6.2a Introduction to mental health
This chapter is dedicated to the study of the mind and its related diseases. Unlike all other physiological systems, the physical structure and functioning of the mind cannot be scientifically measured and described. This is in stark contrast to the measurability of anatomy and physiology of a system such as the skin or the blood. Despite this profound difference, in many ways the mind and its related diseases are categorized and studied within conventional medicine by means of a very similar approach to that used in the study of the more physically defined systems.
In conventional medicine the diseases of the mind are termed mental health disorders. The mental health disorders are managed within the medical specialty of psychiatry and the non-medical clinical specialty of psychology.
The medical specialty of psychiatry is a relatively young discipline in the history of conventional medicine. The term is derived from the Greek words psyche (meaning mind) and iatros (meaning doctor). Psychiatry is the specialty dedicated to the medical treatment of mental health disorders.
Psychology is a term used to describe the academic and clinical disciplines that are based on the study of the workings of the mind. A clinical psychologist is a therapist who has gained a degree in psychology, and then undergone further training in the practical application of psychology in the clinical situation.
Psychotherapy (literally meaning treatment for the mind) is a term that describes any approach that involves the use of the formal and systematic clinical relationship between the therapist and the client as a therapeutic tool. Psychotherapy may be utilized by psychiatrists and clinical psychologists, but also by practitioners who have undergone specific training in one (or more) particular form(s) of therapy. The different types of psychotherapy are explored in more detail in Section 6.2c.
The aim of this section is to introduce the general approach by which mental health disorders are understood conventionally. Psychiatrists and psychologists classify these disorders in a quasi-systematic way, but, unlike most of the diseases studied within the other medical specialties, the two classification systems currently used are in large part based on the manifestation (symptoms and signs) of the disorder rather than on its physical cause(s).
The section begins with a brief exploration of how the mind is generally seen from a medical perspective as a distinct entity with respect to the other physiological systems. This is despite increasing scientific evidence that the mind is inextricably linked with (and may well even be rooted in) the function of these other systems. The section then goes on to consider the conventional understanding of the causation of mental illness.
Mental health and the mind-body divide
The very existence of the disciplines of psychiatry and psychology indicates the depth to which the mind has, in recent medical history, been perceived as a separate entity to the other physical systems of the body, such as the cardiovascular or the urinary systems, and even the central nervous system.
Doctors would generally assent to the understanding that the mind emanates from the workings of the brain. It is commonly believed that the neural pathways, synapses and neurochemicals that are clearly the foundation for the electrical activity of the brain are also the basis for thoughts, memories and emotions. However, this neuropsychiatric perspective is a relatively recent phenomenon, and historically the mind would not have been so absolutely located within the space of the cranium. For example, the Oxford English Dictionary defines the mind as “the seat of awareness, thought, volition and feeling…concentration [and] memory.” The full dictionary description does not mention the brain, but instead describes the mind as if it were a distinct and free-floating entity. Moreover, even in medicine there seems to be a division between the mind and the brain. The structure and known workings of the brain are embraced within the medical specialty of neurology, and yet neurologists are not necessarily expert in the psychiatric diseases. The mind is managed within a totally different specialty. This reflects the fact that as yet the precise links between the workings of the physical brain and many mental health disorders have not been adequately explained.
The idea that the mind springs from the physical workings of the brain is a relatively recent development in Western culture. In contrast, the theory that the emotional and mental disorders were rooted in the bodily humors and their imbalances was described by the Greek physician Galen (circa 200 BC). The belief in the four humors and their expression in personality and emotional balance persisted throughout Europe well into the third and fourth centuries AD. Thereafter, in the West, the influence of the monasteries strengthened the ancient concept that mental illness resulted from a possession of the spirit by evil forces and was something that could afflict even the righteous.
