality.
But often what appears to a more subjective point of view cannot be accounted for in this way. So either the objective conception of the world is incomplete, or the subjective involves illusions that should be rejected.
There seems to be an irreconcilable tension between mental phenomena that appear to be subjective and the rest of the world that is scientifically describable in objective terms and measurements. "We flee the subjective under the pressure of an assumption" says Nagel,"that everything must be something not to any point of view, but in itself" (MQ 208). However, when this objectivity is applied to experiencing subjects that have an irreducible subjective viewpoint toward the world, something is inevitably lost in a purely objective description:
We must admit that the move toward objectivity reveals what things are like in themselves as opposed to how they appear; not just how they appear to one, relatively austere point of view as opposed to others. Therefore when the objective gaze is turned on human beings and other experiencing creatures, who are undeniably parts of the world, it can reveal only what they are like in themselves. And if the way things are for these subjects is not part of the way things are in themselves, an objective account, whatever it shows, will omit something. So reality is not just objective reality, and the pursuit of objectivity is not an equally effective method of reaching the truth about everything. [MQ 212 f.]
This relates to challenges in brain research related to psychopathology, namely whether mental phenomena can be reduced to objective phenomena, and if so, whether psychiatry as a science should pursue such aim. At stake is the integration of aspects in psychiatric knowledge of aspects that are epistemologically, and some argue also ontologically, quite heterogeneous. Karl Jaspers experienced this pressing need for conceptual clarification, and took upon himself the task of finding answers to these questions. His first step in this effort was the characterization of the concepts of erklären (explaining) and verstehen (understanding), in an original and influential attempt to give a foundation to psychiatry as a science. Erklären is concerned with the causal explanation of natural phenomena. It requires repeated experience, collecting examples, and consists of creating theories that have a general validity. Verstehen deals with the meaningful connection between mental states, and is achieved through sinking ourselves in a psychic situation. It is not a form of mechanical knowledge that can be generalized: in understanding, "a fresh, personal intuition is needed on every occasion" (GP 313).
Besides the epistemic dimension of the distinction between these terms as different ways of how we gain knowledge, there is also, for Jaspers, an ontological dimension that surfaces when looking at his distinction between meaningful and causal psychic connections (GP 539). "Meaningful psychic connections" is the phrase Jaspers uses to describe knowledge gained through verstehen. By contrast, erklären establishes rules of causality. Erklären and verstehen involve two different ways of gaining knowledge (epistemic) and provide a different content of knowledge (ontological) as well.
The Relationship Between Mental Phenomena and Brain States, and Psychiatric Practice
Jaspers defined his opinion on this topic in opposition to the views of the psychiatric establishment of his times. In commenting on the views of Theodor Meynert in the GP, Jaspers notes that according to Meynert, "the structure of the psyche and the structure of the brain must coincide." To this he remarks: "This postulate has never been proved. It cannot be proved, because it is meaningless. What is heterogeneous cannot coincide, but at best the one can only be used as a metaphorical expression of the other" (GP 482). Furthermore, he repeatedly states that mental phenomena are not reducible to brain processes, and that no direct connection exists between the two. In the first pages of the GP, he expresses the relationship between the investigation of somatic function and the investigation of psychic function with a vivid analogy:
Yet we must remember that neither line of enquiry encounters the other so directly that we can speak of some specific psychic event as directly associated with some specific somatic event or of an actual parallelism. The situation is analogous with the exploration of an unknown continent from opposite directions, where the explorers never meet because of the impenetrable country that intervenes. [GP 4]
In this description, there seems to be no common ground between the two domains. However, the nature of psychiatric practice forces us to shift our perspective from one domain to the other, depending on the clinical situation we are facing. In order to illustrate this, let us consider the case of a dialogue between two individuals. One of them happens to be a psychiatrist. He asks questions, and most of the time he listens to what the other person is telling him. It is very likely that the contents of this dialogue are about what the other person thinks, or how he is feeling: for example, he might be sad because of the loss of a loved one, or he might be angry because of conflicts at work. In these instances, the psychiatrist is probably grasping intuitively (at least to a certain extent) the lived experience of the other person. In particular, he can immerse himself in the other person's experience, and see in an immediate, straightforward way how some experiences or ideas can lead to other ideas or feelings. In Jaspers' terminology, he grasps "meaningful connections" between mental states. Consider two other cases. In the first, the person tells the psychiatrist about a car that he saw passing by in front of his house. This scene made him think that there is a conspiracy of people who are spying on him, and probably putting into action a plan to harm him. In the second case, somebody is reporting that reading a newspaper article made her realize that the news are just a code, through which God is sending messages to her. In these cases, the ability of the psychiatrist to grasp intuitively the meaningful connection between ideas (what Jaspers called "genetic understanding") is ineffective. We cannot achieve an intuition of how these thoughts arise from each other. The boundaries between our own thoughts and emotions and those of someone suffering from these kinds of symptoms are too large and thus ungraspable by empathic understanding. However, we can make attempts at providing an explanation: some change in the physiology of the brain might account for these phenomena. On the same level, we might suppose that administering some drugs might affect the same phenomena in a specific way.
