The mind is not flat

"Our mental depths…are compelling products of our imagination. But trying to plumb those mental depths, whether by word associations, conversations, interpretation of dreams or brain imaging, is no more likely to succeed than searching for inner life in Rembrant's self-portrait by peeling away successive layers of paint."

I was concerned, when reading Professor Chater's article and his book, The Mind is Flat, that the therapeutic techniques he referred to were being misrepresented and that his depiction of psychotherapy as attempting to "plumb mental depths" risked drawing a caricature. In recent years, practitioners of psychoanalytically informed psychotherapy have finally realised the importance of high quality evidence, so that long-term and short-term psychodynamic therapies have now demonstrated efficacy both in randomised controlled trials and studies into the 'active ingredients' of psychotherapy. Given, however, the current NHS trend towards ever briefer, more manualised, more computerised psychological therapy, coupled with a lack of resources, little excuse is needed for the culling of services. This is especially true if they are seen to be fallaciously exploring murky non-existent mental depths. It feels important therefore, as a clinician working for a psychoanalytically informed therapy service, to contend the ground.  

Depth, when referring to the mind is, of course, a metaphor. As is flatness. As necessarily are all conceptualisations of the mind - Ghost in a machine, iceberg, black box, information processor. Crucially, the metaphors and techniques of psychotherapy take place within a therapy relationship that affects both the therapist and the patient. This fundamentally relational aspect of therapy precedes any use of dream interpretation, word association or therapeutic conversation. 

Attempting to dig down with therapeutic tools – in order to unearth a hidden wish that, even before they came into the therapy room, existed in the mind of the patient in linguistic or pictorial form, somewhere just out of reach – would indeed be a waste of time. An intellectual exercise at best. At worst, harmful to the patient. This is different, however, from creating a therapeutic environment in which actual changes in states of mind and accompanying physiological responses, ideas, memories and predictions about others' intentions are facilitated in the present moment and then commented upon.

The latter is the aim of a psychoanalytically informed therapy setting. To speak of something being "uncovered" or "explored" in this context is a metaphor. There are no actual hidden schemas, core beliefs or unconscious wishes waiting in word or image form. But, that which lies dormant in the form of neurobiological circuitry does hold the potential to reliably manifest as different states of mind in response to different situations. In this vein, contemporary psychodynamic conversation comes primarily from a curiosity about a patient's current relationships, emotions and states of mind.

Priscilla Roth, for instance, writes that when a patient – of all the hundreds of thousands of things they could spontaneously report – suddenly recalls a dream of being pushed into a corner by a dance partner, the therapist could attempt, as a detached observer, to infer a disguised childhood wish bubbling up from beneath. But they could more usefully read this as a commentary on what might be happening currently in the therapy room, with a therapist suddenly perceived as intrusive by a patient who may not want to declare this, but who nevertheless communicates their feeling through the spontaneous symbols and ideas that come to their mind. 

If this sounds foreign to clinicians who do not draw on psychodynamic concepts in their work, it can be understood as essentially akin to the process by which we might start to salivate at a cake shop window: association. One process is a bodily response to an inanimate object that gratifies a need, the other is a bodily response to an animate caregiving object who could gratify a need, but who could also frustrate one or cause us harm. In the first case, salivation occurs, in the second, a depiction of intrusion is readily accessible because of its symbolic salience to the current context. In neither case do we need to be able to share an explanatory narrative for the response to occur. For all his mistakes, Freud, recognised that templates of early care leave traces in our bodies that can affect us in such a manner. This is robustly demonstrated in contemporary attachment research, and most psychological therapies practiced today make use of the way in which earlier experiences affect the way we approach and respond to later experiences, especially with caregiving figures, partners and peers. 

We all unknowingly walk into familiar patterns in our relationships because of what we've been through. We also construct explanations on top of this – "Oh, I'm a people pleaser, you see" – but this constructed self is not what a psychoanalytic therapist is interested in. They would be interested in what the patient actually doesin their relationships, including the therapy relationship. Information about what spontaneously happens in the therapy room at the level of physiological responses, behaviours and accompanying associations, is far more useful than what post-hoc intellectual narrative someone has constructed about their self. A psychoanalytic therapist would be as sceptical as Professor Chater of a neat story that explains away distress. 

In the opening pages of The Mind is Flat, Chater works through various imagined scenarios of Anna Karenina's suicide, concluding that even if she was a real person, we could never know why she decided to end her life, because any attempt at an explanation would be an act of fiction. Even if a journalist, Chater writes, approached her on the bridge and asked her to spare a moment to reflect on why she was doing what she was doing, he or she would not get much of a response. It's true, they probably wouldn't. But this would mainly be because they would be asking someone in overwhelming distress for a story. If, instead, a healthcare professional approached Anna and sensitively enquired into how she felt, they might, as often happens, get a reply that went something like, 'It's all too much', or various other entirely informative insights into her current mental state. 

Subsequently, let's say Anna was referred to a contemporary psychodynamic therapy service within the NHS, the assessing clinician may find out that she had a higher than usual number of Adverse Childhood Experiences (neglect, trauma, loss, abuse) coupled with several recent changes or losses in her life. They would then know from clinical and epidemiological research that this increases her risk of suicidality, as well as predicting a range of other physical and psychological difficulties. This would all be factored into a tentative hypothesis about her current dilemmas, which would be triangulated against the therapist's experience in the therapy room with Anna, as well as information from her significant current relationships. 