With the intellectual revolution of the Enlightenment in the 17th and 18th centuries came an increasing appreciation of the physical world as something that could be understood by means of reason and scientific method. Mind and spirit were believed to be distinct from this physical domain. As church and state diverged, the care of those with mental ill health became the province of the medical profession, and illness of the mind was recognized as different from the biological illnesses that required physically based treatments. The practice of psychiatry as we recognize it today emerged out of the 19th-century phenomenon of asylums. These institutions were a response to the management of mental illness in the overcrowded industrial cities. In these settings doctors, and notably the German neurologist Emil Kraepelin, started to classify mental illness on the basis of common features, and conditions such as manic-depressive illness and schizophrenia (dementia praecox) were distinguished. The concept that there was possibly a biological basis for mental illness became more prominent in this time. This was despite the fact that very often there were no obvious signs apparent in the physical structure of the brains of those with mental ill health. Later in the early 20th century biological treatments such as electroconvulsive therapy and lithium and antidepressants (derived from medication first used to treat tuberculosis) were trialed on patients in asylums and found to have profound effects.23
These discoveries presaged the current psychiatric biopsychosocial model as the theoretical basis of psychiatric practice. This model proposes that psychiatric conditions arise as the result of a combination of biological, psychological and social factors. In this way their origin is seen as linked not only to the mind, but also to physical changes in the body and to factors in the social environment of the patient.
There is now an increasing body of scientific evidence that strongly links some mental health disorders with certain chemical imbalances of neurotransmitters in the brain, and, more controversially, with levels of the hormones that circulate throughout the whole body. This is the realm of neuropsychiatry, a rapidly expanding discipline in which the focus is on how disease of the chemical structure of the brain might manifest as mental illness.
Neuropsychiatry offers a conventional description of an undeniable link between mind and body (i.e. the physical structure of the brain). Moreover, as it is increasingly recognized that there is a significant overlap between the diverse neurotransmitters of the central nervous system and the hormones of the endocrine system, it becomes possible that this mind-body link need no longer be confined strictly to the brain. Instead, as a product of the subtleties of hormone expression, the changes that appear to spring from the mind might have their origin in diverse sites throughout the body.
Exciting though the potential for holism in these conventional explanations may be, the mind-body divide that first became apparent in the Enlightenment does not seem to have been eroded significantly in conventional medical practice. Currently, many patients of conventional hospital practitioners will experience their mental and physical problems being treated as if they have no relationship to each other (with the exception of those well-described diseases of the nervous system that are recognized to result in mental health dysfunction, such as multi-infarct dementia).
The definition of a mental health disorder
The American Psychiatric Association (APA) offers a definition of mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).24
This describes a mental health disorder in terms of it being a collection of symptoms and signs (a “syndrome”) that is the result of a dysfunction of either the psychological, biological or developmental processes which underlie the workings of the mind. A mental health disorder according to DSM-5 would be expected to be a cause of distress for the patient. The definition also makes it clear that an expected and culturally understandable response such as grief does not constitute a mental illness, and neither does socially deviant behavior.
It is clear that both parts of this definition, the features of the syndrome and also what constitutes distress, would be difficult to define with objectivity. What might appear as distress or a disturbance in cognition or emotion regulation to the diagnosing doctor might not be so interpreted by the patient or within their culture of origin.
This definition is useful in explaining how mental health professionals interpret mental health states, and also what they believe to be the root cause of mental health disorders (i.e. a dysfunction in the psychological, biological or developmental processes underlying mental functioning). The definition reflects the biopsychosocial model of thought, which has been increasingly embraced within modern psychiatry.
The causation of mental health disorder: the biopsychosocial model
As implied by the APA definition of mental health disorder, the diverse mental health disorders are generally considered to have a multifactorial basis for their origin. Many psychiatrists would subscribe to this biopsychosocial model of mental illness. The term biopsychosocial refers to the understanding that a combination of inherited and acquired physical factors (biological factors), factors related to the emotional development of the individual (psychological factors) and factors related to the cultural environment of the individual (social factors) are all relevant in the development of a mental health disorder in an individual. Ideally, in every case presenting to a psychiatrist or psychologist, biological, psychological and social causes need to be considered.