Apparently, the two polarities of psychiatric knowledge assist us in different moments of psychiatric practice. Jaspers recognized and commented extensively on the existence of very different methods to acquire knowledge in psychiatry. In his view, adopting a scientific approach to psychiatry entails a keen awareness of the methods by which we acquire knowledge, and a continued reflection on the strengths and limits of each method, that allows us to apply the one that is the best match for a given circumstance. This kind of awareness is perhaps even more necessary in psychiatry than it is in other disciplines, given that devoting our attention first to immersing ourselves in another person's experience, and then considering biological processes in the brain requires a notable shift in our perspective: we started from psychic contents, which have a private dimension and a subjective quality, and we are now considering natural phenomena, which are never seen from within, but from outside only and studied from an objective point of view.
Pertinent to Jaspers' theory of meaningful and causal psychic connections is John Searle's answer to the mind/body problem for which he coined the term "biological naturalism." In developing his view on consciousness, it stands to reason, Searle tells us, that "any philosophical theory has to be consistent with facts." This fits well with Jaspers' notion of methodological pluralism and becomes ever more pressing, given the fact that questions of consciousness appear in a different light as the relevant empirical sciences advance. Searle posits that two sorts of things characterize what we know about the nature of consciousness. One is related to what we know from our own experience, the other is based on what we know about brain functions. A plausible theory of consciousness will have to fit with our knowledge of the natural world in general, and will have to be in accordance with recent evidence from neuroscience; however, without ignoring or disregarding its subjective dimension. Aiming for more precision with regards to clarifying the different notions of consciousness, we can, following Searle, say this: In terms of our own experiences, "Conscious states, so defined, are qualitative, in the sense that there is a qualitative feel to being in any particular conscious state. Such states are also ontologically subjective in the sense that they only exist as experienced by a human or animal subject" (BN 326).
This leaves us with the peculiar task to navigate slippery territory that requires an important conceptual distinction as to how phenomena can be scrutinized that have both subjective and objective dimensions.
First- and Third-Person Ontology: Subjectivity and Objectivity
The objective description of mental phenomena in terms of brain functions cannot easily be reconciled with their subjective experience that is a salient feature of these mental phenomena when experienced by a subject. Let us consider an example: If you look out of the window and see, say, a tree, this tree has both an objective and a subjective ontology to it. The tree's objective ontology is constituted by its physical features; that is, by the height of its stem, the color of its leaves and all the rest of it. Your conscious visual experience of the tree, however, has a subjective ontology; there is a certain private sensation as to how it feels for you to look at the tree. Searle further disambiguates the objective/subjective distinction:
First, there is an epistemic sense of the objective-subjective distinction. The claim that Rembrandt was born in 1606 is a matter of objective fact. The claim that Rembrandt was a better painter than Rubens is a matter of subjective opinion. Objectivity and subjectivity in this epistemic sense are features of claims. But in addition to the epistemic sense there is an ontological sense of the distinction. Most things, such as mountains, molecules, and tectonic plates exist apart from any experiencing subject. They have an objective or third-person ontology. Some things, such as pains and tickles and itches, only exist when experienced by a human or animal subject, and for that reason, they have a subjective or first-person ontology. Consciousness is ontologically subjective in the sense that it only exists when experienced by a human or animal subject. It is important to emphasize that you can have epistemically objective knowledge of a domain that is ontologically subjective. It is for this reason that an epistemically objective science of ontologically subjective consciousness is possible. [BN 326]
Let us nail down this important explanatory apparatus: Third-person ontology is objective in the sense that it describes observer-independent, as it were, brute facts of entities that stand-alone of any experiencing subject. A tree has certain objective features whether or not someone observes them. In contrast, first-person ontology is subjective in the sense that it describes observer-dependent, qualitative features that come into existence only by being experienced by a subject. The particular way in which, say, someone experiences the beauty of the tree's green leaves depends on one's subjective viewpoint.
