Movies in mind: Dr. Strange —‘I think (I am a receptor) … therefore I am’

‘Strange’ that it is a Hollywood blockbuster that would evoke such introspections, but the makers of this action-hero movie should be credited for their serious critique of all things ‘western’, including the fundamental assumptions underpinning modern institutions of medicine.

Dr Steven Strange at first epitomizes the smug narcissism of a stereotypical American surgeon—someone who receives widespread adulation and ensuing material fame for both his dexterity and intellect—to the point that he becomes a medical ‘god’. And then … his sudden fall from grace, followed by the painful journey to wisdom and the acquisition of authentic understanding that lead to his eventual ‘enlightenment’.

The plot is intricate, fascinating and certainly a visual delight for any moviegoer. But more than that, it is the questions the movie poses that truly intrigue: What if all we think we ‘know’ and ‘see’ around us is false? And just because we can’t see it, does that mean it doesn’t exist? What is the role of faith in healing? Are there dimensions of existence beyond this material world? And finally, where does human consciousness fit in? Such philosophical concerns date back centuries—to Plato, on to Descartes’ (1998) famous ‘Cogito ergo sum’, evolving later with Locke’s, Newton’s and other enlightenment paradigms (Gottlieb, 2016) into the modern empirically based medicine that is taught today.

It was nicely thought-provoking, however, to see the intangible ‘mind’ or ‘spirit’ (or astral body as the movie terms it), revived in this movie. In so doing, it reared an ongoing but uncomfortable truth for all physicians: what exactly is it? Is the mind, as Steven Strange first asserts, ‘only matter’? Such conclusory thinking exposes the essential schism between ‘eastern’ and ‘western’ philosophies, particularly with respect to mind’s rather intangible relationship to the body (Unschuld, 2009).

For the majority of practicing psychiatrists (of which I am one), this conundrum remains a daily reality. Human beings will never stop presenting to us in psychic pain and distress. Yet, notwithstanding platitudes, we now (perhaps also smugly) can easily look past this pain to our ‘receptor of choice’, arguably distilling the patient’s narrative into a reductionist ‘formula’ that paves the way for polypharmacy as well as supposedly targeted technologies such as transcranial magnetic stimulation (TMS). Even therapy appears to have given way to rather formulaic approaches such as cognitive behavioral therapy (CBT)—which tend to divorce uneasy, nebulous feelings from concrete, ‘distorted’ thoughts. Hence contemporary treatment approaches and their promulgation of rigid, ‘straight lines’, which appear more akin to mathematics than holistic healing.

This is how we (at least in American psychiatry) appear to have collectively evolved in the last few decades. Thus, it was in 1980 when the American Psychiatric Association successfully demoted the role of nuanced psychopathological enquiry in favor of its monotheistic, Diagnostic and Statistical Manual of Mental Disorders, Third Edition–Revised (DSM-III-R) criteria-based diagnoses. The DSM has, in its various iterations, gone on to dominate psychiatry since (Anand and Malhi, 2011). Then in 1990, we were introduced to the ‘decade of the brain’ (Tandon, 2000), and so ensued a cascade that effectively hitched clinical psychiatry to a wholly medical and materialist paradigm. Now, in the new millennium, we are witnessing the emerging influence of ‘evidence-based’ medicine plus various algorithms for treatment of psychiatric disorders.

Is it any wonder then, with such a ‘digitized’ approach, that we (as professionals) no longer have any use for, or apparent interest in, the terms ‘mind’, ‘spirit’ or ‘psyche’? An irony indeed that the original psych in psychiatry has seemingly evaporated. Perhaps that is why religion and ‘complementary medicine’ (such as Yoga) still hold such enduring appeal for the public. Surely, there is a lesson to be learned for psychiatrists here. The question remains, ‘Is our profession curious enough about something it will likely never understand?’ Perhaps it’s just easier to promote the ‘known’ over the ‘unknown’ because at least that makes us feel credible? If Dr. Strange can teach us anything, it is perhaps that modern medical science should not become a ‘false prophet’, for it is mankind itself that can (and eventually will) suffer.