Biological factors in mental health disorders
A biological theory of the causation of mental illness proposes that physical changes in the body are at the root of any illness. The biological perspective is supported by the fact that many diseases or conditions that are known to involve physical changes in the brain can manifest with mental disturbance (e.g. Alzheimer’s disease, traumatic head injury, alcohol intoxication). Moreover, the fact that certain conditions tend to run in families is strongly suggestive of a genetic inheritance, and thus physical basis, of a condition.
Adoptive studies, which demonstrate that children who have been adopted shortly after birth appear to carry the risk of developing mental health disorders apparent in their blood relations, are very strongly suggestive of the genetic inheritance of mental illness. Studies of twins who have been separated at birth and adopted by different families offer even more powerful evidence of inheritance of disease. Conditions such as schizophrenia, manic depression, simple depression, anxiety and panic disorder, obsessive-compulsive disorder and alcoholism have all been shown by these sorts of studies to have an inherited component in their causation. This means that a child of someone with one of these conditions is more likely than the average person to develop that condition.
The neuropsychiatric explanation offered for an inherited tendency to mental health disorders is usually given in terms of an inherited neurochemical makeup. For example, it is recognized that in schizophrenia there is increased activity of those brain systems that involve the release of the neurotransmitter dopamine. It is possible that the increased tendency for schizophrenia to run in families is due, in part, to an inherited tendency for these physical systems to be over-activated. This chemical basis for the genesis of schizophrenia is further supported by the fact that dopamine-stimulating drugs, such as amphetamines and cannabis, can trigger a psychosis similar in form to schizophrenia. Moreover, the drugs discovered originally by chance to be of benefit in schizophrenia, the major tranquillizers (first developed as anesthetic agents), are now known to act by blocking the action of dopamine.
Similarly, the tendency to develop depression may be, in part, a result of an inherited reduction in the expression of monoamine neurotransmitters such as noradrenaline and serotonin (5HT). This is supported by the fact that the various classes of antidepressant drugs all seem to increase the levels of monoamines in the brain. It is increasingly recognized that some of the addictive recreational drugs (e.g. nicotine, ecstasy) may induce a release of serotonin after their use, which is then followed by a more long-term depletion of this neurotransmitter in the brain. Because of this, use of the drug forces the user to face a long-term state of low mood if they choose to withdraw from the drug, particularly if the use of the drug has been prolonged over a period of months to years.
However, an inherited tendency to a condition does not in itself destine a child to develop that condition. It is clear that other factors are usually required to force the expression of a condition such as schizophrenia or depression. These other factors are considered to be either psychological or social in nature.25
Psychological factors in mental health disorders
The psychological explanation of mental illness rests on the principle that experiences during childhood and early adulthood can have a profound bearing on a person’s mental and emotional health. This is such a commonly accepted principle that few would argue against the suggestion that a shocking experience or a period of deprivation in childhood would have long-term psychological repercussions. However, it is only in fairly recent years that studies of traumatic events in childhood have clearly demonstrated a link between certain forms of childhood deprivation and long-term mental ill health. The studies performed by the psychologist John Bowlby in the 1940s and 1950s demonstrated that prolonged or recurrent absence of a consistent mother figure in early life was associated with difficulties in forming emotional bonds and a tendency to criminality and emotional problems in later life.26
Since that time, psychological studies have shown that diverse factors in the family environment, including expressed angry discord, maternal depression, divorce, bereavement, overprotection, lack of parental authority, physical and sexual abuse, unremitting criticism, and taunting and inconsistent discipline, can all be risk factors for misbehavior in children and mental health disorders in later life.
The theories that propose psychological mechanisms for the causation of mental illness are only just over a century old. Sigmund Freud, now considered the founder of psychoanalysis, first proposed in 1905 that there are both conscious and unconscious aspects to the mind. He developed this theory over the next 20 years, and postulated that unconscious forces deriving from deeply ingrained value systems originating from parents or society (the superego), or instinctive drives (the id), could, together with pressures in one’s external life, challenge and cause conflict with the conscious self (the ego).
