an autodidact meets a dilettante…

‘Rise above yourself and grasp the world’ Archimedes – attribution

Posts Tagged ‘mental health

discussing mental health and illness

leave a comment »

Canto: I’ve been told I’m on the autism spectrum, by someone who’s not on it, presumably, but who’s also not an expert on such things, but I’m not sure who is.

Jacinta: Well of course we’re all on the autism spectrum, it depends on your location on it, I suppose, if you need to worry. ‘You’re sick’ is one of the oldest lines of abuse, but I’m reminded of a passage in The moral landscape, which I’m currently rereading. He describes a funny-but-not-so-funny piece of research by one D L Rosenhan:

… in which he and seven confederates had themselves committed to psychiatric hospitals in five different states in an effort to determine whether mental health professionals could detect the presence of the sane among the mentally ill. In order to get committed, each researcher complained of hearing a voice repeating the words ’empty’, ‘hollow and ‘thud’. Beyond that, each behaved perfectly normally. Upon winning admission to the psychiatric ward, the pseudo-patients stopped complaining of their symptoms and immediately sought to convince the doctors, nurses and staff that they felt fine and were fit to be released. This proved surprisingly difficult. While these genuinely sane patients wanted to leave the hospital, repeatedly declared that they experienced no symptoms, and became ‘paragons of cooperation’, their average length of hospitalisation was 19 days (ranging from 7 to 52 days), during which they were bombarded with an astounding range of powerful drugs (which they discreetly deposited in the toilet. None were pronounced healthy. Each was ultimately discharged with a diagnosis of schizophrenia ‘in remission’ (with the exception of one who received a diagnosis of bipolar disorder). Interestingly, while the doctors, nurses and staff were apparently blind to the presence of normal people on the ward, actual mental patients frequently remarked on the obvious sanity of the researchers, saying things like ‘You’re not crazy – you’re a journalist’.

S. Harris, The moral landscape, p142

Canto: Well, that’s a fascinating story, but let’s get skeptical. Has that study been replicated? We know how rarely that happens. And there are quite a few other questions worth asking. Wouldn’t most of the staff etc have been primed to assume these patients had a genuine mental illness? And surely only a small percentage would have had the authority to make a decision either way. Who exactly had them committed, what was the process, and what was the relationship between those doing the diagnosis and those engaging in treatment and daily care? Was there any fudging on the part of the pseudo-patients (who were apparently also the researchers) in order to prove their point (which presumably was that mental illness can be easily shammed)? And wouldn’t you expect other patients, many of whom wouldn’t believe in their own mental problems, to be supportive of the sanity of those around them?

Jacinta: Okay, those are some valid points, but are you prepared to accept that a lot of these mental conditions, such as bipolar disorder, borderline personality disorder (the name speaks volumes), attention deficit disorder, narcissistic whatever disorder and so on, are a little flakey around the edges?

Canto: Maybe, but with solid centres I’m sure. Depression is probably the most common of those mental conditions, and too much skepticism on that count could obviously lead to disaster. Take the case of South Korea, which has one of the highest suicide rates in the world. There appears to be a nationwide skepticism about mental health issues there, which clashes with high stress levels to create a crisis of care. Professional help is rarely sought and isn’t widely available. It raises the question of the value of skepticism in some areas.

Jacinta: I wonder if the rapid advances in neurophysiology can help us here. Mental health is all about the brain. In the above quote, the pseudo-patients were mostly diagnosed with schizophrenia. That’s surprising. In my naïveté I would’ve thought there was a neurological test for schizophrenia by now.

Canto: Well, the experiment described in The moral landscape dates from the early seventies, but currently there’s still no diagnostic test for schizophrenia based on the brain itself, it’s all about such symptoms as specific delusions and hallucinations, which could still be shammed I suppose, if anyone wanted to. But what about borderline personality disorder – I was told recently that it’s very real, in spite of the name.

Jacinta: Well, there appears to be a mystery about the causes, and a general confusion about the symptoms, which seem to be rather wide-ranging – though I suppose if a patient displays several of them you can safely conclude that she’s stark staring bonkers.

Canto: Yes that’s a thing about mental illness, quite seriously. You don’t need to be an expert to notice when people are behaving in a way that’s detrimental to themselves and others, especially if it’s a sharp deviation from previous behaviour. And if it’s a slow descent, as quite often depression can be, it’s harder to pick from that person’s standard lugubrious personality, so to speak. And in the end, maybe the labelling isn’t so important as the help and the treatment. But then, people love a label – they want to know precisely what’s wrong with them.

