This article has been written in reaction to a fear: Fear of so-called ‘biological psychiatry’. Many don’t like talking about brain scans and neural correlates in psychiatry, because when you reduce a person down to different anatomical brain regions and neurotransmitters inside the head, we don’t find a single self in there. Without a self, there is no single entity, no inner person with likes and loves, traumas and setbacks, that we could direct psychotherapy towards. In light of this, it seems we are left with drugs to treat problems, and if one wants to hold onto psychotherapy, there is this temptation to hold on to a magical view of the mind for it to maintain its relevance. Indeed, we’ve all heard of the distinction of psychotherapy for psychological disorders, and drugs for biological disorders. The choice between “brainless psychiatry”, and “mindless psychiatry”. But this is a false dichotomy.
Those who think that a purely biological view undermines the existence of the self are in fact right; It is an illusion. But what they are wrong about is that it does not undermine psychotherapy. Rather, it empowers the idea, and can help explain the incredible effectiveness of it. Psychotherapy is essentially treatment of the self, so it makes sense that we discern what the self actually is if we hope to make progress. And although I don’t claim to be an authority on such a topic, the following is a working synthesis of my attempt to grapple with this problem.
What is meant by the self?
There’s a few different definitions that try to capture what is meant by the self. William James seems to have done it best, and can be conceptualised by considering what it is like when someone asks ‘who are you?’ Firstly, you would hear the sounds of the words coming out of their mouth, the sight of their lips moving, and have an immediate experience of being asked a question. This would be one part of the self; the moment to moment experience; sometimes known as the ‘I’. In response to the question, you would think back on your life – your name, your occupation, where you live, where you grew up. This would be the narrative formation of you, otherwise known as the ‘me’. Both the ‘I’ and the ‘me’ can be said to make the self.
This self feels like a permanent and self-defining entity. An experiencer separate from the experience. A thinker separate from the thoughts. One single entity with a past that stretches back through time and will continue to extend into the future. We assume we are subjects, sitting inside the head and behind the eyes, that transcends the constant fluctuations of our mental lives. I feel I am the same self as I was yesterday, last month, and last year; that there is some underlying principle that connects these different points in time, and unifies ‘me’.
The self is an illusion
However, the self is not what it seems; It is an illusion. It may seem like the existence of one’s self is an odd thing to question. But by illusion, it does not mean our experience of the self does not exist, but rather our common ideas of what it is, how it occurs, and what it means, is mistaken. If a magician performs a trick in which she miraculously picks your card from a completely shuffled deck, she creates the illusion of magic. Notice that saying it is an illusion does not the magician did not pick your card, rather it occurred in a way that was different to your perception; there was no magic. The creation of the self is the same; it’s undoubtedly there, we all feel it, but like the magician its created by an elaborate trick.
Firstly, this concept of a self makes no anatomical sense, as there is no point in the brain where it could be found. The brain has many different jobs allocated to various sections. They work side by side, spread out over the entire brain, involving completely separate neural pathways, and commonly operating in competition with one another. There is no single point in the brain that receives all the inputs from these processes, and no point from which all the outputs originate from.
As the philosopher Daniel Dennett would say, there is no Cartesian theatre playing for an ‘I’, a little homunculus, inside your head. And if you are still convinced there is a homunculus in the head, it only then begs the question, where is the self inside that homunculus’ head? This thought quickly reveals an infinite regress – you’d have to explain the subjectivity of the subject, and so on and so on.Changing parts will change the whole
Not only is there no single locus where a self could sit in our heads, the parts that construct this holistic illusion are constantly changing. When the parts of a whole change, the whole must also change.
This has classically be observed in unfortunate individuals who have suffered specific types of traumatic brain injury, who then suffer from sudden personality change, memory loss, or the inability recognise their loved ones. But we don’t need severe brain damage to change the self. The brain is not the static organ that we once thought it was. Through a well studied process of neuroplasticity, experience or lack of experience is constantly changing the wiring of our brains. It can be basically understood as the the mantra, “Neurons that fire together wire together”. Everything we learn causes new connections to form, and when we stop doing something the connections melt away. Thousands of connections are being formed and lost in your brain every second.