Now, science usually gets a grip on complex phenomena by reducing them to their basic elements. Consciousness, however, seems to be in principle immune to these kinds of reductions for a simple epistemic reason: there is no appearance-reality distinction. The epistemic basis of the phenomenon in question is its reality itself:
if it consciously seems to me that I am conscious, then I am conscious. We can make lots of mistakes about our own consciousness, but where the very existence of consciousness is in question we cannot make the appearance-reality distinction, because the appearance of the existence of consciousness is the reality of its existence. [BN 327]
Even if, one day, we were to know the exact neuroscientific causal explanation of how consciousness comes about in the brain, all we were to know would be its third-person ontology. This, obviously, would be a profound achievement—still quite far out of reach. Yet, the discovery of the exact neural correlates of consciousness would not be the entire story, since consciousness has its aforementioned salient first-person ontological features. These features, as it seems, could not be accounted for in purely third-person ontological terms—even if our scientific worldview were complete. Again, this is not to say that consciousness consists of some extra substance.
Here comes a disclaimer to avoid possible misunderstandings. Despite having first-person ontological features, consciousness is nothing spooky or ethereal. An overwhelming amount of neuroscientific evidence suggests that all our conscious states are caused by lower level brain processes. What is more, consciousness being caused by lower level neural processes also neatly explains why it is causally efficacious. Take an example. The conscious decision to raise your arm causes your arm going up. This can be described at different explanatory levels, however all of which are causally real levels of one and the same causal system. That is, your arm going up can be described at the level of the conscious intention to raise your arm and the corresponding bodily movement, or it can be described at the level of neuron firings and synapses and the secretion of acetylcholine at the axon endplates of your motor neurons. It is important to acknowledge that these are not separate causal structures; but rather a single causal system described at different levels. Once one realizes that the same system can have different levels of description that are not competing or distinct, but merely different levels within a single unified causal system, the fact that the brain has different levels of description is no more mysterious than that any other physical system has different levels of description.
To give a rapid summary, consciousness has both first and third-person ontological features, and they are both parts of the natural world. On this view, mental and physical properties do not belong to distinct metaphysical categories, but are different parts of one cohesive picture: the natural world. Mental features are realized by physical features, but their first-person ontological reality is not reducible to the lower level third-person ontological features of the neural system from which they emerge. As such, consciousness is a higher-level biological feature of brain systems. This is to recognize that the salient first-person ontological features of consciousness do not prevent it from being an ordinary biological part of the natural world. We experience this on a regular basis. If you are consciously thinking about your desire to go and get a cold beer, this conscious thought is real and by no means illusory; neither can it be reduced to something else. It is subjective as it is a distinctively private sensual experience inaccessible to anyone else, and it is qualitative as it comes with a certain "what-is-it-like feeling" that is different from other "what-is-it-like feelings"—drinking beer feels different from bickering with your spouse. Nevertheless, the conscious experience of desiring a beer is caused by lower-level brain processes that function causally as they may soon make you head to the refrigerator satisfying your cravings.
It is useful to briefly sketch how biological psychiatry has approached the relationship between the brain and psychic phenomena so far. Research in biological psychiatry has been based in the last three decades on the diagnoses defined by the different versions of the Diagnostic and Statistical Manual of mental disorders (DSM). Researchers have tried to uncover biological correlates to these diagnoses. This research program is based on the underlying assumption that mental disorders are discrete entities, and that they are discontinuous from each other and from health. This conceptual approach has been criticized as being excessively narrow and unable to represent accurately the clinical reality of psychiatric disorders. Furthermore, the same institutions that brought the DSM to international acclaim are now questioning whether the DSM still has a role to play in guiding research efforts. One of the biggest funding institutions in neuroscience and biological psychiatry, the National Institute of Mental Health (NIMH), has recently taken a critical stance toward the categorical approach endorsed by the DSM. Thomas Insel, the current NIMH director, suggested that the symptom-based categorical diagnostic system should probably be complemented by more biologically-oriented approaches to classifying mental illness, that might facilitate integrating clinical knowledge with the findings of neuroscientific research. In order to pursue this aim, a new framework has been proposed: the Research Domain Criteria (RDoC). Its purpose is to design and implement "psychiatric nosologies based upon neuroscience and behavioral science rather than descriptive phenomenology." The elements on which this approach is based are "dimensions of observable behavior and neurobiological measures" (TRF 28). The RDoC part ways with the DSMs particularly in their attempt to conceptualize psychopathology as composed of continuous dimensions, cutting across discrete diagnoses. Some authors that have done prominent work in the domain of the philosophy of psychiatry welcomed this new approach. For example, Fulford and colleagues emphasize how the RDoC framework could be a more inclusive framework compared to the DSM approach, in that it could be more open to a plurality of research paradigms. However, other commentators were less enthusiastic. Josef Parnas notes that the RDoC framework basically endorses a type-type identity reductionism, where certain parts of mental life are reduced to certain kinds of neural activity. He concludes his comment pointing out he risk of creating a "psychiatry without psyche" (a term he borrows from Jaspers), which also appears to echo the critique that Noam Chomsky made against Behaviorism saying that to confuse behavior with psychology is to confuse the evidence for psychology with psychology itself.
