WHAT is mind? It is a question that straddles philosophy and science. In this interview to the Arab Times, Dr Khaled Al Saleh meanders deep into the subject, opening a peephole for the layman into the dark factory chambers of our ideas, beliefs and thoughts. What are the basic parts of our mind, and how do they interact with the world around us, to create our personality? How have the practical issues of survival faced by our ancestors shaped our natures, and what are the conflicts that emerge when we try to resize that nature around modern social mores? Read on... and get intrigued.

Question: Psychiatry is a relatively obscure field from a layman’s perspective. Can you tell us what psychiatry is all about fundamentally?
Answer: Basically, psychiatry is a branch of medicine that deals with illnesses or diseases that have psychological manifestations. Diseases or thinking of perceptions, or let’s call it diseases of thoughts and emotions mainly. This is what psychiatry very fundamentally is all about.

Q:  Tell us something about the common types of illnesses that you encounter in your profession?
A: It depends. Here in Kuwait, it is not very different from other parts of the world. The main problems that we see here are depression and anxiety. In the private practice, especially, I encounter problems of mood disorders. Along with that there is also what we call psychotic disorders.
The main psychotic disorder is something that we have all heard about, it’s quite famous, it’s schizophrenia. This is one of the most prevalent psychological disorders that we treat in any psychiatric hospital. Studies show that one percent of any population suffers from schizophrenia. And talking about mood disorders, 15 percent of any population suffers from it. As I said, mood disorders mainly include depression.
So we mainly treat patients with mood disorders, anxiety disorders and psychotic disorders, mainly schizophrenia. In addition we also deal with addiction problems, and some disorders that usually affect children like ADHD or Attention Deficit Hyperactive Disorder, or cases of mental retardation with behavioral disturbances, which make a very difficult combination in children. Usually it’s the families of such children who suffer more. Then there is autism, we also deal with those cases.
And if you look at the other end of the age spectrum, the elderly, we deal with cases of dementia.

Q: Before we get further into the subject, I would like to know if there is any medical definition for mind. What is mind?
A: There are no precise definitions for mind, it’s a mixture of many factors. It’s a mixture of what we think, our cultural background, our personal experiences, beliefs... so it’s a mixture of all of that. In my personal opinion, what we mean by mind is exactly what we mean by personality. Each one of us has our own personality. Personality in turn can be defined as the way how we perceive things or the way how we understand things, and how we react to our basic needs, and how we communicate with others. These factors form our personality.
I think that any definition of mind can’t be very far from this, because our mind defines our personality.

Q: Doctor, all the things you just said about mind, as far as I can understand, are only projections of the mind. How we understand things, communicate, react to needs and so on are things that emanate from our mind. Therefore, the question of what mind is still remains.
A: Okay, let’s go to what Freud said about mind. He divided mind into three parts. He talked about the basic needs or instincts of man, the ‘drives’ as he called them. Sex, aggression and narcissism, he said are the basic psychological needs of man. Those needs, he said, are very important for us to survive.
Then he said that there is another part of our mind that develops as a result of our interactions with our surrounding, from our culture... the higher expectations of life like manners and societal norms, for example.
The mind has an in-between stage, which interfaces between these two stages, and that ensures that our basic needs are met within the context of the higher expectations or societal norms. The basic needs part, is called Id, and the higher level where our manners and other aspects develop from our interactions with the surrounding is called the Super Ego. And the in-between part that balances between our needs and higher expectations is called the Ego.
Freud said that these three parts together form the mind, and the interplay between these parts is a constant process. It’s because of the combination of these three parts that each of us has a different personality. The way my Ego ensures that my sexual needs are satisfied is different from the way it happens in another individual.
This is the Freudian explanation of mind. And I think he is right. There are different schools of thought that emerged after Freud, but from our experience of dealing with patients, we feel that Freud’s school of thought was pretty accurate.

Q: It sounds like mind is a projection of the chemical and neural activities in our brain? Is it right?
A: Our thoughts are the result of certain chemical reactions in our brain. The way they react will make us think in a certain way. We know that for sure. Having said that, let me also say that it’s quite a complex subject, because that begs the question: whether it’s the release of certain chemicals in our body that’s making us feel or think a certain way, or is it our experience of the moment and the interaction between our ID and Ego that lead to the release of certain chemicals.
To put it in another way, let’s say that you are feeling depressed and if I were to open your brain and check it, I will find that certain chemicals in the brain are not in the expected amount. For example Serotonin level in the brain will be low if you are depressed. Now the question is: are you feeling depressed because you have a deficiency of Serotonin or do you have a deficiency of Serotonin because you are feeling depressed?
According to the Freudian school, your Ego is unable to satisfy your Id, which means your basic psychological needs are not met. That’s why you get anxious and that’s why you get depression.
Other schools of thought say it’s just a problem of chemical imbalance. You feel depressed or anxious because certain chemicals are not there in sufficient amounts in the brain. It’s like how at a certain stage in their lives, some people suffer low insulin production and become diabetic. Similarly, at some point of life your Serotonin level drops and you get depression.

