Cartesian dualism and its influence on Medical Profession

by Jay Andrea vea D. Israel

Rene Descartes, born in France on March 1596, was a mathematician,

natural philosopher or scientist, and metaphysician. Descartes was regarded as
the “Father of Modern Philosophy” who pioneered the emergence of modern
philosophy and science. As a mathematician, he connected geometry with
Algebra into Analytic Geometry. As a natural scientist, he was credited with
several achievements in relation to the new concept of matter. He introduced a
world of matter which accounts for physical phenomena by way of mechanical
explanations. He was the first Scientist to introduce the “mind” or “soul” as
separate from the body, giving rise to the dualism philosophy. As a
metaphysician, he argued the existence of God which shows that matter is an
extension and the mind is thought. He introduced skepticism or the concept of
doubt. According to Descartes, some reasoning goes on without the body
(Hatfield, 2007).

In psychiatry, neuroscience, and psychology, its origin can be traced back

to Cartesian theory or dualism. As the term dualism implies the professions
believe that mental disorders have physical (body) and psychic (mind/soul) roots.
In this review, I will be presenting “Descartes’ passions of the soul – seeds of
psychiatry?” by Albuquerque, Deshauer, and Grof (2002). Also, I will be
presenting different claims to support and negate the paper’s standpoint.

The paper began with an explanation of why ideas of Descartes have to

be reviewed. They explained that the roles of ‘cognition’ and ‘mood’, mind and
body in psychiatry can be traced back to the concept of dualism by Descartes.
Cartesian medicine was referred to as a historical cornerstone of Psychiatry
because it mostly deals with the physiology of thought and mood states. The
concept of matter – as the body, and mind as two distinct but interacting things is
the context of Descartes which is likened to contemporary psychiatry. Descartes,
in his work, included a model for illness and the concept of health and mind over
matter. Although the concept of separating the mind from the body was radical
when it was first introduced in the seventeenth century, it still remains vague in
the present times. The paper, to the best of the author’s knowledge, is the first
link of Psychiatric literature to Descartes’ Passions.

Descartes’ explanation of moods was explained in the second part of the

paper. It explained that Passions of the Soul was created as per the request of
Princess Elizabeth of Bohemia in 1646. The Passions is the first attempt to
systematically explain and categorized human emotions in a non-mystical or non-
fictitious way. It tried to how mind – thought and body – a matter interacts and
functions but mostly detailed accounts of emotions. To understand this further,
sadness was explained according to Descartes’ writings. Sadness was traced
back to Descartes to a lack of food in childhood. In a state of sadness, the body’s
reactions include a slow and feeble pulse rate and a constricted chest with a
feeling of a frozen heart. Appetite was influenced by sadness wherein a person
with a melancholic personality can still eat but with extreme hatred, it would
hardly do so. Another manifestation of sadness is skin pallor (Passions A116,
368) which is mostly identified as flushing. Although this emotion is also co-
present with hatred, love, and desire (Passions A117, 369). Trembling (Passions
A118, 369) and Tearfulness (Passions A1 31, 374) were also associated with
sadness. Sighing presupposed sadness (Passions A135, 375). As a totality, there
exists a cause (x) that affects the body that stimulates a reaction of the mind that
arises a passion for “x”. The cause may or may not be known or can be
associated with other factors y and z. In his book, Descartes wanted to describe
a detailed physiology of sadness and the behaviors that accompanies it. As such,
this description is complex emotional physiology.

A question can be carried out on Descartes on how he managed to

interlink interactions of the body and passions of the soul. This paper argues this
question in the context of fear. An example given was ‘fear of an approaching
dog’. The brain is stimulated as a dog approaches because the brain perceives
the dog as a potential danger. This now causes a reaction in the body to either
“fear or have courage” (Passions A36, 342). The brain will dictate whether the
action to be done is to “flee or to fight”. This response may be due to the person’s
experience, training, and/or temperament. Descartes stressed that passions
resulting from sensory events or disturbances are essentially unmodifiable in
themselves. They “cannot be directly aroused or suppressed by the action of our
will” but they can be recontextualized, and managed “through the representation
of things” (Passions A45, 345).

