In contemporary psychiatry, the emphasis is usually on biological aspects of the illness. Psychiatrists study how the brain changes during an illness and what kinds of medicines are needed to normalize brain chemistry.
This has not always been the case – Sigmund Freud, the father of modern psychiatry was a neurologist by training, but he was more interested in the “mind” rather than the “brain” – Freud’s unique (and, in his time, radical) contribution to the field was the idea that the unconscious mind affects us, and can lead to emotional problems.
But in the last many years the orientation of psychiatrists has become increasingly “biological” – which means that the emphasis is on the brain rather than on the mind.
Here I should differentiate between the brain and the mind. The brain is an organ – a collection of nerves, more than 100 billion of them – and psychiatrists who are biologically oriented believe that emotional problems arise due to malfunctions of the brain.
The “mind” is the stream of thoughts and feelings, both recognized and repressed, covert and overt, subtle and obvious.
It’s incorrect to assume that the mind is always at the mercy of the brain – that thoughts and feelings arise as a result of problems in the brain.
There is no doubt that brain malfunction can cause abnormalities of thoughts and feelings.
But – and this has been substantiated by countless research studies – thoughts and feelings also affect brain chemistry and function.
The brain and the mind share a bilateral dynamic relationship, each affecting the other.
With this perspective in mind, , let us consider the case of someone like Suresh (as always, names and details have been changed).
Suresh in his mid thirties says that he has been feeling anxious, sad and depressed for a long time.
A thorough evaluation has to include an understanding of Suresh on multiple levels, from multiple perspectives.
This is why it’s important to understand the role of a psychologist and a psychiatrist.
A psychologist will understand Suresh’s problem as being a product of the mind alone. For example, the psychologist might tell Suresh, “Your depression and anxiety is because you are in a bad relationship, because you have poor self-esteem, because you have negative thinking, because you have the tendency to catastrophise about the future.”
A psychiatrist who sees everything as a product of biology, would say to Suresh, “Your problems are because of chemical imbalances in the brain, and you need medicines.”
Both these approaches are only partly true.
In order for Suresh to achieve his authentic , peaceful, and joyful self, an integrated approach is essential.
This would include attention to the brain, the mind, the body, and the spirit.
What does this mean for Suresh?
That he would achieve his goals with a combination of supplements, proper diet, exercise, sunlight and lifestyle modifications, medications if necessary (depending on the assessment of how much brain dysfunction there might be), psychotherapy and an exploration of meaning and purpose in his life.
A complete and integrated approach would include an exploration of the following: What is his current life situation? What is his current emotional state? How do his emotions and personality affect him and those around him?
What are the genetic and biological factors responsible for his current situation?
What is his lifestyle? How does he treat his body?
This includes understanding his family of origin, and his childhood. For example, if Suresh’s mother was depressed and anxious, then she may have passed on these genes and hence the tendency to be depressed and anxious to Suresh.
We have to also understand how Suresh’s temperament interacted with his childhood situation to create his identity – if Suresh was a sensitive child and his mother was anxious and stressed, then this childhood environment may have created, in Suresh’s mind, the idea that the world is an uncertain and rejecting place.
We have to know: What is he repressing in his unconscious mind? What are his unexamined assumptions and presuppositions of life?
A thorough evaluation of the current situation has to also include questions that may be seen as being under the purview of philosophy or spirituality : What is Suresh’s understanding of existence? What is his current life purpose? What does he see as the meaning of life?
When all this comes together, then Suresh will not only leave behind his anxiety and depression, but he will also transform into the person that he is meant to be – peaceful, joyous, energetic, passionate, compassionate, and authentic.
That is why I believe – all emotional problems are a stepping stone to greater joy and clarity.