So every aspect of our mental lives can change in very specific ways when the brain is altered by tumours, strokes, drugs, disease, trauma, even simple ageing or the mere experience and learning. It changes from second to second, day to day, with a multitude of different influences. What is it to say that we are a constant self when that brain that constructs the self consists of many different working parts, each of which are in constant flux?
The simulated self
So what is the self? Its a simulation of our nervous system. The movie The Matrix popularised this idea, as the character Morpheus explained to his disciple, Neo; “What is real? How do you define real? If real is what you can feel, smell, taste and see, then ‘real’ is simply electrical signals interpreted by your brain.” He’s right. But something he didn’t realise is that this extends to the self. Our brains are model manufacturing machines, and this model includes emotions, beliefs, values and memories; the self.
How is the self constructed?
The self is a very beneficial property. It generally allows us to survive and thrive in a confusing and hostile world. But to create a self it has to be cohesive, and brain does so with little information. Bits of data from an diverse range of sources are stitched together, details are changed, and gaps are filled in to form a cohesive and understandable view of the self and the world around us.
The visual system in particular provides us with concrete example of this, but essentially much of our nervous system work in this way. It seems when we look out at the world we are receiving a wide-ranged, high-definition view. However its quite famously known now that this is not true. Our high-acuity vision encompasses about the size of a twenty-cent piece held at arms length. Everything outside this is essentially a blur, and most of this blur is colourless. The blind spot in our vision s about the size of a lemons held at arm’s length; so our blind spot is larger than our high acuity vision. Our visual system is scrapping together bits of information from here and there, these portions are then glued together and processed heavily – some parts are emphasised, others de-emphasised, false colours are added, contrast is enhanced, and a multitude of assumptions are made, to produce a seamless continuous visual experience.
Optical illusions occur precisely because they isolate one of the multitude of assumptions being made by your visual system at every moment and magnifies it. For example, take a look at the picture below. We all see a white square here, but of course there is none. We are taken in by the suggestion of these three quarter circles, and our brains fill in the rest to make the square. Our edge detecting neurons are actually firing when we look at this, and so we experience a complete square that isn’t there.
Our brains are pattern searching machines; they decide on matches and fill in gaps where needed. We can imagine the self as this square, an illusion created by surrounding elements, but take the context away, and the square, or self, disappears. The visual system is a good concrete examples of this, but our experience of the self works in this way.
One of these contextual elements that creates the self is memory. Memory is fundamental to our sense of self, however they are not recorded and played back like a movie; memories have to be actively reconstructed every time we recall them, and as a result they are highly fallible. It may be surprising – even scary – to know that you have no truly reliable memories, and confidence about the accuracy of memories generally does not correlate with the actual validity of them. Experimental psychology is flooded with evidence of this kind.
But memories are not just randomly bad. Memories are tailored with assumptions and fillers precisely so that they fit in with the self that is being constructing. They can even be entirely made-up. Wade and colleagues conducted a study where, with the help of family members, secretly photo-shopped childhood photos of the study subjects into a hot air balloon. After two sessions where the participants were asked to describe the event, 50% of people came to remember detailed accounts of a hot air balloon ride that never happened. Subjects were induced to accept a new narrative of the self, and so details were unconsciously adjusted and conjured to align with this.
Other contextual elements that creates the self are beliefs and intentions. But like memories, they too will shift and morph to maintain a cohesive self. When we are faced with a discrepancy between our beliefs and actions, our cohesive view of the the self comes undone, creating mental discomfort known as cognitive dissonance. To avoid this conflict we unconsciously alter our intentions and beliefs.
This was the case in one of Aesops Fables, illustrated here, in which a hungry fox wanted to reach some grapes that hung high on a vine. After he failed, he left saying he didn’t want the grapes anyway because they were sour. In this instance, failure to attain the goal clashed with the constructed self of the fox being cunning and athletic, so the belief about the grapes changed. There have now been over 3000 papers studying the effects of cognitive dissonance.
Instead of cognitive dissonance, our brains are usually in search of cognitive ease: simply put, our brains like and believe things that are easy to think about. This pursuit of cognitive ease has endowed us with a bag cognitive biases, including confirmation and attentional bias. We seek out and pay attention to things that agree with our pre-existing views of our self.
So things that fit in with our constructed self are much more likely to be noticed and adopted. But when something clashes with this cohesive story, it produces cognitive dissonance and strain, and our lazy brains will simply change those details so that it does fit in.
