Forms of life, forms of mind

Here’s an interesting discussion thread and conversation between Alexey Tolchinsky, a clinical psychologist and Adjunct Professor at The George Washington University, Center for Professional Psychology, Thomas Pollak, a neuropsychiatrist and researcher working at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, and me. It all started when Thomas sent me an email asking: “If mind is everywhere, where are all the panpsychiatrists?”, and proposing a discussion around these themes:

What can psychiatry helpfully learn from the understanding that we’re all collections of selves within larger selves?

We have an impoverished view of psychological healing; taking TAME seriously would open new possibilities

The phenomenology of recovery in mental health speaks to embodied intelligence

Dissociation and bioprompting

Neurodivergence highlights the heterogeneity of competency and the requirement for bespoke and creative bioprompting

Trauma, dissociation and functional neurological disorder (FND)

At what point does stress (as cognitive glue) become trauma (as dissociogenic toxin)?

The relevance of immunological self-disorders in psychiatry

Suggestibility and hypnosis as bioprompting

Psychopharmacology and bioprompting: the importance of complexity at input and output

A taxonomy of psychiatric interventions: how does the informational richness of the intervention relate to the space of possible behaviours that the intervention facilitates?

Incepting ‘internal agents’ for therapeutic benefit: from shamans and psychoanalysts to medical tulpamancy

Conceiving of one’s illness process as an agent opens relational therapeutic possibilities

If bioelectricity is cognitive glue, then ECT makes sense

Bioelectrical interventions as drivers of both integration and dis-integration

Harnessing the therapeutic potential of the bliss of merging with the bigger self: clues from crowds and mystics

Panpsychiatrists assemble!

Then followed an email chain (below), and then this conversation:

Thomas:

I am a neuropsychiatrist and researcher working at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. My main areas of interest are the relationship between the immune system, particularly autoimmunity, and the development of mental health problems, as well as ‘mind-body medicine’ more generally. You can find most of my publications listed here: https://orcid.org/0000-0002-6171-0810 as well as all the usual places.

Reading as much as I can of your work over the last few months, I have become quite convinced that there is likely to be an awful lot of insight that can be gained from your ideas for the benefit of psychiatry. Similarly, I think that there are a lot of interesting observations within psychiatry which may be interesting to the study of diverse intelligences. I have started to consider bringing some of these observations together in the form of a theoretical discussion paper – I suppose aimed at psychiatrists and psychologists but also for the benefit of people outside that field interested to see how things might connect – and wondered whether it might be of interest to you to be involved and to offer your perspective?

Broadly speaking, there are a few areas which I think are ripe for exploration. First, I keep on thinking about what psychiatry could really look like if it fully takes on board some of the ideas that you express in your TAME theory. For example, I think we have some very limited notions of healing in psychiatry that could be greatly illuminated by your approach. I work very closely with patients with functional neurological disorder, and I think this is a patient group where the kinds of dissociation of subcomponent selves that you speak about in various illness states is starkly visible. It really is an incredibly interesting patient group, full of limbs doing things that the rest of the body doesn’t want them to do (or not doing things), perceptual systems that shut down with no clear structural cause, etc etc. There is a long history of hypnosis and suggestibility-related research in this group, which I think relates in many aspects to your idea around bioprompting.

Second, I think there’s a lot more to say about the immune self-psychological self nexus: taking in some of our work on autoimmunity but also drawing on some of the lovely psychodermatology work and placebo stuff that I know you’re keen on. 

Third, I think your ideas suggest a kind of taxonomy of psychiatric interventions which could be quite powerful… I may need some help here but it may have structural similarities to your bowtie notion. More broadly I think there are a lot of ‘agential interventions’ that need to be explored in psychiatry but about which we’ve only scratched the surface. There’s a bit about bioelectricity here (although I’m on unfamiliar territory), touching on the notion that bioelectrical perturbations like seizures/ECT and anaesthetics can be both dissociogenic AND therapeutic in a psychiatric context. Also, perhaps, something from a bioelectricity perspective on the uniqueness and spectacular efficacy of lithium (as the only elemental intervention in psychiatry).

Finally – I had a sense that possibly there could be stuff relating to the interventions that take place in psychiatry that might have analogues at other levels, related to your notion of somatic psychiatry. In many ways I read your use of that term as a bit more like ’somatic psychology’ and I wanted to think if there was anything more specifically psychiatric that could be brought in. Hence the call for the panpsychiatrists to assemble!


