By Gunnel Minett

Much has happen since Freud started to bring our attention to psychological problems. Freud, who originally worked as a neurologist, saw ‘brain damage’ as neurological disorders, particularly ‘hysteria’, that could be influenced by psychological factors and unconscious processes.

He regarded behaviour as entirely caused by unconscious emotional drives that left little room for personal agency and free will. When Freud discovered that talking to his patients could change behaviour, he turned away from trying to find answers merely in neuroscience and invented what he called ‘talk therapy’. The focus here was to deal with psychological problems through a dialogue between therapist and patient. 

The goal, as Freud saw it, was to bring unconscious conflicts into conscious awareness, allowing individuals to gain insight and manage them more effectively, thus alleviating suffering. The therapist, with his knowledge of psychological illness would ‘treat’ or ‘cure’ the patient, simply by asking the right questions and thus guiding them away from their destructive behaviour. His technique centred on the idea that unconscious thoughts and feelings, often rooted in early childhood experiences, significantly influence a person’s behaviour and mental health.

Further development 

Freud’s follower Carl Jung, took Freud’s talk therapy further and developed analytical psychotherapy to have a more holistic approach. Jung’s approach was initially a theory concerning psychological complexes. Later on it turned into a more generalised method of investigating archetypes, i.e. concept shared in mankind’s collective unconscious. He also emphasised that lifelong personality development could be achieved through, what he called individuation, which is a process of integrating conscious and unconscious aspects of the self to achieve psychological wholeness. Dreams became an important element in this process and the relationship was less formal than the strict analytical approach, based on the idea that the therapist should not be involved in any way with the patient’s trauma. In addition, Jung studied Eastern philosophies and was influenced by them when formulating his understanding of the human psyche. This influence included Jung’s personal experience of yoga, breathing exercises and meditation.

In Freud’s theory, the therapist was clearly ‘treating the patient’ rather than helping them to find a better way for themselves to reach and maintain psychological health. To emphasise this, Freud’s view was that the therapist should sit at the head of the patient’s couch, unseen by the patient. Despite seeking a more holistic approach, Jung too saw therapy in terms of a relationship between ‘therapist’ and ‘patient’, in which the therapist’s expertise ‘cured’ the patient.

Next step

After Jung the next big step in the development of psychotherapy was the introduction of Behaviourism in the 1920’s. It was in many ways a step back to a more scientistic neuroscience approach. Behaviourism’s main strategy was to ‘train’ the patient to change their neurotic behaviour. It was based on a learning theory which focuses on observable and measurable behaviours, emphasising the role of environmental factors in shaping actions. All behaviour was regarded as learnt through interactions with the environment, primarily via conditioning processes such as classical and operant conditioning. Behaviourism saw no need to delve into internal mental processes. Instead, the mind was seen as a ‘black box’ that cannot be directly observed or studied. 

A more comprehensive understanding

Freud’s ‘talk therapy’ has over the years developed into a more comprehensive understanding of psychological illness. Freud’s ‘cause-and-effect’ view of the psyche, which largely excluded free will, lent itself well to the paradigm of neuroscience. Behaviourism’s ‘black box’ approach was also congruent with this approach. 

If psychological problems are caused by, or are causing brain damage, they can be identified and analysed. With time this has widened to include a range of problems. Much of the ‘cure’ has been focused on treatment with psychopharmacology. These are drugs developed from the study of the brain and microbiology.There are now a wide range of medications which are primarily used to treat mental illnesses. These drugs affect mental processes, emotions, and behaviour.

To develop these drugs, neuroscientists studied the brain to see which parts are involved in certain activities and behaviours. This research is still to a large extent based on the assumption that the brain operates on a cause and effect basis, like a game of dominos, where one piece triggers another, which triggers another, and so on. The goal is to isolate the key part(s) of this chain reaction in order to change the whole chain. This is despite the fact that the domino effect has started to be challenged by some modern neuroscientists.

This method is used to treat common psychological problems, such as depression, anxiety, ADHD and PTSD as well as other types of brain-related disease, such as Parkinson’s and Alzheimer’s disease. This is despite the fact that their pathologies show many clear differences. A problem with this general approach is that it does not always work and neuroscientists struggle to understand why. According to the theory, when a problem area has been identified and isolated and the ‘mechanism’ to ‘repair’ has been discovered, then it should work. So when this does not happen, they have to go back to square one and re-investigate the problem area. Why it does not always work is still puzzling. Although the problem may have been known for decades, there is often still no real solution in sight, despite huge efforts. This includes problems such as depression and anxiety.

One result of this is to simply to take a ‘try and see what happens’ approach with new drugs. Although the trial and error approach is both time-consuming and costly, the pharmaceutical industry can make large amounts of money if and when they find the ‘right’ cure. This is why they are willing to spend the money to fund years of research in the hope of finding the pot of gold at the end of the rainbow!

Medicalisation 

The neuroscience approach has resulted in the development of a pharmaceutical treatment and classification approach to psychological illness. Medicalising a wide range of psychological problems is still the mainstream approach in many countries. In particular in countries where the main treatment model for disorders is part of a national health system. A major benefit of this approach is that, unlike talk therapies which can take years, the patient can be prescribed medication and sent home after a short consultation with their doctor. This way many common psychological problems can also be treated by a general practitioner without specialist training.