To maintain a cohesive self, we also alter our moment-to-moment perception. Top-down influences are cortical processes that shape our perceptions by constantly creating predictions about what’s coming next. This would have afforded a huge survival value in our evolutionary history by enabling us to make sense of our environment quickly, and move on. When you first walked into this room, your prior experiences of lecture rooms and your expectation to find chairs, a computer and a projector screen allowed you to not have to inspect every detail of every object in order for you to make sense.
The top down influences are highly dependent on our prior experiences, memories, and expectation, and so they are dependent on the self, and in turn reinforce the self.
For example, this is photo of a funny shaped rock on the surface of Mars, taken by one of the Mars rovers. However, if you are a conspiracy theorist believing there are aliens on Mars, your top-down processes send that expectation downward to alter your incoming perception. Perception is a blend of what we are sensing now and what we’re expecting.
A helpful illusion
Whether in the present moment or over time, experiences are fragmented episodes unless they are woven together into a cohesive narrative. The self provides, or simply is, the focus of this story.
We cannot continually question ourselves and our surroundings. If every moment of our lives we approached experience as if it were a baby’s first step, we would never leave the house in the morning. The self is a construct that is preserved by assumptions, biases and fillers, and it serves a great purpose, that is if the self is a positive construct. But what happens when the self is a poor one?
As i said at the start, psychotherapy is essentially treatment of the self, so it makes sense that we understand what the self actually is, rather than be fooled by our intuitions. There are a few things we should note about psychotherapy. Firstly, psychotherapy is quite effective. On average, a patient undergoing psychotherapy will be better off than 75% of those who don’t undergo psychotherapy. Secondly, most valid and structured psychotherapies are roughly equivalent in effectiveness. Thirdly, psychotherapy works for a wide range of psychiatric disorders. And lastly, benefits of treatment not only endure, but patients tend to continue to improve following therapy completion. How this is all achieved, we don’t actually know. There is no agreed mechanism by which it works, and the most predictive factor in the effectiveness in psychotherapy is the quality of the relationship between the therapist and patient. How could this be? I think the mechanism of psychotherapy could be conceptualised as altering the illusion that gives rise to the self. Since our brains construct the self, we can induce the brain to alter that self.
To understand this, consider someone suffering from depression – we have come to understand that they will have a distorted perception of the world, known as Beck’s cognitive triad: I am worthless. The world is unfair. The future is hopeless. Through memory cognitive dissonance, top-down processing, cognitive bias, and memory alteration, people will construct a world around them that fits their existing narrative. Their brains will seek out and accept those things that fit their world-view, and when they don’t, they will modify the details so that they do.
Classically, the most prevalent model of psychological health is of the person who is willing to go deeply into his or her own problems. Hidden within this view of mental health is that one is attempting to establish a sense of certainty about the self, as if it could be known, or exposed, completely; as if we could dig down, as Freud wished, through the archaeological layers of the self to its roots in order to know it absolutely.
However, there is no immaculate self to find, nothing to dig down to discover or fix. As we have seen, the self is an active construction that is constantly changing. We can take advantage of this fact. By knowing how it is constructed, we can tailor therapy to override or highjack the mechanisms that give rise to it.
Cognitive dissonance and psychotherapy
Cognitive dissonance is one mechanism by which the self is cohesively maintained, and we can turn this mechanism on itself in our favour.
When we do something that is in conflict with our views of ourselves and the world, it produces dissonance. One of the ways to resolve this and maintain the self illusion is by unconsciously changing the views to fit in line with our behaviour. If we encourage our patients to act in a way that challenges a preexisting view, we put pressure on that view to shift. Behavioural therapy encourages repeated challenges to the self, which can in turn alter views of the self that align with those actions. Once we start to change the self that the brain is constructing, protecting and maintaining, we get a positive feedback loop, a snow-balling effect, of reinforcing this new self illusion.
However its not the simple case of instructing someone to do something and then their views of themselves will change. Cognitive dissonant studies looking at the difference between “low-coercion” and “high-coercion” groups have revealed that if an individual can rationalise another explanation, such as payment, threat, or the therapist told me so, to explain their inconsistent behaviour, then the effects of cognitive dissonance will not occur. This may be a reason why therapeutic alliance is the most important factor in predicting success. You can’t be forced to do psychotherapy, it doesn’t work. Successful psychotherapy creates the space whereby the psychotherapist guides the patient into their own decisions.