Alexey:

Thomas, it’s a pleasure to meet you and read your ideas. It appears we think alike and share values. I look forward to reading your work. I can’t agree more that Michael’s work is essential in psychiatry – in fact, I wish we were taught in graduate school that all intelligences are collective. Perhaps, we can work together to advocate for that and make this case and further develop these ideas from Michael’s work in biology to psychiatry and psychology.  

Michael has been generous with his time and advice, and we authored two papers together, one is on DISGUST and its close relationship with the immune system. 

I did a seminar at the neuropsychoanalysis association on this paper yesterday and the audience was interested in the topic.

Our NPSA congress last rummer in Trieste was dedicated to functional neurological disorders. We were fortunate to hear from Jon Stone, whom you likely know, and many other experts. There were lively debates and discussions. (Sadly, I have not heard colleagues mention TAME, only FEP).

With respect to the model of the Self in health and pathology (e.g. dissociative disorders), we wrote another paper, which is in peer review now. Here is an early preprint. (it is shorter and in a submitted paper we have clinical and neurobiological components added)

Here is a presentation of our work with Michael, Chris Fields, Lancelot Da Costa, Rachael Murphy, Daniel Friedman, David Pincus, and me, at the Active Inference Institute Symposium:

This is largely based on Michael’s TAME and also his experimental work on cancer: 

Thomas:

Thank you so much for your kind replies. Alexey, what a wonderful feeling to watch the video of your talk and to see such beautifully resonating ideas! I was shouting ‘Yes!’ at my laptop on occasion, and then again when reading the preprint. I think we have arrived at broadly similar takes on some things, although you express your ideas with far more elegance and clarity than I am currently able! 

I really enjoyed reading your Frontiers paper, and I’m somewhat embarrassed I hadn’t read it already! (And just as a side note, I know Jesus Ramirez-Bermudez very well. He’s a good friend and an absolutely wonderful mind. I’m sure that having him review a paper of yours would be a great experience.)

It’s wonderful that you were in Trieste recently. Some of my colleagues were there and had a great time. I know Jon Stone, and I draw on many of his clinical observations in the thoughts that I’ve been developing. I think there may be a reticence on the part of the FND community to engage too much with the notion of ‘selves’, as there is a feeling that the disorder has only just been reclaimed from the machinations of psychoanalysts who have for decades been telling patients that it’s all in their head. Of course, by approaching the disorder in a TAME framework, there is no reason at all to hold that all the selves are in the head!

Interestingly, the notion of dissociation has somewhat gone out of favour amongst many FND researchers as well. So I have found myself a little at odds with them, insofar as my recent trajectory of travel has been rather to see that dissociation is so fundamental a process that it is relevant far beyond what we would normally call ‘dissociative disorders’. But I really am so excited to think about how this framework could be applied to the breadth of these disorders. I see patients sometimes with psychogenic amnesia or fugue states, and of course it’s rather more easy to think of these patients as dissociative. But in ‘motor FND’ where the dissociation is largely, or at least overtly, a matter of motor control, I think there is less of an inclination to use terms like dissociation. 

My deep clinical sense over the years is that so-called functional symptoms aggregate together, and I am definitively a lumper rather than a splitter in this regard. The notion of dissociated selves then, I think, has potential to illuminate other functional symptoms outside of psychiatry and neurology, including, I suspect, functional gastrointestinal symptoms, functional dermatological symptoms etc. I’m really not sure how deep one could go with this.

I think there’s a cool piece also about how the spectrum of agency and the spectrum of ego-dystonicity/syntonicity interact, and how they might scale up or down into different systems/diverse intelligences. I’m fascinated by how my FND patients very rarely reject their dysfunctional limbs as their own, in much the same way that OCD patients don’t experience their intrusive thoughts as alien, despite clearly not aligning with their goals.

I’m most interested to hear what you might think, and I 100% agree that this framework is one that really needs to be appreciated more in psychiatry and psychology, and it would be a great pleasure to be an advocate for it.

Alexey, I’m so grateful for you taking the time to give such detailed feedback on the document I sent. It’s really very rare in my experience to receive such thoughtful comments and in such a very short space of time. I’m glad that there is much that resonated in the second half of the document and I’m also not surprised that some of what I said did not go down quite so well! I was probably caricaturing some aspects of both psychiatry and psychotherapy in a way that may or may not be helpful, and I do apologise if it came cross as devaluing of psychoanalysis or any psychotherapy! Your point about the seductiveness of theories of everything is well taken, and one consequence of this can be a tendency to caricature, so I am likely guilty as charged!

