Q. Do you think there is a cure for serious mental illnesses...

Q. “Do you think there is a cure for serious mental illnesses like psychosis, schizophrenia, etc, particularly as related to the types of things you talk about in general?”

A. There are many sub-questions within this question to unpack, like, for example, what exactly is schizophrenia? It’s one diagnosis, but it covers a wide range of differing behaviors. I will write a general response here without delving too much into sub-questions, starting by framing the problem.

Mind, World, and Hallucinations

A mental illness is always seen and diagnosed against the background of what is considered mental normalcy. So the first step here is to understand what the range of the mind is and the nature of the mind is. I’ve written about that before so for now I’ll just say that in my view, the world is a mental experience. This includes the “physical” world we believe in. (I’m not saying that the world is primarily in my personal mind or in my head, nor in anyone else’s personal mind or head.) This by itself should change our understanding of certain types of psychosis.

In a sense, we are all hallucinating with every perception, including the perception of the brain. Neuroscience is beginning to arrive at this conclusion. When we agree, we call it objective. When we disagree, we call it subjective. When we really disagree, we call it hallucination. The point is to recognize that what we call hallucinations are no less real ontologically than our everyday perceptions, which are consensus hallucinations (the “real world”), and also to recognize that as the mind is tuned differently—intentionally or unintentionally—it accesses different ranges of what is here. As it is, we already know that the human nervous system is able to filter in and interpret only a very narrow stream of the electromagnetic spectrum. In other words, we don’t perceive the vast majority what is here right now.

Groupthink invalidates experiences that are ontologically equal.

The prevailing groupthink in our society tells us that perceptions outside of consensus hallucinations are unacceptable, unless it fits the special cases of childhood imaginary friends, dreams, extreme situations like trauma or psychedelics, or “religious experiences.” In these special cases, there are enough peers who experience atypical perceptions to validate a new subset of consensus hallucinations, thus normalizing them and allowing them. If there is not enough consensus, the reality of the perceptions are invalidated, further isolating some people, affirming to them that even science and nature (not just a couple experts) “know” that we and they live in irreconcilable worlds when in fact the worlds are ontologically the same.

Suffering due to mental fluctuations is real.

Having said that, understanding and even perceiving the mental nature of reality is not enough. We still have to marry ontology and relevance. It is not enough to say that the world is mental and therefore we are all hallucinating. That doesn’t account for the very real fact that some perceptions are more useful, tolerable, and enjoyable than others. It doesn’t account for the fact that some people have perceptions that cause them a great deal of suffering, often in the form of being so at odds with consensus perceptions that they are unable to interact meaningfully with others, and/or being completely overwhelmed by perceptions to such an extent that they can’t function as they would like.

What is the cause?

So now the question becomes—what is the cause of, for example, hallucinations? In my view, it is caused primarily by a shift in the range of the personal mind, which begins to access/interpret more of what is already available. This can also happen through trauma, psychedelics, starvation, intention, and unintentional processes. This shift in the mind is reflected as brain processes, such as the increase in the levels of dopamine.

Given this frame, what might be the cure?

I’m not ready to use the word cure yet, because I don’t think we understand the disease to begin with. My version of cure begins with understanding what is happening and leads from there. For a practitioner who diagnoses and treats “mental illness”, it might look like this:

  1. Understand the relationship between mind, identity, and world. (This includes understanding some basic philosophy, introspecting, and experimenting with the mind. There’s no way to understand “mental illness” without knowing what and where the mind is. You would never expect someone to diagnose cardiac disease without knowing what and where the heart is.)

  2. Recognize the different ranges of the mind. (Same as above, as well as reading texts from different cultures that describe ranges of the mind.)

  3. Recognize the factors that influence which ranges are accessed. Two big ones are emotions and attention. (When Steps 1 and 2 are practiced, this one comes easily.)

  4. Work with those factors—not just when a problem comes up, but as a regular part of living.

This isn’t rocket science. It’s also not a magic bullet. What will make it challenging is an impatient mindset looking for quick answers, and also a closed mindset that is unwilling to acknowledge and/or see what we don’t know, including what and where where the mind is. It all depends on where the fear line is drawn within ourselves. It is only from an open, prepared, and at times courageous mindset that we can truly explore and discover. If Steps 1 and 2 are taken seriously, the way we see “mental illness” will shift. I have focused on hallucinations in this explanation, but the same steps hold true for delusions, depression, and other states of mind.

Will these steps solve or cure all unwanted fluctuations of the mind?

No. What it will do is teach us what the mind is, what its full range is, and how to influence its range. It will also teach us that there are a variety of lifestyles, communities, and cultures that may the right one for a person—and it may not be the society we were born into, nor one we or the people around us would have initially considered. As this learning happens, we will come to see a lot of what we thought of as mental illness differently. The alleviation of suffering and the fuller recognition and integration of what was previously seen as illness into a society is what I see as cure, not making others behave like us.

How fast can we improve diagnosis and treatment?

This isn’t a quick fix. Today, we diagnose and treat based on an understanding of a narrow band of the mind—the First Mind—and our entire healthcare system and society is cultured in a way to accommodate that. Diving headlong into uncharted regions of the mind in search of a quick cure without a system designed to support that practice is as likely to cause more problems as it is to come up with new insights. It takes openness, the willingness to face our fears, preparedness, humility, and diligence to unlock those doors. Once open, anything is possible.

(For more, see “What Is Mental Illness?”)

Anoop Kumar, MD, MM is board certified in Emergency Medicine and holds a Master’s degree in Management with a focus in Health Leadership. He practices in the Washington, DC metro area, where he also leads meditation gatherings for clinicians. He is the author of Michelangelo’s Medicine and the upcoming book Is This a Dream? He tweets @DrAnoopKumar.