The conscious self was considered by Freud to develop to its healthy adult form in distinct stages throughout childhood. Freud proposed that the healthy child has to progress appropriately through oral, anal, phallic, latent and genital phases in order to mature as a healthy adult, and problems encountered in any of the stages could result in lasting psychological disorder. For example, he proposed that the anal stage was when the toddler ideally achieves a sense of separateness and becomes independent in terms of toilet training. Problems in this phase might appear in adulthood as a fear of losing control, obsessional traits or depression because of not living up to expectations.
Freud’s theories and their rigid distinctions are less accepted nowadays, but his beliefs that the psyche undergoes progressive development throughout childhood, and that unconscious material originating from episodes scattered along the course of that development can persist to lead to mental illness, still very much influence modern psychotherapeutic practice.
The concept of defense mechanisms, proposed first by Freud and later developed by his daughter Anna Freud, is one that is still very much recognized in modern psychology. A defense mechanism describes any mental response used by a person to protect themselves from psychological pain such as guilt, anxiety or shame. The naming of the various defense reactions has entered common usage. Commonly described defense reactions include denial, repression, regression, rationalization, displacement, projection, introjection, sublimation and reaction formation.
Defense mechanisms can be healthy, and responses such as distraction (e.g. looking for the positive or use of humor) are likely to be used by people who enjoy good mental health. However, mechanisms such as repression of unpleasant feelings (such as might follow an episode of severe abuse), or denial of what has really happened (e.g. an inability to take in a diagnosis of cancer), may actually lead to long-term problems in mental health. The theory is that these sorts of defense mechanisms simply shift conscious mental pain into the unconscious, where the pain may still be felt in the form of depression or anxiety, but from where it is much harder to treat the pain at its root. With this perspective on causation, a psychotherapist works to enable the patient to arrive at a place where this unconscious material is made conscious and the roots of the pain can be understood, and so transformed.27
The cognitive behavioral psychological perspective developed from practical therapies such as Albert Ellis’ “Rational Emotional Behavior Therapy” and Aaron T. Beck’s “Cognitive Therapy” after the 1960s. According to cognitive behavioral theory the causation of disease is based on the idea that the patient has learned inappropriate responses to the world around them because of negative past experience. The cognitive behavioral model interprets unhelpful behaviors in the light of the incorrect thoughts that underlie them. For example, a child who was shocked by the barking of a dog might then tend to be fearful whenever a dog comes close. A behavioral response of avoidance, and maybe even a physiological response of palpitations and sweating, might then persist into adulthood. The cognitive behavioral interpretation of this problem (termed a simple phobia) is that, because of the childhood experience, the belief that “dogs will make me frightened” has been learned, and the inappropriate reaction to dogs has become ingrained as a result of that belief.
Anxiety disorders, eating disorders and depressive disorders are examples of disorders that can be analyzed according to cognitive behavioral theory. The negative responses to the world expressed in these disorders can be related in cognitive behavioral theory to unhelpful learned patterns of thought.
Social factors in mental health disorders
A social perspective on the causation of mental illness necessarily overlaps with the psychological perspective, because it sees factors in the social environment as impacting on the developing psyche. Social theories of the causation of mental illness are particularly bound up in the studies of cultural factors common to communities. Studies on the incidence of mental illness in communities have identified that mental illness can relate to variables such as gender, age, marital status, social support and economic status. For example, there is a recognized link between depression in men and being divorced, a link that is far less pronounced in women who are divorced.28
The study of the effect of life events, such as marriage, birth, divorce, emigration and bereavement, falls into the remit of understanding the social causation of mental illness.
Predisposing, precipitating and perpetuating factors in mental illness
A psychiatrist or psychologist seeks to understand the evolution of mental illness in terms of three factors of causation: predisposing, precipitating and perpetuating factors. Ideally, the factors that have predisposed to the condition, those that have precipitated the condition and those that might be perpetuating the condition need to be clarified if the most appropriate treatment is to be chosen.
Predisposing factors in mental illness
Predisposing factors are those that might have led a person to have become more at risk of developing a mental illness before the illness became apparent. For example, if one looks at the case of schizophrenia appearing for the first time as the sudden onset of a paranoid psychosis in a 22-year-old male student, the predisposing factors might include a family history of serious mental illness (grandfather was in an asylum for ten years and mother had an episode of postnatal psychosis after the birth of his younger brother). There might also be a volatile emotional environment in the family home (mother and father have frequent arguments, and mother often breaks down in tears when stressed). As a child, this student was recognized to be withdrawn and awkward socially.