Interpersonal differences are also described in the article by Albaquerque

et.al (2003). Accordingly, Descartes described interpersonal differences for both
body and soul. We are born differently, even at the genetic level. Cases
highlighted in the Passions that are relevant to the said paper include individuals
who cry with ease, those with bodily imperfections, or those with ‘leaden
complexions. Descartes also described a mother’s experience and its impact on
the fetus along with early childhood events. These considerations greatly
influence both the body and the soul creating a unique individual.

Descartes according to the authors received medical training but do not

practice but had “therapeutic suggestions”. These suggestions include
approaches that are directed to the mind and to the body, a practice that is
continued in psychiatric practice to this day. Some examples of these
“therapeutic suggestions” include rest, spa, bloodletting, and botanical
treatments. In this context, Cartesian physiology understood that in order to have
a healthy body, one must also have a healthy mind.

According to the author, Descartes’ Passions of the soul identified

systematic methods in order to understand emotional problems. Cognition and
emotion were reaffirmed to be distinct, although one may say intellectual and
bodily emotions were weak. However, the influence of Descartes’ Passions is
strong in separating the body and soul in that up to this day, its impact remains.
According to the authors, Descartes did not retreat to the relative safety that
theory alone might afford but used it as a tool to provide solace and health. His
theory was, in a sense, a method, that if followed, led to a good life.

In a philosophical review conducted by Hernandez et.al (2009) entitled

“Descartes influence on the development of the anotomoclinical method”, they
agreed with Albuquerque et.al (2003) that Decartes’ philosophical principles
influence the historical course of medicine. According to them, there are certain
similarities between the guidelines of the anatomical-clinical method and
Descartes’ philosophical principles. Their comparison using a reductionist
scheme was as follows:

“1. Descartes proposed reaching truth by not accepting any

preconceptions that could not be demonstrated, while the
anatomoclinical method aimed to reach a diagnosis without accepting
conjectural elements that could not be demonstrated.

2. Descartes proposed breaking each problem into as many parts as

needed, while anatomoclinical method reached a diagnosis by
analyzing the symptoms and signs, seeking each one in each patient

3. Descartes proposed reconstructing the elements in an orderly way,

from the simplest to the most complex, while the anatomoclinical
method analyzed the semiology of the patient, either individually or
as part of a group, to find the location of the lesion. This analysis was
often carried out gradually, to define the anatomical structure most
likely to be affected.

4. Descartes proposed making as many enumerations as possible so

as not to omit any important elements, while the anatomoclinical
method reached an aetiological diagnosis by establishing a
differential diagnosis where every conceived possibility is considered,
and which was then confirmed through detailed analysis of the
evidence available”
 Hernandez et.al., (2009) does not claim that the anatomoclinical method
originated from Descartes’ Passions with an immediate cause-effect relationship
but rather it is the birth of analytical thinking which gave a major influence on the
development of science and the evolution of medicine.

Cartesian theories have had a great influence on the way mental

pathologies were considered throughout the entire 17 th and 18th centuries. On
the other hand, emotional symptomatology finally began to be used in diagnostic
criteria for mood disorders. The systematic method for this can be traced back
to Descartes’ Passions. Descartes’ believed according to the authors that
Passions were sensitive movements of the soul experienced due to its union
with the body. Descartes, in his theory, the pineal gland is where the soul is
located which controls bodily functions and the ‘animal spirits” keeps the body
from functioning accordingly. The said animal spirits are like signals from the
soul to the body. In today’s modern physiology, the “animal spirits” are likened to
“nervous impulse” or “synaptic connections” or even down to “molecular
changes”. In this sense, Neuroscience today is no different from the principles of
Descartes. (Munoz et.al., 2011)

What is beyond any doubt is that the Cartesian theories on passions and
their role in the disorders of the mind outlived their author by 200 years. While
today we have dispensed with Descartes’ philosophical ideas on the soul, we still
continue to witness an astonishing similarity between the ideas of the French
philosopher and the most recent discoveries in neuropsychophysiology and
psychopathology. In fact, the modern concept of “passion”, unlike that of
“emotion”, is closely linked to the psychopathology of thought, in that it assumes
a deformation (an overvaluation) of the subject's ideas. In any case, the
Cartesian description of sensory perception and passions, including sadness,
may be an unsettling premonitory metaphor for the scientific breakthroughs that
took place in the 20th century.

