Submitted by Andrew McCarthy MD, Sep 17, 2007 18:27

Dear Dr Y,

I think you agree with me at one level yet do not realize it. You believe that science or rationality, or whatever you deem this ‘intelligence' to be, that it will be able to figure everything out and there is absolutely nothing of value when you discuss what may be immeasurable. Yet you still hold out some degree of empathy for your patients, even if it is only on some vague term for what this empathy is. I will congratulate you on that for you have proven my point, I think, that this is something that has nothing to do with numbering, measuring, or defining and it must have something to do with something else. And thus even you practice psychology with more than just some kind of rational formula, at least as I read your last message. And therefore my original premise that psychology, as well as neurology for that matter, are not just pure sciences or just pure pursuits of some kind of knowledge based state of function and/or dysfunction. We take care of people not just rational disease states. And it involves human communication that is everything that pure rationality is not.

What is this skill that you have and that you fail to categorize as something beyond rationality? And if you do categorize it what does it become? Is it a separate form of rationality? Is it some kind of irrational behavior? Is it simply a category that you pull out as an extra-rational trick that allows you to really have some kind of feigned and crafty compassion for such a person who gets down or confused or agitated or whatever? Do you simply look down upon such a person from above since you yourself have never felt such ills? Is it put into the category of emotion, as a kind of double minded skill that allows us all to decouple our rational side from our emotional side? Or is it now being referred to as emotional intelligence by many of the new avant garde of evolutionary psychologists? Well at least in my mind as well as in Aristotle's, such a cheap trick can only be done on paper. It cannot be done in reality. It is really a kind of nonsense that you just assume because you want it that way.

John Keegan in his great book has a very practical name for this attribute. He calls it good will and it was entirely lacking in the diplomats of all European countries at the start of WW I. And I think doctors call this ‘bedside manner' in that they get to know their patients as human beings and not as just as some rationally defined disease state. And Socrates gives the best example of this when he calls such a thing as something that is immeasurable in a person. And he is right to say that for it has nothing to do with measuring anything. It is about caring for someone beside yourself. And it is an art very much like any other art. It is often intuitive and never learned. Some have it some do not and it is something that is hard to master unless you have a gift for it.

Thus I am not the one who is being specious or sophistic. I think it is your view of rationality that makes you forget that when you practice your field, when you talk with a patient, that it has always been a very special art. And Dr Drury (Danger of Words, pages 33-34) has an excellent explanation of what this is called. He calls it psychology A in that it is subjective and personal as well as something that eludes all objective measurement which he calls our Psychology B. And he explains in a very rational manner why A can never be B: "It is a big assumption though to assume without discussion that precisely the same method which has proven so powerful in the physical sciences will be applicable to every other investigation… We should ask ourselves first, can psychology make use profitably of the same methods that have been so advantageous in the physical sciences, for I am not calling into question the accuracy of the measurements made, but only question their importance and future promise…What about an individual human being? He no doubt has many properties that he shares with every other human being… But to me, at any rate, what is of supreme interest is just the uniqueness of this very person, the way in which he differs from any that came before him or will come after."

Dr Y, the thing that bothers me about all rationalists like yourself is their irrationality to think that humans are nothing else. You deny every aspect of life that brings joy when you do such a thing. And there are consequences as John Keegan points out when 10 million soldiers died in a world war because of ‘rational war plans' and lack of ‘good will'. And it is why he said that this war was the end of the Enlightenment Period and it should have been the end of certain rational philosophers, such as Hitler's favorite Georg Hegel, who were the cause of so much of this. And I totally agree with Keegan especially when I read how you try to view life as just some rational objective enterprise. Is it really just some huge rational science and/or business project that only a few of the chosen can benefit from? (And I suspect that you want to be one of those chosen.) And it is not such a funny thing that in 2007 Professor Hegel's speculation are again running rampant in our universities.

Dr Drury goes on to discuss the view of the embodiment of consciousness or, as he puts it, mind dependent on brain that seems to be your speculative conclusion about life. Here is what he says on page 88 of Danger of Words : "To suppose that conduct can be divorced from speculation or that we may do good without caring about the truth, is a danger that is always tempting. So now let me draw your attention to certain broad principles in our own field of psychiatry where a decision on this ethical question is urgent and imperative. And yet where neither common sense, nor further information, nor any scientific discovery, can ever come to our aid. Where the will alone must decide the truth it will believe.

Some of us have to take care of and do as much in our power for those who either by genetic defect or birth trauma will never develop into maturity. Some indeed who will never learn to speak or even carry out the simplest acts of self preservation. Now if Pavlov was correct and mind was dependent on brain we must assume that where there is gross brain damage, mind is almost nonexistent too. I have lived through an age [WW II] in which a great and cultured nation [Germany] deliberately acted as if this was so; and counted it wise and praiseworthy to destroy such monstrosities. Knowing the history of man I see no reason to be optimistic that our children and our children's children may not have to fight this same battle over again…"

And thus the battle as always is being raised anew. Do you really want to take the side you are taking?

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