Precipitating factors in mental illness
Precipitating factors are those that have actually triggered a particular episode of illness. In this case these might include the stress of leaving home for the first time, and the inability to fit into a supportive network of people at college. A recent history of experimenting with ecstasy and frequent use of cannabis could also be included as precipitating factors.
Perpetuating factors in mental illness
Perpetuating factors are those that might prevent the resolution of the mental illness. In this case these could include the lack of social support, continued drug use and self-neglect.
The biopsychosocial model and the choice of treatment
Although there is a general appreciation amongst conventional practitioners that there are diverse factors at play in the generation of mental illness, psychiatrists and psychologists may vary in their treatment approaches as a consequence of the way in which they understand the causation of the disease. For example, for a patient with a mental health issue, a hospital psychiatrist who has expertise in neuropsychiatry and the biological basis of mental illness might favor medical drug treatments. In contrast, a psychoanalyst who is educated in the psychological causation of mental illness might treat the same patient by encouraging them to explore unhelpful emotional reactions that first started to emerge in childhood. The diverse approaches to the treatment of mental health disorders and their relationship to the perceived underlying cause of the disorder are explored in more detail in Section 6.2c.
Mental health disorders: a Chinese medicine perspective
There are many terms used in Chinese medicine texts associated with the mind, but Shen (Spirit) and compound terms that include the term Shen, such as Jing Shen (Spirit Essence), are those that are used most commonly. In Chinese medicine the Shen with Qi and Jing (Essence) are described as the three treasures. These three substances are the interdependent manifestations of Qi.
Therefore, in Chinese thought there is no duality between the mind and body as is so evident in Western thought. Instead, the mind (Shen) is understood as a less substantial aspect of Qi and Essence. All three together comprise the body-mind (Xing-Shen).
Any imbalance or disturbance in the flow of Qi in any of the Organs will have a manifestation at the level of the Shen. All Chinese medicine patterns may therefore include signs and symptoms of a mental and/or emotional nature.
Unlike conventional medicine, in Chinese medicine mental health is not seen as a distinct specialty, but instead as one aspect of health as a whole, and may be treated by experts in “internal medicine” with herbs and acupuncture and methods for relaxation. Psychiatric or psychological diseases are described in Chinese medicine as Jing Shen Bing (Essence Spirit diseases). This term again pays reference to the unity of the substantial body with the less substantial mind.
The Shen is classically the most insubstantial and rapidly moving form of Qi, and is specifically associated with the mind. Shen is also associated with Heart Qi, and the Heart is said to house the Shen. Spirit, in the Chinese sense, has many layers of meaning, but when used from the perspective of the psychological diseases, it embraces the outward manifestation of life, together with consciousness, thinking and feeling.
The five Shen
The Chinese considered the Shen to consist of the five spiritual aspects of a human being, each of which is associated with a Yin Organ. The five aspects are the Hun (Liver), the Yi (Spleen), the Zhi (Kidney), the Po (Lung) and the specific spiritual aspect of the Heart Organ, also given the name Shen. To minimize confusion, in this text this last particular aspect of the Shen will be called Heart Shen.
Each of the five aspects of the Shen is recognized to have particular characteristics, as described below.
The mind/spirit (Heart Shen)
The Heart Shen is that aspect of the spirit which specifically resides in the Heart, but which also embraces the other four Shen. It is considered to be responsible for consciousness, intelligence, thought, insight, the generation of ideas and memory.
The Heart Shen is also important for the ability to fall asleep easily and to have sleep that is deep and refreshing. Shen is also used to describe the quality of liveliness that is inherent in someone who is emotionally very healthy.
The Heart Shen gives the capacity to have insight and to feel the emotions. The ability to form healthy relationships and to feel love and joy is a characteristic of the Heart and Pericardium, which must, in turn, be related to their spiritual aspect, the Heart Shen.