Let’s now look at how Descartes’ dualism influence today’s medical

profession. Psychiatry deals with mental, emotional, and behavioral disorders
(Trivedi & Goel, 2006). Psychiatric disorders’ brain basis has been really difficult
to understand, thereby treatment becomes even harder, especially because it
defies the odds of neurological interpretations. They were thought to have no
organic roots, often called “functional”. Hence, its roots can be traced back the
Cartesian dualism. In the 20th century, psychiatry became a separate medical
specialty from neurology which gave the profession a hard time in terms of
funding and recruitment. As a consequence, there was a diminished value of
careful diagnosis and psychiatry has been reduced to psychological support
(Fitzgerald, 2015). Although at present, psychiatry is gaining more attention due
to the increase in mental and behavioral disorders. Advances in technology show
us that structural brain disorders (neurological) and functional brain disorders
(psychiatric) are difficult to separate or distinguish.

In neuroscience, the innate nature of knowledge as per Descartes’s

definition is being applied. The discovery of neurons proves that signals are
transmitted despite the experience of an individual which is in reference to the
animal spirits of Descartes. In an experiment conducted by Pousaz (2011), they
observed the behavior of rats when tested on neuronal circuits. According to their
assumptions, if neuronal circuits were built based on individuals’ experience then
the rats would give different or individual responses. However, the rats gave
similarly characteristic responses, suggesting that neuronal circuits were already
present, innate, and created prior to their exposure or experience. Thus, the
project or research suggests that some building blocks of knowledge are present
at birth and possibly genetic. Clearly, a separation of soul and body can be seen
in this scenario.

In an article entitled “Dualism persists in the Science of Mind” by Demertzi

et.al., (2009), they tried to make a two separate but related surveys from
students, health workers and lays from two Universities to determine attitudes
toward mind-brain relationship and the variables that account for differences in
views. It revealed that in one University, dualistic attitude is pre-dominant or
belief in the aspect of mind-brain as a separate entity. Similarly, the other
university where respondents are younger, women and those with religious
beliefs were more likely to agree that the mind and brain are separate, that some
spiritual part of us survives death, that each of us has a soul that is separate from
the body, and to deny physicality of mind. Religious belief was found to be the
highest predictor of dualism. On the other hand, most of the healthcare workers
denied the distinction between consciousness and soma, one third of health
professionals regarded the brain and mind as separate entities. This result
according to the authors are in line with developmental psychology and other
surveys of scientist about the mind and body.

In congruent to the survey conducted by Demertzi (2009), many believe in

the concept of dualism and as a consequence neglects their body having
perceived it as only a vessel (Forstmann et.al., 2012). In this article, they
investigated the relationship between dualistic beliefs and health behaviors. The
result of the study showed that participants who greatly believe in dualism
reported less engagement in healthy behaviors and less positive attitudes toward
such behaviors than of course the participants who primed the physicalism. In
addition, they reported that those who practice dualism make real-life decisions
that may ultimately compromise their health.