Top-down processing and mindfulness
Another self illusion mechanism we can interrupt is top-down processing. Remember that this top down processing involves guesses based on our expectations, which shapes our perception so that we can quickly make sense of our surroundings.
This can be dissolved by mindfulness meditation. Mindfulness is widely used in psychiatry now, and can be basically understood as training attention on the unfolding of raw experiences. Mindfulness can prevent one from grasping onto usual expectations and the reactions that follow, by being able to notice and disengage from them.
Consider seeing someone waving their hand up in the air. Based on top down expectations, if you are in a classroom you automatically experience this as someone asking a question, whereas on the street you would automatically see this as someone hailing a cab or waving at someone. But if one was physically abused as a child, someone raising hand at dinner table during heated discussion to make a point, top down processing may cause fear of being hit. Same gesture, different perception. When one is aware of being aware, otherwise known as meta-awareness, we can free ourselves from the habits of the self.
Stabilising the self illusion: Chaos theory & network science
When we treat the self like a single core entity, we assume it is a linear system. Simply put, a linear process, given a slight nudge, tends to remain slightly off track, and given a stronger nudge, will deviate further off track. But the self is nonlinear; a chaotic system. You may have heard of chaos theory through the household term, ‘the butterfly effect’. This term refers to a property of complex systems, in that immeasurably small changes in conditions at one point in time can result in unpredictable and large differences in a later state.
Chaos theory has shown us that finer knowledge of a complex system does not necessarily give us better power to predict how it will behave: This has been the end of the Newtonian dream. People are like weather patterns; We can make very basic probability predictions in a short time into the future, but further than that, we cannot know. Unpredictability is hard-wired into the world, us included. So the inability to predict future mental states and behaviour of our patients is not simply a pragmatic issue, its a part of the fundamental laws of our universe.
For example, we don’t know when someone is going to do the most consequential thing in their lives: kill themselves. Studies have revealed that psychiatrists are barely better than a coin flip at predicting suicide. However, we shouldn’t feel bad about this, and there is something we can do about it.
Principles of chaos theory show us that networks such as economies, ecosystems and brains are the most robust and flexible when they are endowed with good integration or interconnectivity. Integration can be achieved by linking different parts of aspects of our mental lives and relationships. As I mentioned before, the wiring of our brains change in response to experience, and one form of experience that we know does this is attention. When one focuses attention on the aspects of the mind and their relationships to one another – to emotions, beliefs, memories and current behaviours – we can help develop connections between these different domains that can then provide stability. This is how mindfulness and the general art of introspection in most domains of psychotherapy can make their contributions.
By taking a wider conceptual view one may view integration as linkage and coexistence of different dimensions and drives, such as professional pursuit, playful exploration, reproduction and child rearing, and social affiliation. Whilst contradicting each other, collaboration across these states is healthy. The notion that we can have a single, totally consistent self is rigid, idealistic and unhealthy.
The psychotherapist illusion
Psychotherapists must also remember that they themselves are an illusory self that their brain is generating, and it too is propped up by constant biases and made up stories. The constructed narrative that “I am a good psychiatrist, I know my patients well and make good decisions about their care” will undoubtedly employ the self illusion mechanisms I have talked about, which can easily fool ourselves into thinking we are doing the right thing, especially in the closed loop environment of patient and therapist. The self illusion helps us realise why anecdote and case studies can be unreliable, and underpins the ongoing need for rigorous, well designed empirical research in psychotherapy.
We all have a constructed narrative – a cohesive view of our selves as coherent beings in a world we understand. When we acknowledge that the self is an illusion we realise how much we can, and indeed do, change. This is an empowering idea.
When we look under the hood of the self, at its inner workings, we find its simply made up of a bag of tricks. Instead of being afraid of this fact, these tricks empower the idea of psychotherapy, can help explain the incredible effectiveness of it, and can help us improve it in the future.
(Apologies for the lack of references at the moment, these will be added soon).
(This is a rough transcript of my presentation ‘Psychotherapy & The Self Illusion’. You can also watch the talk here: https://www.youtube.com/watch?v=PEvtPDnfX94)