Jacinta: I suppose the difficulty with mental illness and labelling, as opposed to labelling other more ‘physical’ illnesses or injuries, is the near-ineffable complexity of the brain. For example, I notice that among the symptoms of borderline personality disorder are apparent behaviours that don’t really cohere in any way. This site places the symptom of uncertainty and indecisiveness along with extreme risk-taking and impulsiveness, and then there is fear of abandonment, and other odd behaviours which seem to head in different directions, seeming to have one thing alone in common – being extreme or abnormal.

Canto: Yes, again, behaviour that tends to harm the self or others.

Jacinta: At the moment, I think there are still too few connections between neurology and psychiatry and the treatment of mental illness, though it’s a matter of enormous complexity. I had thought, for example, that the role of the neurotransmitter dopamine was essential to our understanding of schizophrenia, but more recent research has found that the neurochemistry of the condition involves many other factors, including glutamate, GABA, acetylcholine and serotonin. There’s so much more work to be done. But we also need to be very aware of the social and cultural conditions that tip people over the edge into mental illness. Changes in the way our brain is functioning might be seen as proximal causes of an increase in depression and suicide, but it’s more likely that the ultimate causes have to do with the stresses that particular organisations, societies and cultures impose upon us.

Written by stewart henderson

June 30, 2019 at 12:45 pm

what to do with a serious problem like Trump: part one

leave a comment »

When I first encountered Trump, I suppose a couple of decades ago now, I quickly felt an intense, visceral loathing and disgust. He struck me as tasteless, vulgar, ignorant, vain, an exemplar of the absence of all humane values. A boorish, blustering, bigoted, bragging blundering, bullying, bullshitting buffoon, not to put too fine a point on it. And then, when those he demeaned and belittled began acting as if they deserved it, I began to wonder – who is worthy of more contempt, Trump, or those who take him seriously for more than a second? How could anyone with an ounce of sense not see that he was a walking advertisement for abortion?

But then, when you start thinking everyone’s a fuckwit except yourself, you know something’s going wrong. Okay, you do start listening around and find that in many circles Trump’s a laughing-stock. But then he’s somehow super-rich, and people like to hob-nob and ingratiate themselves with the super-rich no matter how obnoxious and boring they are.

So why was Trump super-rich? I have to say that, having lived mostly below the poverty line in one of the world’s richest countries (that’s to say I’ve rarely come close to going hungry), I’ve never really associated with rich people, never mind the super-rich. They’re like alien beings to me. But it stands to reason that there are two types of super-rich people; those who inherited wealth, or those who gained it by their own talents and efforts – legitimate or illegitimate.

So which of these was Trump? He struck me as flamboyantly imbecilic, far removed from the Bill Gates and Steve Jobs types. And I have to say it wasn’t a burning question for me. Naturally I was far too superior to concern myself with such riff-raff, and yet…

Information fell into my lap over the years. He’d inherited oodles of wealth from his father, a ‘business tycoon’. He’d never done a day’s work, in the general sense, in his life. He’d been bankrupted many times. His net worth was anything from negative infinity to positive infinity. His principal business was real estate, which was as hazy to me as scalar field theory. But his principal interest was self-promotion, which I felt a bit more cluey about. It seemed he was little more than a ‘big noise’.

So that was it, until he began to run for President, and shocked almost all pundits, including this pseudo-pundit, by winning quite well on an electoral college basis, though losing the popular vote.

Of course during the run-up to these ludicrously long US presidential elections, especially in the final months of 2016, we were pretty well forced to learn more about Trump than many of us ever wanted to know, and it’s been an ongoing ‘reveal’ throughout the last eighteen months or so. But I return to my initial response to Trump, and my feelings of contempt, and easy superiority.

How did Trump become what he is? How did I become what I am?

How free are we to form ourselves?

I think the answer is clear, though clearer when we look at others than when we look at ourselves. We didn’t get to choose our parents, our genes or our upbringing, we didn’t get to choose or influence our experience in the womb and in our earliest formative years, which the Dunedin study, inter alia, reveals as more character-forming than any other period in our lives.

More questionably I didn’t get to choose a character that loathes someone like Trump, any more than Sean Hannity and many others got to choose a character that finds Trump appealing, refreshing and admirable, assuming that I’m reading more or less accurately Hannity’s mind.

So am I saying we’re all blameless when it comes to our flaws, and unpraiseworthy when it comes to our virtues? Further, am I saying that moral judgment is inappropriate?