Not everyone agrees with the concept of dualism. An article by Arshavsky

(2006) has a different point of view on dualism. In fact, it tried to explain the
“Scientific roots” of dualism in neuroscience. This is an attempt to clarify that the
body is not separate from the mind. In neuroscience, neurons simply generate
electrical potentials or transmitters of signals to other neurons. This now is the
controversy of cognitive neuroscience (ie. Consciousness). Consciousness has
no direct relation to the function of neurons where it relays signals to organs of
the body to function. Consciousness, production of comprehensive language,
pattern recognition, declarative memory, emotions etc are some unexplainable
attributes of the mind that neuroscience cannot explain. In the review of Arhavsky
(2006), she was able to explain the scientific concept dominating neuroscience.
According to her, the complexity of the neurons makes the brain function
including consciousness and the like. She also says that this concept is a direct
way to dualism. She argues that cognitive function is performed by the
complexity of neurons whose role is not simply to generate electrical impulses.
Furthermore, she likened this hypothesis to a computer wherein there is a
complex information-processing system. Thus she believes that the brain is not
empty of information in terms of cognitive functions at the onset, but rather is
already present. That there is a “program” innate to human beings. The
understanding of the intraneural mechanisms underlying cognitive functions is
probably the most direct way to overcome covert dualism that exists in cognitive
neuroscience.

Hagen (2015) has a different take on evolutionary psychology that

negates dualism. The brain, according to Evolutionary psychology is developed
by the same process and to the same end as the rest of the body. Social and
behavioral cognition constitutes Evolutionary psychology and research in this
field employs the formation of core sociobiology like kin selection, reciprocal
altruism, and sexual preferences. He argues that “mindmatter dualism” is the one
that evolutionary psychology rejects and accepts genuine mind-body dualism.
Hagen (2015) used the invention of the computer to describe how the mind
works, through the physical system to “think” which unified the mind and matter,
thus, abolishing the Cartesian theory. This spawns a cognitive revolution that
continuous to roil the human behavioral sciences.

Mudrik and Maoz (2014) also do not support dualism. In their paper “Me &
My Brain: Exposing Nueroscience’s Closet Dualism” they commented that the
theory is quite misleading. The article calls out those that promote dualism and
calls it the double-subject fallacy (DSF) in neuroscientific writing. To them, it is
wrong and socially dangerous when dualistic thinking prevails among lay people
in reference to the writings of scientists and philosophers. Mudrik and Maoz
(2014) reiterate that neuroscientists are perceived to be authorities of the brain –
since their main role is to study the brain, they should be careful and rigorous
thinkers not advocating something that can be misleading, in this regard dualism.
Steering up the concept should not be taken part of neuroscientists but rather
wait and promote scientific evidence for cognitive neuroscience.

A different approach to dualism is pointed out by Maung (2019). There is

an aversion to dualism in the parts of the psychiatric literature. In his paper, he
cited theoretical distinctions in the recent philosophy of mind to show that
aversion does not fairly represent dualism because of the failure to acknowledge
that there are different varieties of dualism. He presented Kenneth Kendler’s
which conflates the psychological and phenomenal concepts of the mind.
According to the author, it overlooks the metaphysical contributions of
philosophers who propose that physicalism fails to account for consciousness
and that dualism is the only acceptable account. He argues in neuroscientific
research, Cartesian dualism is challenged and not acknowledged, however,
David Chalmers’s dualism does not pose any problem. For him, the scientific
claims of biological psychiatry accept the dualism theory of Chalmer.

To end, there are things that are difficult to explain that a matter of fact
exists. From a philosophical view of human beings’ nature, it has consequences
on our understanding based on the issues that they face. When taken with
physical/scientific evidence it now becomes the foundation of knowledge. In my
point of view, having been a Christian my whole life, the power of wisdom was
given to humans which is why we are regarded as special. To be brought up with
a belief that one person has a soul and that this soul will depart from the body
once it dies is the main concept of dualism. The idea of it is that the soul is not a
matter, it has no physicality, and it is not a wind that can be felt nor take up any
form. Although all other beings have a mind on their own, they do not have the
wisdom that God has endowed with humans. In fact, human beings were given
the responsibility to subdue and take care of God’s creation. Exploring and
explaining the mind is really a difficult task however, slowly but surely, technology
has given us a breakthrough in understanding it. We do not disregard however
the writings and teachings of the old because it has guided us, molded us, and
directed us to where we are at present. It is however wise to distinguish what is
or what’s not. That I believe is what makes us human.

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