Q: Can depression be cured through administering of Serotonin? If, yes, then isn’t it an evidence against the Freudian school?
A: Yes, drugs like LSD and other freak drugs are said to be addictive precisely for this reason, they are mood enhancers. And these contain Serotonin. People abuse these drugs because they are cheerful under their influence. So, yes, I can give you Serotonin and you will be happy. I can change your mood, if I can adjust the balance of chemicals in your body. So, you are right, this evidence goes against Freudian school.
However, we also have evidence to show that if the basic needs of the Id, such as sex, aggression and narcissism are satisfied in a person, depression can be cured. And when you analyze the history of all the patients suffering from depression, you can find there is a problem in the satisfaction of their basic needs.

Q: How scientific is psychiatry as a discipline? From all the various conflicting schools of thought, without any of them having a definite empirical backing... it just makes the whole thing look a little fluid, and subjective.
A: Yes, psychiatry as a branch of medicine is very new. It was initially a part of neurology, and after Freud is when it evolved into a discipline of its own. We are expecting that in the coming few years, things will be very different. In all the branches of medicine, the cause of illness is very precisely known. If it is diabetes, you know exactly what’s causing it, what happens to the pancreas, and how the insulin production is affected and so on so forth.
However, in psychiatry the cause of illness is not known accurately. We don’t know why for example Serotonin production is going down, what’s happening in the brain, or if there is any specific gene responsible for this. Now, we have made progress and have in fact identified specific genes that are responsible for certain psychiatric illnesses. Once we find out the causes for illnesses, we will be able to treat them better. This will make the whole discipline more scientific.
I know a lot of emerging patterns of thought that are against psychiatry. Scientology for example. It’s like a new religion, and its adherents are very aggressive when it comes to attacking psychiatry.
But I think increasingly psychiatry has been evolving as a strong discipline, and we are making progress. Look at psychiatric patients in the 1940s and 1950s. In those days, patients were not able to lead a normal life or even be a part of the society. They were incarcerated in certain facilities, where they had to spend their entire life. Now, with the new drugs that we have, we are to a great extent able help these patients function in the society. Now anxiety and depression patients can go out and socialize with others with the help of medicines. This is the strongest evidence that we have to show psychiatry is a scientific discipline. It means that medicines are changing the lives of patients. It is solving their problems. Moreover, there is no alternative to this. People who ridicule psychiatry don’t present a clear alternative to treat the problem.

Q: One of the biggest accusations against Freud is that he interpreted man as a sexual creature, tracing all his psychological manifestations to basically sex. So, is that all man is? Is he nothing beyond a bunch of neurons and chemicals constantly whipping up a sexual storm?
A: This is a complicated subject. I believe that sex plays a very important role in all our lives. We don’t like to think about it a lot, because we feel that it is something very basal and animalistic and to think too much about it is like degrading ourselves as humans.
But if you look at it very objectively, humans or for that matter any species has survived through the ages only because of very strong sex drives. Without it, we would have never made it from the primitive stages. Have you thought why we like to eat high-calorie food all the time? It’s not just an accidental taste that we have developed with the emergence of fast foods. This is how we have been from the beginning. If it were not so, then we wouldn’t have survived through the harsh conditions of the prehistoric age. Food was at a premium in those times, and we had to make the most of high-calorie food whenever it was available to prepare ourselves for the uncertainties of future. Because you may have food today, and you may have to go hungry for the next couple of days. That’s what has happened in the case of sex. The times were so difficult that only a few offspring would make it to adulthood for the continuation of species, and we needed to reproduce a lot to maintain the population. For this we needed very strong sexual drive.
Today, we have inherited the same sex drive of our ancestors, but due to our modern way of living, expressing it has been highly controlled. As a result, most of us are suppressing our sex drive to cope with the new environment. Some of us are able to suppress it successfully, while others are not. When you are not able to suppress it, then it leads to big problems. Mainly the anxiety problem. And it takes a long time before you know that you are suppressing your sex drive in a faulty way. Because you are loath to talk about your sexual problems, you may try to blame your boss, your children, wife and so on for your problems. You take a lot of stress.
Similarly, narcissism. It is a very strong need. You want appreciation for what you do. If this need is not met, most of the time you get depression.

