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"Revolution" or "revolutionary" are often very over-used words, and boil down to little more than hype for things which seldom deserve such sensational slogans. But a true revolution in psychotherapy is in the making in relation to the so-called “diametric model” of mental illness. Diametric derives from diameter, the line which equally bisects a circle, and nicely expresses the essential insight that mental disorders can result from too little or too much mentalism: our innate ability to understand our own and other people’s behaviour in mental terms. Autistic spectrum disorders (ASDs) are essentially hypo-mentalistic, and psychotic spectrum ones such as schizophrenia, hyper-mentalistic. Normal mentalism occupies the safe, central ground: enough mentalizing ability to understand other people’s minds, but not so much as to be paranoid or so little that you become autistic. As such, mentalism represents a familiar one-dimensional balance seen in other areas of medicine where too much or too little is pathological but the right amount normal: for example, blood pressure, salinity, or glucose; body temperature, weight; and so on.
Revolution/revolutionary derive from astronomy and specifically from the way planets revolve in the solar system: originally supposedly around the earth, but ever since Copernicus (1473-1543), around the sun. Indeed, historically, this was the paradigmatic revolution: one that changed our view of the universe and our place in it once and for all. This was a revolution in the sense that our thinking was completely reversed: from seeing the earth as the center around which the rest of the universe revolved, we now see our planet as just one of many in a vast universe with no center as such. Such a 180-degree reversal in thinking is a conceptual revolution in the true sense, and this is exactly what the diametric model implies for psychotherapy.
According to the new model, the first step in diagnosis would be to ascertain a person’s standing on the mentalistic continuum. Measures such as the Autism Spectrum Quotient (AQ) already exist to calibrate hypo-mentalism, and comparable ones could easily be devised to correspondingly calibrate hyper-mentalism: a Psychotic Spectrum Quotient (PQ, comparable to the existing Magical Ideation Scale). Ideally, AQ might be expressed negatively and PQ positively, meaning that perfect normality would get a summed Mentalism Quotient of zero. The greater the deviation in either direction, the greater the pathology. And thanks to the larger imprinted brain theory of which the diametric model is just a part, such psychometrics could be objectively validated against measures of gene expression predicted—and now increasingly demonstrated—to be their ultimate cause.
Once placed on the continuum by their MQ and genetic tests, the patient’s treatment would be indicated: mentalistic skills training for those with significantly negative scores and the contrary for those with positive ones. Such compensating social and mental skills training is already successfully applied in ASD, but the real revolution in psychotherapy would be in relation to the diametrically contrary situation: those patients with abnormally high MQ. Such people need the exact opposite form of psychotherapy: they need to be taught to be more autistic in the sense of being less mentalistic, and the latest evidence is that they would also benefit greatly from mechanistic skills training. Computers epitomize such skills, and are an ideal method of delivery, even for social skills training. On-going trials report sustained improvement in schizophrenics in relation to training in such mechanistic skills as pitch-discrimination (something which is often perfect in autistics). Indeed, the success already reported with computer-based psychotherapy in general suggests that psychotherapists, like so many other occupational groups in the modern world, could see themselves increasingly displaced by machines—at least where such skills training could be appropriately applied.
This would indeed be a revolution, and diametrically-opposite to the hyper-mentalistic—and occasionally downright paranoid—“talking cure” epitomized by psychoanalysis and still enshrined in much conventional psychotherapeutic wisdom. If I am right, diametric psychotherapy will mark the end of the middle ages in psychotherapy and a complete reversal in the way in which many patients are treated—not to mention the emergence of a new industry producing psychotherapeutic software suitable for every patient.
