麻豆传媒

WHATEVER happened to that reliable scientific theory of consciousness we鈥檝e been waiting for? We badly need one, not only to make sense of schizophrenia, anorexia and personality disorders, but suicide bombers and war. Conventional approaches are deeply frustrating.

To see why, try the Bathwater Challenge. Kneel beside a half-filled bath, put in your hand, wait for glassy calm, then wrench it out. Repeat, until you鈥檙e convinced the resulting wave pattern is too complex for verbal description. Agreed? Well, consciousness is even more difficult to pin down than turbulence in a bath. Analyse the brain chemistry as much as you like, but it鈥檚 the ever-changing patterns, not the chemicals, that make all the difference.

In truth, there are simply no fixed reference points in consciousness, so the temptation to invent some is overwhelming. Freud invented freely, as if there was no tomorrow 鈥� and all his inventions, including 鈥渋nfantile sexuality鈥�, are now shibboleths. Modern attempts are failing, too. Jerome Kagan (Surprise, Uncertainty and Mental Structures, Harvard University Press, 脗拢20.50, ISBN 0674007352) tries to tie consciousness down to two concepts, 鈥渟chemata鈥� and 鈥渟emantics鈥�, but both prove insubstantial in practice.

Behaviourists long ago sidestepped the challenge by downgrading consciousness to 鈥渟ub-vocal speech鈥�. J. Allan Hobson and Jonathan Leonard (Out of Its Mind, Perseus, $26, ISBN 0738202517) follow suit, renaming it 鈥渘euroscience鈥� and delving deeper into thalamus and hippocampi. But this heavy excavation yields scant benefit. Even Leonard鈥檚 own panic attacks persist, despite him understanding that it鈥檚 all down to his amygdala. The chemicals don鈥檛 differ, whether you panic over a spider or a scorpion: as before, it鈥檚 the patterns of chemicals that matter.

Horacio Fabrega (Origins of Psychopathology, Rutgers University Press, $60, ISBN 0813530237) struggles to innovate, offering non-human primate psychopathology, even pre-Neanderthal psychosis. But his prose is heavy, the pickings light, and the benefit to our acute psychiatric crisis far from obvious.

Consciousness is not only fluid, it is indefinable. The temptation to oversimplify can be overwhelming 鈥� a bit like agreeing to play chess without the king. Try the Bathwater Challenge Plus. Suppose, while watching the bathwater, a small hump-like wave suddenly appeared, gadding all over the place like a mouse under a rug. You don鈥檛 know where it鈥檚 going next, but 鈥� and here鈥檚 the conceptual crunch 鈥� it does. This doesn鈥檛 happen with bath-water, but it does with consciousness. It鈥檚 called intentionality. No wonder orthodox 鈥渆xplanations鈥� wilt. The illustrious Samuel Johnson explains why. 鈥淎ll theory,鈥� he wrote, 鈥渋s against [intentionality], all experience for it.鈥� So when theoretical approaches predominate, as now, pragmatic experiential methodologies wane.

Try another thought experiment. Look at every corner of this page. Which did you look at first? Glance at each in turn. There is simply no theory that can predict which order you choose. Do you believe in free choice? Freud didn鈥檛 and those studying psychiatry and insanity don鈥檛 seem to either. Advertisers, democrats and lawyers most assuredly do. Without 鈥渋ntent鈥�, the practice of law would inevitably collapse, much as psychiatry has done.

Robert Whitaker (Mad in America: Bad science, bad medicine and the enduring mistreatment of the mentally ill, Perseus, $27, ISBN 0738203858) has no time for collapse. He has written a humdinger of a book, starkly demonstrating psychiatric fraud and obdurate prejudice in the face of hard clinical evidence of inefficiency and fearsome side effects.

This is such an important book that every psychiatrist should be compelled to read at least the preface, every year. And everyone else should then insist on them describing in writing, every year, what they鈥檙e doing about it.

But you will need a strong stomach for it. He calls one chapter 鈥淭he Nuremberg code doesn鈥檛 apply here鈥�, a reference to the principles of consent in experiments on humans, agreed in response to the Nazi outrages of the Second World War. Here he鈥檚 referring to present-day psychiatry. I鈥檓 leaving that one unread until I feel stronger. Powerful stuff.

I have a personal problem with psychiatry, and this book provides the clearest answer yet. I grew up near The Retreat in York, a pioneering Quaker mental hospital founded in 1796. I then spent 40 years working to find a cure for psychosis and neurosis. When success came, my career imploded. I have been evicted from consultant psychiatric posts in Parkhurst, Broadmoor, Ashworth, Grendon, Milton Keynes and, oh yes, The Retreat. Why? The Mosher effect.

In 1971, Loren Mosher wanted to know which was better for schizophrenics: drugs or dignity. Three years later, the answer was clear. Dignity was better than drugs on all counts. But Mosher was then vilified, sacked and downgraded. Many others, including the World Health Organization, have also found that the mentally ill prosper most when treated as people. Indeed, Whitaker says the early Retreat years were by far the best, long before dependence on drug treatments became the norm. But none of this saved Mosher.

The KGB, for example, used anti-psychotic drugs to torture and control people. Today, only anti-psychotic drugs are sanctioned in treating schizophrenics. Other treatments are blocked. In my book Emotional Health, I asked, 鈥淚s psychiatry bankrupt?鈥� This seems feeble compared with Whitaker鈥檚 analysis. He gives irrefutable evidence that psychiatry is damaging the most vulnerable in society 鈥� and who can stop it?

Whitaker blames money and status 鈥� especially the cost of disagreeing with the medical establishment as Mosher did. It鈥� s an excellent book, eloquently and robustly written, with copious references. I learned a lot about my profession, though most of it was disagreeable.

E. Fuller Torrey and Judy Miller鈥檚 The Invisible Plague (Rutgers University Press, $28.00, ISBN 0813530032) raises fascinating epidemiological challenges. Why does the rise in mental illness since 1800 correlate so closely with rising industrialisation and urbanisation? Allan Horwitz in his cool and erudite Creating Mental Illness (University of Chicago Press, $32.50, ISBN 0226353818) is more comprehensive. But none of these authors pays sufficient attention to attachment theory: industrialised obstetrics must surely impair neonatal bonding with serious consequences for adult mental health. Alex Beam鈥檚 Gracefully Insane (Public Affairs, $26.00 ISBN 1891620754), though hardly profound, provides a graceful illustration of the disgraceful impact our psychiatric crisis had on a living institution. The McLean Hospital in New England was a humane mental home that had to close 鈥� another example of the Mosher effect.

All these books confirm the end of Freud鈥檚 hegemony. And they all document the depth of our psychiatric crisis. The question of 鈥渋ntent鈥� makes academic theorists apoplectic, but consciousness is pickled without it. Must we wait for intentionality to be sorted out before we can sort out psychiatry?