I hope not. After all, humans are the most social of all creatures – vertebrate creatures at least. We’re interested in getting along, in minimising harm and maximising advantage, for us all. We shouldn’t turn a blind eye to any person, or policy, or activity, that threatens that well-being. So we should discourage, and sometimes punish behaviour that harms or demeans others, while at the same time recognising that the bully or aggressor is acting under the sway of traits she has less control over than we might think.

So we should judge behaviour as immoral when it damages others or damages the institutions or activities that tend towards the general well-being. And we should check or punish those who commit those faux pas, which we might call crimes, misdemeanours, or bad behaviour, to the extent that they understand that resistance of the general will is futile – that’s to say, that continual commission of those faux pas will be counter-productive to their own well-being.

Let me return then to the case of Trump. In watching and listening to him, I find him, as President, consistent with the person I loathed decades before, though I also realise, as I did then, that there is something unfair and slightly unseemly about my contempt, for reasons described above. Trump is the product of a background and influences which are clearly far removed from mine. I was also, like many, somewhat fascinated by him as a specimen who revealed, more effectively than most, how infinitely variable human experience and character can be.

However, though I recognise that he is what he is and can’t help but be, I’m also alert and alarmed that he is now the President of the USA – a shocking development, considering the man’s character.

For, though nobody should be blamed for his own character, there are some characters that the general society needs to be protected from, because of the damage they are capable of doing, or incapable of not doing, given certain powers and opportunities.

Trump came to his current position with a reputation which, I feel, was deserved, given everything I observed of him, and everything I learned. That reputation was one of dishonesty, self-aggrandisement, wilful ignorance and anti-intellectualism, and indifference to the feeling and suffering of others, with possibly a few exceptions, and leaving aside his children, whom he would see as extensions of himself to a large degree.

There are some characters who are so pathological, so damaging to themselves and/or others that society needs to be protected from them, unless of course their pathology can be identified, treated and cured. In the case of Trump, the terms psychopath, sociopath, malignant narcissism and narcissistic personality disorder have been given an airing. It’s surely not coincidental that these claims about Trump have been much more frequent since he has become President. His power to damage the wider society is at its zenith.

When I first heard the term narcissistic personality disorder directed at Trump, it was in a discussion with a mental health professional, early in the Presidency. That professional was critical, even angry, that the term was used to describe Trump, because, he felt, this term described a real and debilitating pathological condition which was far too serious to be used for political purposes against Trump. His words gave me pause, but now I think it’s time to look at this matter more closely.

First, before actually looking more closely at the ‘mental disability’ terms described above, I should say this. As Stormy Daniels’ impressive attorney Michael Avenatti has said, Trump’s behaviour, especially his constant self-promoting and self-protecting lies, should concern all Americans regardless of their political persuasion. Trump’s behaviour in office is essentially not a political issue, in spite of its massive political consequences. One pundit recently described Trump as a ‘lifelong Democrat’ before switching to the Republican party a few years ago. It’s my contention however that Trump was never a Democrat and has never been a Republican. He has never been interested in politics in the usual sense – that of believing in and promoting policies and practices for the most effective running of a state. He has little interest in or knowledge of political history, political philosophy or international affairs, and no knowledge whatever of science, or history in general. He doesn’t read or have anything like an enquiring mind. He has expressed very little compassion for others, except when it may benefit himself, and his concept of truth is not something that anybody seems to be capable of recognising or describing.

This description of Trump is not a political one. It’s a description which most sensible people would broadly agree with. It’s a description of a person so singularly ill-equipped to be the President of the world’s most powerful military and economy, that the question of how he came to be in that position and how he can be removed from it before further damage can be done, should be paramount.

Before I go on, I should address those outliers who say that Trump has been a successful and impressive President. They would cite the booming economy and the administration’s tax legislation, the only major piece of legislation enacted thus far. On the tax legislation, I will not consider its fairness or unfairness, or the effect it has had on the US economy. I will simply say that Trump recently claimed more or less sole responsibility for this legislation, a claim that was demonstrably false. Trump did not participate in the writing of this legislation, and he most certainly hasn’t read it. He simply presided over a Republican congressional majority responsible for its production. As to the US economy, that is a massively complex area, full of winners and losers, which, of course, I’m not competent to comment on, any more than Trump would be. Suffice to say that the reasons for an economy’s success are manifold and generally historical.

So there is a problem with Trump as President. In my next post I will go into more detail about what the problem is, and why there is no easy solution.

Written by stewart henderson

May 5, 2018 at 11:33 am