I plan to respond to all of your very thoughtful comments, but also to check out the papers and talks that you have linked to, so this may take me a little while. I can’t believe I hadn’t seen there was a conversation between you Alexey, Mike and Alex Schmidt! I’m going to watch it now. 

One quick Q though, if I may, as I’m worried I may have misunderstood part of Mike’s approach. In the second half of the document, I threw in a few SUPER speculative, far less clinical, and quite possibly untestable thoughts on spirituality, ‘merging upwards’ etc. and that’s partly because I’m a Buddhist with a dedicated meditation practice and I go on regular retreats and the like. I’ve listened to Mike on a number of podcasts now with people who move in overlapping ecospheres of Buddhists, non-dual practitioners of various stripes, and analytical idealists etc. I’m aware that they see in the TAME theory much that is potentially consistent with a worldview in which merging or assimilation into some sort of higher order mind is either theoretically or even experientially possible for humans such as ourselves.

You mentioned once or twice in your comments that the selves as outlined in TAME are essentially informationally isolated and that this precludes merging. I understand you to be saying that the ‘veils’ are impenetrable and, by that, I presume you mean it is simply not possible to ‘see through’ a Markov blanket, as it were, and presumably this is a formal property of these constructs (I note you do also mention ‘partial Markov blankets’…). So this appears to rule out the possibility that there can be continuity of experience when a larger self dissociates into a smaller self, or a smaller self merges into a larger self?  Obviously, by talking about continuity of experience here, I don’t wish to bring up the consciousness issue if it can be avoided. But I think what I’m getting at is, are we really committed to a notion of selves which are as demarcated as this?

I rather had an image of the theory as implying that we are all nested selves with borders that are elastic, can balloon/contract and can become porous (or perhaps usually are) and which are constructed by veils which can occasionally be pierced and seen through (and maybe that the veil itself is somehow observer-dependent). That is to say, I’m less sceptical about the possibility of a mind meld, and even a mind meld in which it was apparent that something kind of important was happening, or that had an affective quality (maybe even intensely affective). And that this story may play out at any level. Obviously the question of how that might be experienced or reported becomes rather vexed (if I change enough, how can I still be me), but I can’t say that it’s a non-issue or something that can be ruled out. I recall Mike once talking about what it might feel like for an agent if we really were part of a higher-order intelligence and as I recall, he suggested that it might feel like synchronicity. I assume that the implication here was that the lower-order intelligence is simply not equipped to see what structure there may be so in some way ‘gets the vibe’ of a kind of acausal structure. I think that’s partly what I was getting at when I was talking about the sense of mystery/the numinous…

Alexey:

A pleasure to talk to you. I think that your paper on FND from the TAME/FEP perspective would be quite useful. Auto-immune psychiatric syndromes, e.g., PANDAS – is another paper and I think it is much needed. 

With respect to Buddhism, I think one of the ideas is contentment, zero, nothing, peace – that one is transferable to biology and psychology. Biologically and mathematically, this state of contentment can be seen as the minimum of Variational Free Energy, corresponding to “all my needs are met” – I am “okay,” – not euphoric or happy, not blissful, just content. A peaceful contentment state is attainable in meditation or in Yoga – Shavasana.

Contemporary psychodynamic theory following Mark Solms’ work is exactly about that – he even calls it the “Nirvana principle” – when all the affects are at or near their homeostatic settling points. I get this idea of contentment more than the  one about “merger,” as in a merger of me into some mystical higher Self.

I think that Greek and then Christian attention upward is not about the disappearance of the Self, but rather the transformation – transcendence of the Self into a higher form of being. 

And limited in knowledge as I am on meditation, I have experienced the state, which Thomas Metzinger calls a “non-Egoic” state. I perceive it before I fully wake up – things just flow through my mind, but the “I” is not onboard just yet, or at least I don’t experience it, I just see a “river” of rather disorganized percepts, concepts, memory traces, etc.

In our model in the last paper on dissociation, the big “I” is constructed by the Autobiographical Self. In a Non-Egoic state, we can sense things, observe things, and we can just “Be”. The Core Self is intact and not dissolved into a higher something; The Bodily Self is fully intact and not dissolved into anything. The inner monologue is not on. I don’t see a need to merge into something mystical, e.g as a drop of water dissolves in a puddle. 

