[Cartesian misunderstanding as a cause of therapeutic failure]

Headache patients disassociate themselves from their own automatic responses, relying on the traditional separation of body and mind. On the other hand, patients who obtain voluntary control of automatic functions by biofeedback training modify not only vegetative but also voluntary behaviour patterns, losing "neurotic" traits. The basic misconception of the separation of body and mind, Cartesian dualism, is now ingrained in our culture. In the 17th century Descartes asserted that concepts applied to the soul must be entirely different from those used for the body in order to improve comprehension of the immortality of the soul. This dualism also led to "enlightenment" and to many later social and philosophical developments. But his basic neurophysiology was obsolete when he wrote it down. Other models from mainstream natural philosophy were better compatible with observation and experiments. Gassendi assumed a "body soul" consisting of energy as the functional principle of the nervous system, and Willis accommodated a series of anticipations of 19th century discoveries within this model. No comparable progress resulted from Descartes' own medieval model. Cartesian dualism has become untenable in view of recent neuropsychology but it still obstructs our management of functional patients. Instead of reinforcing the delusion of separation of psyche and soma, we ought to encourage patients to understand that their malfunctioning organs are on-line with their emotions, and with their mind.