Plato vs Paul - Is Dualism Dead?

The radicalisation of Paul Garner & the fable of Neil Oliver

Paul Garner & his buds in the Oslo consortium made headlines this week (25th September 2023) as we all stuck our hands to our foreheads in a collective groan. There’s a lot to unpack in their machinations but this week I’m going to go back and address one of their core beliefs - dualism is dead. Dun dun duuuuun…

Dualism

So, the question we seem to need to answer in the field of Long Covid & ME/CFS is; 'is dualism dead?' Why do we have to discuss this? Has your rheumatologist refused you treatment, pointed his pen at you and shouted “language is dead” due to his avid interest in Wittingstein? Has your dermatologist kicked you out the consulting room because you only exist in the mind of God as he's a Berkeley fanboy?

The likely answer to most of the above questions is no. Yet Paul Garner, once noble ally of people with Long Covid, Emeritus Professor, assuages us with the hashtag #DualismIsDead, persistently, in an attempt to justify the dodgy treatment of people with Long Covid & ME. "You're a dualist," is the common cry of the BPS if you counter their narrative. Well Plato was a dualist, was he wrong? Maybe, but philosophers are generally fairly cautious caretakers over certainty.

There's no question that Cartesian or substance dualism is out of favour in the philosophy world. This is where the mind and the body are seen as separate and of two different substances. Most would prefer a slice of property dualism with their cup of tea; where mind and body are of the same substance but have different properties. But this isn't enough to dismiss dualism and write its death certificate. My old philosophy teacher was a logical positivist for the sheer hell of its unpopularity. (He was proud that I got the highest score in the country at A -Levels, yet due to Long Covid I now can't remember his name). Descartes is still a key figure in philosophy classes & curriculums the world over - no one has hidden him in the attic. He might be dead but his influence isn’t. Maybe the hashtag #DescartesIsDead would be more accurate? He wasn't the only dualist in history, we have Plato, Socrates, Einstein, Kant, Galileo, Pythagorus and many religious thinkers including the Sankhya and Yoga schools of Hindu philosophy. To be honest there is a whole soup of categories of dualism - are they all dead? Can dualism actually die? Likely not although different flavours have their moment in the sun.

Another blog will go over what dualism is and its pros and cons in more detail. Yet trying to call the death knell of dualism to support your unpopular medical stance is not sensible. It shows an inherent disrespect to the field, depth and process of philosophy. Saying philosophy of mind is a huge subject is a huge understatement in both the western and eastern philosophical systems. It has perplexed some of the best minds for centuries - it’s not going to be solved by some confused psychiatrists with hashtags. Unfortunately it’s a breach into territory that he has no expertise in, it’s a dive into the neutral zone or epistemic trespass to give it its fancy name. So why is he doing this? One answer is that it's prime dead cat, red herring, straw person territory all hanging out in the back alley. Instead of talking about the medical harm that people with Long Covid and ME experience we now have to talk about fucking dualism. It’s essentially a way to sound clever and to give your opponent a hard time in trying to respond. Let’s talk about monocytes? But what about your will to power - shouts your Nietzschian Dr, use that on your immune system!

The inclusion of philosophy in medicine & science is important because it brings the ability to understand argument and logic. Yet using it without skill to prop up treatment with no robust clinical evidence (yes we've seen the NICE evidence review) is ridiculous. Most philosophers love to get in the mud pit and have a good fight using debate and dialogue. This often is not the case in medicine, criticism can go down as well as a dead donkey. There's many reasons for this, the difference in academic training, class, ego etc. Prof Diane O'Leary, philosopher, has offered many times to debate this issue and there's always a tumbleweed in response. (please do see her work on dualism in medicine, it's exceptional).

Why does this matter for medicine? It matters because Engel was right that medicine’s view on mind and body has a big impact on its success at helping people be well. First, the campaign to stop thinking of mind and body as separate is self-refuting if we accept Engel’s goals, and no science is at its best when its foundations are faulty. Prof O'Leary

What no one generally wants to talk about is that we actually know sod all about consciousness really. It's the last great bastion of humankind, the last great frontier. And this is where the problem with psychiatry lies - it doesn't fundamentally know its substrate, its substance, what exactly it's dealing with. Dualism remains in some sense because the alternative to some is pretty scary, oblivion. There is no existence outside the body, nothing else, nada, nida, ziltch and that can go against a fundamental need for meaning.

Plato was concerned about The Good Life as was Felicity Kendal. Maybe this is what medics should be talking about if they don’t know what is causing the illness? How do we give people with ME and Long Covid a Good Life? If Plato met Paul in the agora maybe this is what his main concern would be? Even without a cure this can be done through social care, occupational care, help with benefits, hell even a ready made frozen freezer of food and a cleaner. To be completely honest these folk shouting from their parapet of anti-dualism would be of much greater use if they went and cleaned the oven for someone with ME/LC.