A healthy Heart Shen also confers wisdom, which is the ability to respond to knowledge and challenges with discernment.
The ethereal soul (Hun)
The Hun was thought to be that part of the spirit that leaves the body after death. It is rooted in the Liver Yin, from where it enables a sense of purpose, vision and direction in life. It is also linked with the courage required to face life’s challenges, and the ability to make decisions.
If the Hun is well rooted, sleep is normal and dreams are few. However, the ability to gain inspiration, be intuitive and have dreams is a characteristic of the Hun. The Hun can make images, archetypes and symbols accessible to the conscious mind, and has a link with the universal mind (comparable to the collective unconscious as described by Jung).
The ability to move easily between introspection and relationships with other people has been attributed to the Hun. A balanced Hun prevents the emotions from becoming excessive, so underlying a healthy emotional life.
The Po was thought to be that part of the spirit which is linked to the body, and which remains with the body after death. The Po enables the body to move, and gives the skills of agility, balance and coordination.
The Po was also seen to be very important in enabling appropriate movement of the Jing (Essence), and so is involved in the first physiological processes after birth (such as the perception of the senses and the onset of breathing).
The Po is also important for the acuity of the senses. The Po is responsible for the experience of grief and for crying. It is also closely linked to breathing, and so can be calmed if the breath is regulated.
While the Hun is important for relationships with other people, the Po is more important for the establishment of internal integrity and protection from external psychic influences.
The intellect (Yi)
The Yi was thought to reside in the Spleen, and is responsible for clear thought. The ability to study, to concentrate, to assimilate new ideas, to retain facts and to work things out are all functions of the Yi. Memory will be good if the Yi is healthy, and this particularly relates to the memory of facts and ideas.
The will (Zhi)
The Zhi was thought to reside in the Kidneys, and is also important in the function of memory. The Zhi appears to be linked with long-term retention of facts and ideas, whereas the Yi is related to the laying down of memory of facts and ideas.
The Zhi is also linked to the drive and determination required to follow through with an idea. It also has the characteristic of tenaciousness in following an idea through to its conclusion. The Zhi is also characterized by the courage required to stand up to the challenges that life presents and which threaten to prevent success in one’s endeavors.
The causation of mental illness in Chinese medicine
Just as is true for bodily illness, mental illness in Chinese medicine will result from the six climatic excesses, the seven emotions and the miscellaneous causes.
The six climatic factors of heat, summer heat, damp, dryness, wind and cold are less prominent in the etiology of mental illness, but each may cause organ damage, and in particular Stagnation of Qi, which will, in turn, engender mental and emotional symptoms.
The seven emotions of joy, overthinking, anger, fear, sorrow, fright and anxiety are well recognized in Chinese medicine to directly damage the organs when in excess. Whilst the seven emotions are normal expressions of the ebb and flow of Qi through healthy-functioning Organs and the interaction of a person with the ever-changing environment, if in excess each emotion can directly damage a particular Organ or Organs. For example, anger will damage the Liver and anxiety the Heart and the Spleen. Conversely, unhealthy organs will lead to unhealthy emotional expression, and so a damaged Liver will express itself in anger, and injury to Heart and Spleen might be manifest in anxiety. There is a bi-directional relationship between the organs and their corresponding emotions.
The miscellaneous causes of disease include faulty diet, lack of regulation between activity and stillness, unhealthy sexual activity, and the effects of medications and drugs. All these can conspire to cause Organ depletion, Stasis of Qi and Accumulation of Damp Phlegm and Heat. Very often it is this combination of Depletion, Fullness and Stagnation that is causative in mental illness. Each of these pathologies affects the Shen in characteristic ways.
The pathology of the Shen
There are three general patterns described in Chinese medicine that result from imbalance of the Shen: Deficient Shen, Disturbed Shen and Obstructed Shen.
