Is thinking dangerous?

On psychiatry’s longstanding fear of metaphysical rumination

I can still remember being a junior doctor on psychiatry wards and young men who started exhibiting the first signs of psychosis being told not to think too hard. They would be told by the consultant to try and stay present, as if the metaphysical speculation that they were involved with was a toxin of some sort. It's funny because I had forgotten this; I hadn't heard this line of thinking much until last week when I attended a lecture from an Italian psychiatrist who suggested, apparently in all seriousness, that an important part of treating first episode psychosis is to encourage the individual to refrain from existential or metaphysical thought.

In a conversation that I had recently with the biologist Michael Levin and the psychotherapist Alexey Tolchinsky, Mike at one point wondered out loud whether there is such a thing as a thought that breaks the thinker. Mike, whose ideas are themselves so deeply philosophical as to render the traditional boundaries of academic disciplines almost absurd, reflected on how it was increasingly common for him to encounter individuals who were extremely intelligent, but for whom some deep ideas were sufficiently destabilising that they could send them spiralling. This is at minute 7:20 of the video here.

It turns out that the fear of too much thinking, particularly about big abstract or unresolvable questions, has a long and strangely respectable pedigree. As far as I can tell, in certain psychiatric traditions it was almost treated as axiomatic. There is this idea that deep thought can somehow unmoor the self. Even now, some psychiatrists warn their more fragile patients against studying philosophy, and I can even think of some patients in whom I have gestured towards that. The assumption here is that a sufficiently mind-bending thought can become an infection; a minor scratch that could, if left unchecked, bloom into psychosis.

As a neuropsychiatrist, I have seen this unfold in a number of ways. Patients, often male, well-educated and freshly out of the parental home, sometimes present with a characteristic flavour of distress. I guess this could be characterised as a kind of collapse into questions that have no obvious solution. These questions are familiar to any student of philosophy, and I often wonder whether the relative lack of prominence of philosophy in our state education has somehow meant that these ideas hold a potency that they might not otherwise if, like the French or the Greeks, we made it a mandatory part of our education. Am I real? What is a thought? Is the self an illusion? Does time exist? These aren't meaningless queries, but when they arrive with obsessive and dislocating intensity, they can resemble what we might call philosophical insanity.

The concept appears in 19th century British and continental European psychiatry, where one finds frequent reference to patients whose delusions take on abstract and metaphysical forms. These patients are not ranting about neighbours or poison, but they're trying to solve the nature of time or redefine the laws of reality. There's some relationship here to Bleuler's use of the term autistic thinking in schizophrenia, here understood not in the contemporary understanding of autism but as a withdrawal into a private world of symbols and metaphysical systematisation. Karl Jaspers considered primary delusions to be un-understandable, not because they lacked content, but because they emerged fully formed, like intuitions mistaken for facts - and were in some sense is psychologically irreducible. In these cases of philosophical insanity, I'm not quite so sure about this. One can observe that the patient's path started in a realm of genuine existential questioning.

It is in the early stages of a psychotic disorder that the destabilising potential of abstract thought may be most evident clinically, and to the loved ones of the individual concerned, as well as in many cases to the individual themselves. Psychosis typically has its onset in late adolescence or early adulthood, which is precisely the time that many young people grapple with the big questions of identity and purpose and reality.

In many of the patients that I have treated, the prodrome, the period leading up to full-blown psychosis was marked by an intense reorientation or deepening orientation towards metaphysical curiosity and confusion about the nature of reality and self. Some researchers describe this period as involving disturbances of the basic sense of self, what some have called ipseity. One hallmark of this is a kind of hyper-reflexivity in which the mind turns its focus excessively onto itself. In one way of conceptualising it, there is an intensified self-consciousness wherein ordinarily automatic processes like thinking, perceiving, or even the sense of being oneself can become objectified and eventually alien.

Put simply, an individual might become acutely aware of the kinds of phenomena that many healthy minds just take for granted, and this can lead to a frightening loss of meaning and a feeling of de-contextualisation in which the normal structure of reality can no longer be taken for granted. It is almost as if either willingly or unwillingly the individual is engaged in a philosophical reduction from which they cannot remove themselves, and their assumptions become stripped away until almost everything, even basic reality, might feel uncanny. This is often not the period where frank, unshakable delusions are present, but it's often reported to be an even stranger, more liminal state in which the whole sense of reality is in flux.