Despite his critique of a psychiatry that is unilaterally dominated by a neuroscientific approach, it seems relevant to remember at this point that Jaspers was never dismissive of research in biological psychiatry per se, and he emphasized the importance of the study of the nervous system. It is intriguing to wonder if contemporary research in neuroscience has anything to add to the questions we have considered so far. A domain of current research that would probably have aroused Jaspers' interest is the investigation of the neuroscience of empathy.
The Neuroscience of Empathy
Jaspers elaborated on a specific functional mode of understanding in his 1913 paper where he pointed out that there are two ways of understanding how psychic events arise out of other psychic events. The first is the use of logic, which allows us to understand connections rationally. The second is through empathy: "But if we understand the content of the thoughts as they have arisen out of the moods, wishes, and fears of the person who thought them, we understand the connexions psychologically or empathically. Only the latter can be called 'psychological understanding'"(CMC 83). In the GP this concept is stated again: "Rational understanding is only an aid to psychology, empathic understanding is psychology itself" (GP 304). The centrality of the role of empathy in psychological understanding could not be affirmed more clearly.
Recent reviews on the neuroscience of empathy, reveal how vibrant and active this area of research is today. It is intriguing to note that brain functions associated with empathy constitute a necessary condition for psychological understanding. This is an example of considering the activity of specific areas of the brain as precondition of a set of mental phenomena, as opposed to mapping mental phenomena on brain processes in a type-type identity sort of fashion. Considering a certain kind of brain function a conditioning factor of mental phenomena appears to resonate well with Jaspers' conceptualization of how we should consider the relationship between the brain and mental phenomena:
We know that in general no psychic event exists without the precondition of some physical basis. There are no "ghosts." But we do not know a single physical event in the brain which could be considered the identical counterpart of any morbid psychic event. We only know conditioning factors for the psychic life; we never know the cause of the psychic event, only a cause. [GP 459]
This resonates well with Searle's claim that casual reducibility does not necessarily entail ontological reducibility:
So there is a sense in which consciousness is reducible: the mark of empirical reality is the possession of cause and effect relations, and consciousness (like other system features) has no cause and effect relations beyond those of its microstructural base. There is nothing in your brain except neurons (together with glial cells, blood flow and all the rest of it) and sometimes a big chunk of the thalamocortical system is conscious. The sense in which, though causally reducible, it is ontologically irreducible, is that a complete description of the third-person objective features of the brain would not be a description of its first-person subjective features.
The Human Being as a Whole
Engaging with Jaspers' thought suggests some considerations on the conceptual approach of contemporary research programs in biological psychiatry like the RDoC. These criteria are a positive contribution to psychiatry as long as their application is guided by methodological awareness and by respecting the validity boundaries of available methods to provide an account of the phenomena in psychopathology. The criteria can be a guide for gaining relevant knowledge to treat some aspects of mental disorders, but considering them a new paradigm for psychiatry as a whole would be dangerous and could lead to similar limitations that became evident in DSM-based research. The emphasis that Jaspers placed on methodological pluralism and his opposition to approaches that portray brain research as the dominating paradigm in psychiatry are still relevant today, and should be present in the minds of the researchers who will shape the future of psychiatry as a discipline.
For this methodological pluralism it seems important to recognize that mental phenomena are sui generis:
They refer not to private objects like souls and sense data but to subjective points of view and their modifications—even though the range of mental phenomena is not limited to those we ourselves can identify subjectively.
Along these lines, Nagel asserts:
Whatever unification of subjective points of view and complex physical structures may be achieved, each of us will still be himself and will conceive of other perspectives by means of sympathetic imagination ["empathic understanding" in Jaspers' terms] as far as that can reach, and by extrapolation from imagination beyond that. The difference between the inside and the outside view will not disappear. For each of us, the site and origin of his conception of the world as a unified physical-phenomenological system will always be the particular creature that he himself is, and therefore the conception will have a centered shape that is at variance with its centerless content. But that need not prevent us from developing that content in a way that captures the evident unity of what in our own case we can experience both from within and from without.…and that requires the willingness to contemplate the idea of a single natural phenomenon that is in itself, and necessarily, both subjectively mental from the inside and objectively physical from the outside—just as we are.
The attempts by Searle and Nagel to reconcile the subjective and the objective dimension of human beings resonate well with Jaspers' opening lines in the GP: "The psychiatrist as a practitioner deals with individuals, with the human being as a whole" (GP 1). Let us return to Jaspers' earlier analogy: The two explorers following the paths of brain processes and mental phenomena might be meant to never meet. It is possible that this is the price that psychiatry has to pay, if it wants to consider the object of its study as the human being as a whole, as an experiencing subject that can never be fully described by brain circuits alone.