Q: Can you explain how people suppress their basic needs the right way and the wrong way? Also, do you think polygamy can offer some solution to the fulfillment of repressed sexual drive?
A: Freud spoke about what is called the ‘Defense Mechanism.’ This is the mechanism by which you make sure that your basic needs are met in a way that is accepted socially. Suppression of sex drive is a defense mechanism. So, there are some 12 defense mechanisms which we usually employ; however, if not applied appropriately, we end up with anxiety and depression. So if you are not married, or your wife is not able to satisfy you, or if you have a fetish and you are not able to express it duly — by the way most of us have fetishes, whether we accept it or not — and your Ego is not able to suppress it effectively, then it will show up as anxiety.
While, I support the Freudian school, I think there are some things that need to be added. We know from our studies and experiences that ‘loss’ is a big factor that contributes to psychological problems. Loss of anything. In my opinion, dig into the history of any depression patient and you will find there is sense of loss. It could be a loss of somebody you loved, or loss of health, independence... if a person who is very active in life is suddenly rendered inactive due to paralysis or some other reason, in 99 percent of the cases, the patient will go into depression, because he is losing his independence. Also, when a person suddenly develops diabetes, and is unable to eat things that he loves to eat... this can result in a sense of loss and depression. So, loss is a very important factor in mental illnesses, and Freud didn’t touch upon this.
Then there is another significant phenomenon, called ‘Learnt Helplessness.’ Some children learn that whatever they do will never get appreciated by their parents or their caregivers. And this leads them to feel that doing anything is useless. This sense of helplessness is carried into their adulthood, and they will turn out to be very negative individuals. It’s learnt from their childhood, and so ‘Learnt Helplessness.’
Coming to the subject of sexual repression, in the past we were able to better manage our sex drive. Because in the old days, it wasn’t a shame to have many partners. Having many partners was helpful. Even if you look into nature, you can see that in many animals and birds, the courtship rules dictate that the female feels loyal to the male, while the male has many partners. I believe that even we humans basically have this nature, and because of modernization, we have moved away from that nature, at the cost of our sex drive.
We are not really frank in dealing with our sexual drive. And our ideas of morality have changed, and make us guilty to pursue our nature. Even when people go to countries with relaxed moral codes to have a good time, they don’t feel good about it deep within. They are hounded by a sense of guilt. In the old, multiple sexual partners were a matter of pride for men, but that has changed now.

Q: So, what is the right approach? Should we return to the ways of the old and have a more open attitude to sex?
A: I can’t say what is right or wrong. Definitely, to be restricted in our sexual behavior will make us better humans. But that for sure is not closest to our true nature.

Q: One way of testing the rightness of anything, especially in a sociological context, is to check how close something is to our innate nature. From that point of view would you say that polygamy is more suited to us, and so more right?
A: It’s a package. Because if you are going to give your sexual drive a field day, then what about the need for aggression. Certainly, keeping our aggressive nature under check is good for all. So, suppressing that need has done the society good... secondly, what about the female partner. When man keeps his sex drive under control, the female gets more security. Therefore, it’s a package and has to be seen in its cumulative effect.

Q: I read that certain chemical reactions in our brain that are beyond our control actually influence our choices? If that’s true, isn’t it damning the whole idea of free will? How free is our free will?
A: The center of our decision-making is in the fontal lobe of our brain. How we make decisions depends a hundred percent on our personality. Now, we also know that every thought in your mind is represented by a chemical reaction in your brain. So when you make a decision, certain chemicals undergo changes in your brain. Can I influence your decisions by changing the chemicals in your brain? Yes, I can. For example, I can make you take some vary daring decisions by giving you stimulants, like cocaine. Similarly, I can make you back out of something by giving you medicines that triggers anxiety in you.

Q: The influence of drugs on our free will... is it open ended or is there a limit to it... for example, could Osama Bin Laden have been converted into a US lover from a US hater through medicines... or would it only be to the extent that you could have made him back out of carrying out an attack in the US?
A: Yes, drugs have their limit. Making Osama love America... no, that’s not possible. Drugs can’t alter deep ideological beliefs. It can only make mild alterations in the immediate contexts of certain decisions. The technique of ‘Brain Washing’ was experimented by the US army during the Korean War... or may be it was in Vietnam, I am not sure. They were trying to turn enemy combatants into friends through this technique, and they were said to have succeeded to some extent. It involved drugs and therapy. But due to the ethical questions the experiment raised, it had to be abandoned.

By Valiya S. Sajjad
Arab Times Staff

Dr Khalid Mohammed Al Saleh is a psychiatrist. After graduating from the medical school in Kuwait in 2000, he pursued higher studies. He is a Fellow of the Royal College of Physician and Surgeons in Canada. He is practicing at the Psychiatry Hospital in Kuwait, and also does private practice in the afternoons. Dr Al Saleh has been practicing psychiatry in Kuwait for about 11 years now.