Under FEP, the boundary – Markov Blanket is informational, not material, like skin. The “thing” can only persist (be conditionally independent from the environment) when the Markov blanket remains functional. In that sense, a merger of a Self “N” into something larger “M“ would mean that the Marvov blanket of N is no longer – which means there is no more N, it’s gone, it’s dead – thermodynamic entropy took over, complexity decreased.

In contrast, when N has maintained its structure and engaged in organized communications with A, B, C, or with a larger Z – all of which maintain their own informational structures, then the overall complexity increases. Integration can be seen as a systematic synthesis of clearly differentiated components, not a dissolution of one into another. 

So when we die, our organic matter goes back to earth, which is then consumed and used to build other biological things. We are gone – as a previously integrated informational system – we are no longer.

In biological terms – from an example Michael and I talked about – there is a regenerative technique now to take stem cells, from, say, an olfactory bulb, and transplant them into the area of the stroke in the brain. What happens here is that a stem cell that had been transplanted does not “dissolve” or “merge” into something, like a drop of water merges into a puddle, but it maintains its structure, while communicating with the cells around it – neurons, glia, etc. And then, something more complex is constructed (or reconstructed).  

These are just my musings on what you wrote and, perhaps, Michael has another view – Michael knew Daniel Dennett personally and is far more advanced philosophically than I am. 

Thomas:

Thanks so much for getting back to me, and sorry it’s taken a while to get back to you and Mike. Thanks again also for your kind comments on the Brain essay the other day. I hope I’ve addressed all your comments now, although as ever there will be many more questions asked than answered! 

Please don’t apologise for trash-talking the soul. Buddhists are notorious for their belief that no such thing exists! I really do think that there is much in Buddhist psychology that resonates with aspects of the TAME theory. Anyhow, I feel rather guilty that I have sidetracked us with a talk about Buddhism when clearly my initial approach was to discuss psychiatry, psychology and related issues. 

I agree that a couple of papers could potentially come from this, if you thought promising, and that one on FND and another on immune considerations might be a good place to start.

I’m also very keen to think of as many empirical predictions as possible within the field that might come from this. I’m particularly interested in an approach which aims to assess the intelligence or otherwise of some putative lower-order agent that most psychiatrists or psychologists would be reluctant to say had agency. I’m definitely keen to think about whether any of the existing data on the dynamics of intrusive thoughts, hallucinations or other phenomena show evidence of agential intelligence (I think Mike has expressed  similar interest). And if not, how a study could be designed to do this. Fascinating to think about things like avatar therapy as one way in here.

I also actually think FND could be a very useful model to work with, given that we would not necessarily be relying on patient report because we can also measure physical parameters like tremor or limb movement. 

Mike, you have probably had many versions of this question but wouldn’t it be very cool if it were possible to build anthrobots from the cells of a population of people with schizophrenia and compare the result of behaviour of the anthrobots with that of a group of healthy controls or another group? Given that much of the polygenic risk for schizophrenia is located in ion channel polymorphisms, I would think that this might resonate with you. The (entirely intuitive) hypothesis might be that you can observe some proto-version of the disorganised behaviour which is so apparent at a macro level in the behaviour of these schizophrenia-derived anthrobots, particularly as a group.

We’re actually just starting a large study of the immune system dynamics in schizophrenia and other psychotic disorders, getting plenty of biosamples. It may definitely be feasible to get other tissue types from them over the course of the study, which lasts for the next six years. 

Mike I loved your thoughts in the last 15 minutes. I’m guessing that your comment about the soul suggests you have an intuition that this platonic space of kinds of minds is broadly speaking the ‘fundamental reality’ that people like Bernardo Kastrup are referring to when they state their analytical idealism, and that the ‘ingression of these patterns into the physical world’ could also be understood as matter being the outward manifestation of these phenomenal patterns? Although I have a sense also that perhaps you might diverge from an idealist approach in that you might consider the truly salient/fundamental characteristic not to be phenomenal consciousness but something more like cognition/information? (I suppose if one takes a IIT-type perspective that would unify things)

Mike:

            I think consciousness is primary but it manifests as information, intelligence, and cognition as it projects into the physical world.

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Featured image by Jeremy Guay of Peregrine Creative.