In the 1858 textbook of John Charles Bucknill and Daniel Hack Tuke, which was one of the most influential of its kind in mid-19th century Britain, the section on the causes of insanity includes “over study” as one of the most common moral (= psychological) causes. They report an analysis of 29,769 cases admitted into a large number of asylums in England, France, and America, distributing them according to the classification of causes. They identify “excess of study” as the sixth most common moral cause of insanity. They review data from the Bethlem Hospital indicating that out of 1720 cases admitted, excessive study produced madness in 6.34% of male lunatics.

The authors state that “the mental faculties are the thinking man's tools, constantly in use, and often necessarily subject to very rough usage, but still oftener to unnecessary wear and tear… the inference would seem clear that the liability to mental disease is greater (other things being equal) in a civilised and thinking people than in nomadic tribes, or in any race whose intellectual faculties are but little called into action. Knowledge brings with it its miseries as well as its blessings. The tree in the garden of Eden which was ‘a tree to be desired to make one wise’ was nevertheless the tree of the knowledge of evil as well as of good.”

They go on to speculate “in many an over-stimulated child or overworked student there may be only sown the seeds of future mental disease” and suggest that the contribution of excess of study may even be underestimated due to masking by factors like loss of rest which might overshadow the clinical picture.

Later, in a fascinating section on the moral treatment of the insane, they put forward an argument that psychological treatment and physiological treatments cannot really be separated. Quoting from Dr Connolly's The Treatment of the Insane without Mechanical Restraints: “We seek a mild air for the consumptive, and place the asthmatic in an air which does not irritate him, and keep a patient with heart disease on level ground; and on the same prophylactic and curative principles, we must study to remove from an insane person every influence that can further excite his brain, and to surround him with such as act soothingly on both body and mind, may favour the brain's rest, and promote the recovery of its normal action.”

Even in the biographies of some philosophers, it is not uncommon to encounter the notion that it was their philosophy which drove them mad. This is frequently encountered in discourse around Nietszche, for example: he was a visionary philosopher as well as a patient in a Basel psychiatric clinic treated by Dr Otto Binswanger. One hypothesis of Dr Binswanger was that his mental breakdown was partly due to overwhelming philosophical exertion, suggesting to Nietzsche's mother that the intellectual and emotional energy that her son poured into his philosophising had effectively overstimulated him. Most historians would add that Nietzsche likely had an underlying organic illness, such as tertiary syphilis, but the image of a mind burnt out by metaphysics is nonetheless powerful.

Some of his letters describe a fear of going insane and effectively losing himself in the corridors of his own mind: “at times, a premonition runs through my head that I am actually living a very dangerous life since I am one of those machines that may explode.”

Interestingly enough, while the British Philosophical Association has a most welcome page for academic philosophers focusing on mental health, its focus is entirely on the pressures of an academic career rather than the subject matter of philosophy itself. This indicates that, at least amongst this cohort who almost certainly do have some insight into the matter, there is not an overwhelming notion that philosophical inquiry can itself be toxic to mental health. The situation may be different for individuals who have not chosen philosophy as a vocation but are still inclined towards explorations of the deep end of science and contemplative practise, as this Reddit thread suggests.

What can be disturbing about these kinds of inclination in people suffering from or developing psychosis is that sometimes the people espousing these notions can sound brilliant, but in fact, they are suffering. Frequently, teachers, family members, loved ones or lecturers encourage the creativity that is apparent until it all becomes too much. One doesn't wish to pathologise every teenager who reads Nietzsche, gets too into the Matrix movies or starts to explore Buddhism, right? But in the mid-20th century, it appears there was an informal tradition within British psychiatry (and, I’m quite sure, beyond) of gently steering certain students away from philosophy. Mentors and supervisors have told me anecdotes in which bright but fragile students were advised quietly to pursue more grounded disciplines. The logic here was that philosophy and especially metaphysics could reveal existential uncertainties that the psyche might not be able to hold.

I'm not sure that these are just intellectual curiosities or characteristics of a disorder as it applies to a particular demographic of people. I think this reflects a particular cultural stance: the idea that some minds are simply too porous or too permeable to engage in abstraction. The idea here is that thinking, a bit like altitude or exercise, requires acclimatisation. Perhaps stated even more basically, there is an intuition here that ideas themselves can be philosophically toxic or psychotogenic.