There would be no need to posit that in the basement of Anna's mind sits an actual, all-encompassing schema that says, for example, "I am furious at my absent parent". Instead, we would simply need to understand that Anna's experiences have left traces in her mind, constrained by which she improvises her way through each new situation. This is something that Chater seems to acknowledge when he writes of 'mental channels' in the brain, and when, in a lovely section of his book, he describes people as 'traditions'. He seems to stop short, however, of drawing a link to the value of a therapeutic environment in which an elucidation of these traces via exploratory techniques is facilitated. The aim of any therapeutic conversations with Anna would not be to drill down in order to find out why she tried to kill herself on that one occasion, but to help her gain insights into states of mind that might make that course of action more likely to occur again. This process would be aided by the fact of there being two people in the therapy room. Anna's therapist, just by virtue of being another person, potentially viewed as caregiver-shaped, or peer-shaped, would elicit reactions in, and be emotionally affected by Anna. They would be interested in what spontaneously comes to Anna's mind – a dream, image, fictional character, newspaper story – because this would provide glimpses of a current mind-set that she might not be able to or not want to report.  

In his article, Chater describes how we mistakenly attribute hidden depths to "found faces" in inanimate objects and to Rembrandt's ambiguous self-portraits. He then draws a parallel to our own apparently manufactured hidden depths. I think, paradoxically, that these examples demonstrate the depths that they are intended to refute: not in the found face or portrait, but in the observer. Characterful faces are so readily seen in our surroundings because our ancestors were better at reading expressions in others than their competitors. And, we evolved not too look at handbags and cheese graters but to get by as best we could in a ruthlessly competitive world, in which our survival was utterly dependent on our primary caregiver and then on the acceptance of our peers.

We therefore have a heightened and sensitive area in the brain for reading facial expressions as well as various other unconscious circuitry for navigating the social world. Part of the reason that ambiguity in art is so captivating is that we instinctively search for intention and meaning in social situations. We do this because, more often than not, there is intention and meaning in our close relationships, which we really can read in facial expressions and in our own bodily responses. "Found faces" and an interest in ambiguity in art are by-products of our fundamentally relational nature. And, while this does not exist in the form of hidden linguistic or pictorial depths, it is apparent in the salience of social cues and their propensity to elicit changes in our states of mind. 

Contemporary psychodynamic practice takes for granted this relational nature. And, while some of us may eventually become able to notice and mindfully let go of distressing thought patterns – in the Mind is Flat Chater does acknowledge some worth in mindfulness practice – we first need to be able identify, cluster and get a handle on these patterns, to recognise that they might be part of, to use the analogies of Mindfulness Based Cognitive Therapy, that familiar tape or circuit. This can be difficult to do without another observing mind. Patients who dive straight into mindfulness practice can often unwittingly bring a problematic state of attention to their practice. For example, without knowing it, they practice mindfulness to control or avoid emotion while still holding an underlying assumption (or, to avoid any inference of hidden linguistic depth in the mind: a neurobiological pattern that potentiates a certain set of emotional, behavioural and linguistic responses in certain situations) that they ought not to have upsetting feelings. A therapist who points out this tendency and models a more benign, accepting attention, creates an opportunity for a patient to do the same. 

But more than this, people come to therapy because they are trying to communicate something that a therapist is trying to hear, even if neither knows straight away what it is. The patient is grappling with present-moment dilemmas in their relationships that are shaped by their previous experiences. They might not be able to declare it outright, but their relationships cause them distress often because of something they are doing, expecting or avoiding, in the same way that someone else might ride their bike incorrectly for a reason that they might not be able to explain. At first, this may have been in an attempt to avoid dangerous objects or ride toward others; objects that are no longer in their path, but habituated traces of which still exist. Helping a patient realise what they might be grasping at or avoiding is aided by the rich, symbolic, relational material that they bring to therapy. 

This exploratory mission inevitably has misfires, wrong lines of pursuit, overly theoretical leanings, intellectualisation, and the construction of faulty narratives, but I worry that Professor Chater's argument, seen through a particular lens, risks mistakenly dismissing the entire endeavour. 

Gareth Drake, Clinical Psychologist

[email protected]

Why therapy matters for flat minds

Nick Chater, Behavioural Science Group, Warwick Business School 

Despite its title, I find myself perhaps unexpectedly in considerable agreement with Gareth Drake's stimulating response "The Mind is not Flat."

I think we agree that the idea of uncovering mental depths is misleading. Rather the project of understand ourselves and other people –including talking therapies of all kinds – is constructive. We are creating a new interpretation, as we would of a painting or a poem; and these interpretations can be challenged, and modified and re-thought endlessly. And it is by no means the case that all interpretations are as good as each other – ndeed, were that true, such challenges and debates about which interpretation is most appropriate would be mystifying. But, as with works of art, it would be completely misleading thinking that one interpretation truly captures the 'underlying' truth that is somehow hiding beneath the surface. The idea of the existence of a canonical true interpretation (perhaps the intention of the author or artist) has long been abandoned in literary theory and aesthetics; the existence of a canonical true interpretation of the reasons for an action, a dream or a troublesome pattern of thoughts and behaviours is no more defensible. 

But none of this implies, of course, therapy is misguided or futile. Indeed, Drake and I share what one might term an improvisational view of therapy. Helping people rethinking how they see their lives can be crucial to determining how they shape their future. As I discuss in The Mind is Flat (Penguin, 2018), our past interpretations matter not because they correctly or incorrectly reflect a hidden psychological reality, but because they guide the present and the future.