Christopher Dowrick is a GP in Liverpool and Chair of the WONCA Working Party for Mental Health. He has recently retired as Professor of Primary Medical Care at the University of Liverpool. He is on Twitter: @cfd1951
Demian Whiting, a former colleague of mine in Liverpool, is one of a rare and valuable group of academics working at the interface between health care and philosophy. He is academic lead for medical ethics at the University of Hull, and has published important papers on traumatic brain injury and risk-reducing mastectomy.
In this important book, Whiting argues persuasively that we should take our emotions much more seriously than we ordinarily do. Instead of assuming that emotions arise as consequence of or in reaction to something else – our conscious thoughts, or our experiences of the external world, for example – we do better to see them as primary, as entities in their own right, as having original existences. Further, our dispositions to behaviour are grounded in or realized by our emotions. And hence our moral judgements, our beliefs about what are vices and what are virtues, are also grounded in or realized by our emotions. Our intrinsic nature, the core of the self, is based on our emotions; ‘… emotion is that thing that characterizes what we are like in and of ourselves’.
Our intrinsic nature, the core of the self, is based on our emotions.
Whiting vigorously defends the Scottish philosopher David Hume, who proposed ‘Reason is and ought only to be the slave of the passions, and can never pretend to any other office than to serve and obey them…’ He is also supportive of the contemporary neuroscientist Antonio Damasio (and hence, indirectly, my hero the 17th century philosopher Baruch Spinoza) in placing values at the heart of his theories. Our desires – but not our beliefs or our intellectual capacities – are mental states which dispose us to behave in certain ways. People who suffer defects in emotions as a result of brain damage may struggle to choose between different decisional options because they do not have the ability to ‘somatically mark’ their available options.
This is radical stuff! For readers of BJGP, most of whom have been brought up to believe that rationality is the hallmark of civilised society, and that we should apply clear-headed thinking to address the clinical problems we encounter, it may raise anxiety, or hackles, or even both. And in the mental health field, it undermines the basic tenets of cognitive-behaviour therapy, where feelings are assumed to be secondary to cognitions.
But Whiting is not arguing that we throw our cognitive faculties away, rather that we should acknowledge their secondary status. As he notes, there is evidence that practice of cognitive therapy works (perhaps due to the therapeutic alliance or belief in its efficacy), even if its underlying theory is flawed.
Whiting is not arguing that we throw our cognitive faculties away, rather that we should acknowledge their secondary status.
In clinical practice, this means that we should take very seriously indeed our patients’ emotional states, how they are feeling, and hence what they may desire from the consultation. These states are no longer epiphenomena, but are central to our conversations.
If we take joy as a sense of equilibrium, ease, capacity to act, a transition to a state of greater perfection; then sorrow is a sense of function disequilibrium, dis-ease, a reduction in power and freedom of action, a transition to a state of lesser perfection. These feelings act as mental sensors. As such they play a crucial role in our decision-making, problem solving and social behaviour. They help us solve non-standard problems involving creativity, judgement and decision-making, that require the display and manipulation of vast amounts of knowledge. They improve and amplify the process of managing our life. Our cognitive processes take the lead from, and are guided by our emotions. Our route to health, whether our own or our patient’s, is therefore to increase the occasions of joy and to reduce the occasions of sorrow.
Demian Whiting. Emotions as Original Existences: A Theory of Emotion, Motivation and the Self. Palgrave Macmillan, 2020. https://link.springer.com/book/10.1007/978-3-030-54682-3