This shows up in literature too. Hamlet is the most famous example. He is a man whose intellect is so acute that it paralyses him. He's inclined to big picture thinking and becomes melancholic, indecisive and haunted. His family worries that he thinks too much. Dostoevsky is replete with characters who are pathologically over-philosophising, and rationalising every feeling until they become socially and morally unhinged. More recently, Sylvia Plath writes about female characters whose descent into mental illness is marked by a sense not of cognitive chaos but of too much clarity. These women see through the cultural and societal myths that they're handed and find nothing beneath them, and they are thrust into metaphysical crisis. Crucially though, this crisis is equally a symptom and an insight.

I sometimes wonder whether the danger lies not just in thought itself but in thought without witness, thought that cannot be bounced off another person. Perhaps it's less possible to become locked inside an idea when in the company of someone with whom we are in relational dialogue. As someone who is deeply prone to this kind of thinking myself but thankfully, as far as I know, has not let it consume me, I think we have to be cautious not to pathologise inquiry or metaphysical speculation itself, while remaining alert for when someone's abstract explorations start to become anguished, all-consuming, or detached from their interpersonal lives.

There is, of course, a tradition in psychiatry that sees philosophical reflection not as a risk but as a resource. Finding meaning is conceived by some thinkers as necessary for survival. We see in the writings of Carl Jung the notion that meaning is not the luxury of the well but a necessary orientation for the distressed, a notion which is seen also in the writings of Viktor Frankl on his experience in the concentration camps. Indeed, Frankl's technique of logotherapy explicitly invites patients to philosophise in the best sense, to ask what their purpose is and how do they make sense of this suffering? But of course here this is guided thinking, not the encouragement of unchecked speculation.

Incidentally, over the last few weeks, we have seen a number of concerning cases in which generative AI appears to have been in some sense complicit with the amplification of existential and metaphysical speculation, taking the individual with them into increasingly abstract and distant philosophical and psychological territory. We have a pre-print coming soon about exactly this kind of danger. And quite frankly, it's remarkable to see how easily this can happen just in a 45-minute long chat with Gemini or ChatGPT, for example.

I can rarely resist the temptation to engage in philosophical dialogue with my patients when they bring it up, although of course, I try not to proffer it unprompted. I'm careful not to throw out ideas that could be destabilising. In fact, now that I think about it, I'm similarly careful when I talk to my daughter, who has developed a fairly remarkable interest in the kind of mind-bending questions about reality that I only started becoming interested in when I was 12 or 13 (I still remember the thrilling wooziness I felt the first time I picked up Douglas Hofstadter's Gödel, Escher, Bach; more on that in another post). She's only seven.

I wonder if the key clinically is that stabilisation might come about not by avoiding abstract thought but by finding better expressions for it in writing, in therapy, in community or in other artistic expression. In some cases, though, philosophical distress might be more simply driven by fear or by collapse.

We have to remain open to the affect that underlies this thinking. Philosophy can cause us to stare directly into the abyss. For some, that is thrilling; for some, it is terrifying; for others, it is compulsive. If we, as clinicians, are interested in these ideas, we have to be careful not to let them distract us from our primary aim of healing our patients.

We mustn't let how articulate or hyperlucid a patient might appear to be to obfuscate the deep internal disorganisation or negative affect that may be underlying their inquiry. So, I think this is where psychiatry and philosophy need each other. Well, in fact, I think there are a million other places where they need each other, but in this particular area, psychiatry needs to be able to learn not to fear abstraction reflexively. Conversely, I think philosophy needs to acknowledge that its questions really can wound as well as heal.

I wonder if between these polarities we might find a way of interacting with ourselves and with our patients in a way that honours the reality and truth of metaphysical distress without reducing it to pathology. Because I think the world is strange and there is something true in all of this. The self is fragile, our language does a pretty awful job at capturing existence, and yet to realise this too quickly or too young or too alone can be really destabilising.

The answer is not, as these old school psychiatrists might have done, to shut down these questions, to lobotomise the philosophical instinct. I think it is to accompany it, to ‘hold space for it’ - as the instinctively nauseating, but actually rather helpful phrase, might have it.

I wonder if our fear of philosophical insanity might reflect a deeper fear. This is a fear that madness and insight are closer to one another than we might think, and that the line between pathology and revelation is porous. Many people have suggested ideas like this for many hundreds and thousands of years. But even now, psychiatry struggles with the idea that thinking too deeply can both risk disintegration but also risk the enticing possibility of becoming more whole.

So, I think we all have a task, or maybe even a duty, to those who were born asking questions that make other people uncomfortable. Can we find a way to connect with these people without asking them to be less philosophical? Can we engage in ways of dialogue that don't isolate but connect?

Maybe we do all need to read a bit more philosophy. Maybe that is the only way to make it less scary.