In line with this approach, the diagnosis of new psychological disorders are continually being added to publications such as the The Diagnostic and Statistical Manual of Mental Disorders (DSM). This is the primary handbook used in the United States and much of the world for diagnosing mental disorders. In addition to diagnoses and criteria, it includes information on the impact of factors like racism and discrimination on mental health. Particularly in USA, where health care is mainly paid for by insurance companies, having a mental disorder listed in such a publication is essential to secure payouts from health insurance. A major problem with this approach is that far too many psychological problems are classified as ‘disorders’, needing treatment by a specialist, rather than being accepted as the natural, emotional ups and downs of our individual lives.

A way forward 

The advanced technology in modern brain research has started to generate a more sophisticated understanding of how the brain works. The brain is not simply driven by cause and effect reactions: rather, there are a number of feedback and feedforward loops which influence the workings of the brain. There is now a growing acceptance that a healthy brain works to maintain a delicate balance at the ‘knife edge’ between feedback, order and chaos.

This new, holistic approach is gradually beginning to lead the way for research into psychological illness. Even if the change is slow, neuroscientists such as Professor Nicole Rust have recognised the need for change. In her new book, Elusive Cures, Why Neuroscience Hasn’t Solved Brain Disorders – And How We Can Change That, she is suggesting the need for a New Great Plan for neuroscience to change its approach in its search for a better understanding of brain related problems. 

One such reform, Rust suggests, is the use of psychedelic drugs to treat a variety of disorders, including addiction, PTSD, depression, psychosis, OCD and chronic pain. Studies with mice have shown that some drugs, such as psilocybin, LSD, MDMA and ketamine, have a positive effect on their social behaviour. This has led to a growing number of hospitals and clinics offering drug induced therapy under strictly controlled forms.

A step too far?

One problem with psychedelic drugs is their possible side-effects. Not all patients have a positive reaction. And despite the promising results with mice, their brains and social life is nowhere near as complex as they are for humans. So, to really advance in this area, the methodology may need to be developed beyond what is possible in the current scientific paradigm. This will probably require a new understanding of consciousness and new ontological concepts, such as pan-psychism, energy and non-verbal communication, which are currently not accepted as part of science and generally dismissed as ‘paranormal’. 

One method which could lead the way for such a step forward is breathwork: it can, at the least, provide a safe alternative to psychedelic drugs. Breathwork is not in any way a new method for accessing the inner world of the psyche. Altering the breathing pattern has been part of Yoga and Chinese medicine for thousands of years. Some forms of altered breathing have featured in most ancient, cultural rituals. In Yoga and Qigong there are a number of breathing exercises aimed at both invigorating and calming the body and mind. The Swedish philosopher Emmanuel Swedenborg developed his own breathing technique 350 years ago. Through his use of breathwork he ‘intuitively’ learnt a lot about the human psyche which modern neuroscience has confirmed to be accurate. 

Many modern breathing techniques can produce the same positive effects on the psyche as does psychedelic drug therapy, but with the added benefit that they are completely free of side effects. Done correctly, breathwork should not cause hyperventilation, a potentially harmful reaction that often is confused with some forms of breathwork therapy. There is, however, one clear obstacle when it comes to introducing breathwork to brain research within a neuro-scientific framework: it does not lend itself to ‘un-biased’ blind trials with comparative groups, aimed at avoiding the placebo effect. You can’t have a separate group in which subjects are unaware that they are doing breathwork as part of a trial. Neither does it work well to try and replace the presence and guidance of an experienced therapist with recorded instructions in an effort to avoid any form of bias. 

Several universities in Britain are researching the possibility of using breathwork as a form of psychotherapy in the National Health System. In order to meet the required scientific standards, they are obliged to try to develop and record breathing instructions. The idea being that they can develop a standard test as to whether the breathwork is proving effective. Such recorded  instructions are intended to ensure that procedures are standardised, in order to safeguard against any ‘unscientific bias’. Observing such rigorous methods is regarded as essential if the research is to be accepted as ‘scientific’. But it also shows a total lack of understanding as to the importance of the physical presence of a therapist. 

In Breathwork (as in other forms of psychotherapy) creating a positive relationship between patient and therapist is as important as the implementation of the actual technique. Another equally important factor is enabling the ‘patient’ to understand that they are not the passive receiver of therapy, but rather the active ‘client’ working towards healing themselves with the help of an assisting therapist. In other words, its necessary to emphasise the difference from conventional forms of medical treatment, in which the doctor is the authority and the patient merely the receiver of treatment. 