Yet the real humdinger, the real bamboozler is that the stance that Paul and co take is dualist. They are property dualists but they don’t seem to understand this as they’ve tarred all dualism with a Descartian tar brush. If you believe in the BPS the Bio Psycho Social then these are inherently different properties. They might not believe in a separate mind out there and state that the mind is in the brain but this means mind and body are of the same substance but with different properties and dualist. Clue - mind body medicine tends to give the game away. Prof Diane O'Leary covers these points especially well in 'Reconsidering the Place of Dualism in Medicine and Psychiatry – A Dialogue with Diane O’Leary'. You couldn’t have psychiatry if they didn’t separate mind and body (but that’s a whole other hornet's nest) in some way. If they weren’t dualists they would be medical monists engaging in a reductive physicalism. Which is precisely what the BPS approach was formed to counter. So the fatal flaw is that they have made a fundamental category error, an attribution fallacy because they don't understand the philosophy. To be honest it’s a really basic mistake. Everyone is talking potatoes but just because one is mash and the other a jacket doesn’t mean they aren’t potatoes - the substance is the same but they have different properties. “I’m not a potato,” someone screams.

effort to avoid “dualism” interferes with patient care. (I put “dualism” in quotes when I’m referring to separation of mind and body.) In cases of unexplained symptoms, for example, clinicians are advised to end diagnostic effort because it’s “dualistic." Prof O'Leary

So we have a pseudophilosophy going on here. Big men throwing around big words in an attempt to give themselves authority but in reality they’d fail a basic 101 philosophy class. They aren’t interested in filling the pathophysiological gap so they’ve diverted to philosophy instead. Bloody hell what a detour. Yet the consequences of this has a profound devastating reality to people with ME and Long Covid. It's not ivory tower navel gazing. It means there is no treatment, no care & no recognition.

Let's conclude. What we have in medicine is a fallacy in medicine's, specifically psychiatry’s, understanding of dualism and you can’t have logical truths if the foundations are rotten. This misunderstanding is rooted in the Biopsychosocial model combining dualism and reductionism - you can’t combine two polarised states. You can’t be dead and alive (unless your Schrodingers cat). The second is that they make the assumption that dualism is the separation of mind and body. Nope. Descartes was a dualist because he thought the mind and body existed not because he thought they were of different substances. Yet the substantive issue is the effect on the reality of the patient experience - which is horrific.

Hysteria

It’s the classic problem of hysteria - the wishy washy nature of diagnosis through the inclusion of the mind in symptoms stops genuine investigation into the origin of disease & therefore treatment. This leads to gaslighting and serious safeguarding issues in patient safety. This epistemic trespass leads to harm and all because of a fundamental philosophical error. It is clear this is a matter of social justice and an urgent one seeing the explosion of Long Covid which has been caught in the net of - the medically unexplained, mind-body, it’s stress, has psychosocial factors - narrative. 

The reality is that if philosophy was in charge then what is seen as medically unexplained would be batted out of the park of psychiatry and back into biological science because the flaws would be easily seen. But maybe this is why there is no genuine dialogue & involvement between BPS proponents and philosophers - they would be very soon out of their depth.

Image credit: Existential Comics

Radicalisation

What we see is a radicalisation process happening to some in medicine. Where a certain group have adopted radical views in opposition to the experience of a vast swath of society - that they can’t be dissuaded of. So much for methodological doubt - another thing for the Descartian trash bin. It works like a cult. It is a membership of a belief system that has no grounding in reality, in patients' lives. If as a medic you can’t listen to a tsunami of patients telling you that these approaches don’t work and are harmful - something has gone very wrong. It’s essentially disinformation.

Yet maybe this extremism is running from a place of fear? There is an issue of credibility in psychiatry, that it isn’t really a science, not really medicine. This crisis of confidence has led to a drive to integrate psychiatry into the body, into the physical through the rejection of dualism. As if psychiatry was seen as only dwelling in the mind, which is difficult to apply to the objective scientific method, it would be disregarded? Yet this is not a valid fear as they have not understood property dualism. The mind can be integral to the body within dualism - it’s just a different property not substance. 

Yet academics are not invulnerable to radicalisation, look at Neil Oliver, look at Garner. May they be a cautionary tale to others of how not to get pulled down the rabbit hole. History certainly won’t be kind.

We haven’t even got started on the misdirection going on in their determination to tell you that your symptoms are real. Reality, there's another vast philosophical topic reduced to a fly swat. That’s the subject of another blog…