The general patterns of these pathologies of the Shen are:
Lack of spirit or vitality
Lack of joy
Insomnia and dream-disturbed sleep
Anxiety and propensity to startle
Confusion and dull depression
These patterns describe general imbalances that are seen in all manner of mental illness. However, each one of the five Shen has its own characteristics, which, when out of balance, may be discerned in mental illness. The characteristics of imbalance of the five Shen are:
Aspect of the Shen
Characteristics of imbalance
Heart, Small Intestine, Pericardium, Triple Burner
Low intelligence, unclear thought, lack of clarity of ideas
Poor memory for events
Difficulty falling asleep and disturbed sleep
Dull and lifeless personality and lack of joy
Confusion and lack of consciousness
Lack of experience of emotions or oversensitivity to emotions
Problems in interpersonal relationships
Unwise life decisions
Hun (ethereal soul)
Lack of purpose, vision and direction
Timidity and indecisiveness
Dream-disturbed sleep and out-of-body experiences
Lack of inspiration and intuition, and a sterile inner life
Marked emphasis on the intuitive and second sight (e.g. connection with the spirit world, seeing ghosts, clairvoyance)
Excessive emotional outbursts, in particular, anger
Po (corporeal soul)
Lung, Large Intestine
Difficulties with movement, clumsiness and lack of coordination
Weakening of the senses and uncomfortable sensations (e.g. itching)
Excessive grief and crying, or inability to feel grief
Breathing difficulties, hyperventilation and shallow breathing
A poor sense of self, and vulnerability to external influences and vibes
Dull intellect, slow thinking, poor memory for facts
Difficulty in concentration
Poor long-term memory
Lack of drive and initiative; ideas and dreams do not reach fruition
The organ syndromes and mental-emotional problems
As described earlier, the Shen is simply an aspect of Qi or Essence. If Qi is out of balance when an Organ pattern is being expressed, it is to be expected that there will be some accompanying imbalance of the Shen. For example, in a state of Qi Deficiency one might expect Shen Deficiency, and in Qi Stagnation one might expect some degree of Shen Disturbance. As Qi is a Yang substance, the same applies to any pattern in which Yang is out of balance. In Yang Deficiency one might expect Shen Deficiency, and when Yang is Rising one might expect Shen Disturbance.
Similarly, a disorder of the Shen can be expected if there is an imbalance of Blood, as Blood is not only directly related to Qi as the mother of Qi, but is also said to House the Shen. If Blood is Deficient, Shen might be expected to be Deficient, but also Disturbed as it can no longer be properly rooted. As Blood is a Yin Substance, a Deficiency of Yin might also be expected to be accompanied by a Deficiency and Disturbance of the Shen.
In Full patterns it is also possible to predict the effect that certain Pathogenic Factors might have on the Shen. One might expect Heat and Wind to Disturb the Shen, and Phlegm and Damp to Obstruct it. Empty Heat simply Disturbs the Shen, but Full Heat can affect consciousness and thus can Obstruct as well as Disturb the Shen.
The disorders of the Shen and their overlap with the main pathologies in Chinese medicine are as follows:
Chinese medicine pathologies
Yin Deficiency with Empty Heat
Yin Deficiency with Empty Heat
It is possible to use these correspondences to understand more about the mental-emotional disturbances described in the particular organ syndromes. Even more insight will be gained if the mental-emotional correspondences of the five Shen are also used to inform an interpretation of a particular organ syndrome.
For example, in the syndrome of Spleen Qi Deficiency, some features of Deficient Shen and also some features of Imbalance of the Yi might be expected. It is no surprise, then, that tiredness, lassitude and overthinking are features of this pattern, which reflect Shen Deficiency, but with a particular flavor associated with Imbalance of the Yi. On this basis, difficulties in thinking, generation of ideas and memory for facts might also be expected to be features of Spleen Qi Deficiency, and these are indeed familiar symptoms seen in patients in clinical practice.
Using the approach described above it is possible to describe what sort of mental-emotional features might be apparent in a presentation of any particular Chinese medicine syndrome. This aspect of the Chinese medicine interpretation of mental health symptoms and signs has been elaborated in some detail, as it will provide a foundation for the Chinese medicine interpretation of conventional descriptions of mental illness in subsequent sections in this chapter.29,30