A change in attitude 

Being the client rather than patient is not how Freud, and subsequent experts in the field, have understood therapy. Nor is it in line with the ‘un-biased’ scientific approach of ensuring that research is open to replication. However, this revision of roles in the therapy session must become accepted in brain research if we are to understand how psychological ill health can be healed. Today’s neuroscience is still focused on a ‘mechanical’ approach to understanding mental ill health. One negative consequence of these earlier approaches is that many psychological problems are being diagnosed and medicalised, often quite unnecessarily and with negative results. Not all these ‘conditions’ are ‘disorders in need of treatment’, for example, many cases of depression. Not all hyperactivity is caused by brain malfunction. Not all anxiety is without an explanation. Some physical changes in the brain can be explained by an understanding of psychology. Despite the fact that pharmaceutical research has successfully produced a range of drugs to help against psychological problems, they may not always be the right answer, or even be helpful. On the contrary, prescribing anti-depressants or tranquillisers will often lead to a weakening of a person’s ability to deal with their problem: rather, real help would be to support and encourage the person to understand how they can solve their own problems. We need to take a wider approach to psychological problems, and accept that they may often be healthy reactions to problems in life.

Ever since Freud decided to focus on talk therapy rather than understanding how the brain works there has been a clear divide between neuroscience and ‘talk’ psychotherapies. Neuroscience has proved a rich field of research, in particular since the development of new scanning techniques and with generous grants from the pharmaceutical sector. However, despite our increased understanding of how the brain works, there is still too much of a ‘let’s try and see what happens’ approach in mental health research and too many, possibly bogus, new diagnoses of psychological disorders. On the other hand, those practicing talk therapy often consciously  distanced themselves from the idea that to understand how the brain works is relevant to their work.

Neuroscience should definitely play a role in the understanding of psychological problems. The American psychologist, Louis Cozolino, combines the understanding of brain functions, offered by modern neuroscience, within his work as a psychotherapist. He also emphasises the importance of creating the right client-therapist relationship. In his book, The Neuroscience of Psychotherapy, he describes how he explains the various brain functions to his clients as part of his therapy sessions. Understanding the basics of how the brain works, he argues, helps the client to realise that their psychological problem may be a very natural way to deal with a tricky situation rather than some form of pathology. He also describes his role as a therapist as having to constantly confront his own vulnerabilities, while remaining aware of his limitations and also the psychological processes taking place beyond the conscious awareness of both client and therapist. In other words, in a therapy session, both client and therapist are actively involved in a joint healing process, in which the therapist is using their knowledge of the psyche to achieve the best possible outcome. This process can be described as the therapist ‘lending’ the client the therapist’s ability to handle a trauma: this ‘loan’ acts as a sort of guide to teach the client to help himself rather than providing a ‘cure’ for their problem.

Tomorrow’s world

Breathwork and other forms of meditative non-verbal therapies can offer insights into the human psyche which are personal and intuitive rather than based on scientific research. This kind of knowledge may be very different from that found in, for example, papers in scientific journals. (An article like this one would almost certainly be rejected as non-scientific.) Though this would, I believe be a short-sighted mistake! If we are to fully understand the connection between brain and psyche we need to be more broad-minded. Emmanuel Swedenborg claimed to get his knowledge of the human psyche and brain from talking with angels during his breathing sessions. His work was treated with suspicion, even during his lifetime, but he has now been proven to have acquired in-depth knowledge of the psyche, as modern neuroscience has only recently been able to confirm with the help of cutting-edge technology. 

It may require a large step away from the current scientific paradigm to investigate the experiences and effects of non-verbal psychotherapies such as breathwork or psychedelic-drug therapy. However, given the very positive results from these techniques, it would be a real mistake to not investigate them further. Rather than excluding these alternative techniques because they do not fit into the current scientific paradigm, the time has now come to instead question that paradigm. It may be a challenge to find ways to move forward, without losing the current level of scientific stringency. Challenging the current scientific ontology may even up-end our current understanding of the universe, but hopefully the time is right to break these taboos.

Failure to grasp this ontological nettle will mean more medicalisation of mental conditions and increased costs for societies around the world: something has to change. This is of course not to say that scientists should start to talk to angels or meditate to achieve new knowledge. Despite Artificial Intelligence being the current, scientific ‘buzz’ word, when it comes to exploring the human brain and psyche, AI may actually not be as knowledgeable as Swedenborg’s angels. But hopefully there will be some scientists realising that the brain is more than algorithms and that there may be a need to explore other ways forward. Nature has after all lead us to where we are today, so learning more about natural ways of dealing with psychological problems may produce positive surprises.

References:

Abarbanel, Avigail; Therapy Without A Therapist : A DIY Guide to Good Mental Health & Growth, Fully Human Psychotherapy, 2020

Cozolino, Louis; The Neuroscience of Psychotherapy, WW Norton & Co, 2002

Freud, Sigmund; The Psychopathology of Everyday Life, W. W. Norton & Company, 1971

Minett, Gunnel; Exhale, An Overview of Breathwork, Floris Books, 2004

Minett, Gunnel; How to Grow a Healthy Mind, Mmedia, 2016

Minett, Steve; How Consciousness Probably Works, Kindle Books, 2021

Papadopolous, Renos K; The Handbook of Jungian Psychology, Taylor & Francis, 2006

Rust, Nicole; Elusive Cures, Why Neuroscience Hasn’t Solved Brain Disorders – And How We Can Change That, Princeton University Press, 2025 

Swedenborg, Emmanuel; Heaven and Hell, Jazzybee Verlag, 2013