Tuesday, June 26, 2012

Mask of Sanity: Anna

I was trying to look up something remembered in Hervey Cleckley's "Mask of Sanity" the other day and stumbled upon the hilarious account of the woman Anna.  I especially like his description of his first impressions of her:

There was nothing spectacular about her, but when she came into the office you felt that she merited the attention she at once obtained. She was, you could say without straining a point, rather good-looking, but she was not nearly so good-looking as most women would have to be to make a comparable impression. She spoke in the crisp, fluttery cadence of the British, consistently sounding her "r's" and "ing's" and regularly saying "been" as they do in London. For a girl born and raised in Georgia, such speaking could suggest affectation. Yet it was the very opposite of this quality that contributed a great deal to the pleasing effect she invariably produced on those who met her. Naive has so many inapplicable connotations it is hardly the word to use in reference to this urbane and gracious presence, yet it is difficult to think of our first meeting without that very word coming to mind, with its overtones of freshness, artlessness, and candor.

She had passed her fortieth birthday some months before. Neither her face nor her figure had lost anything worth mentioning. Despite her composure, she gave a distinct impression of energy and playful spontaneity, an impression of vivid youth. In response to ordinary questions about her activities and interests she spoke of tennis, riding, and reading. More specific inquiry brought out opinions on Hamlet's essential conflict, comparison between the music of Brahms and the music of Shostakovitch, an impressive criticism of Schopenhauer's views on women, and several pertinent references to The Brothers Karamazov. She expressed opinions on current affairs that seemed to make excellent sense and talked with wit about the cyclic changes in feminine clothes and the implications of atomic physics for the future. What she had to say was particularly interesting and she said it in just the opposite of all those many ways of talking that people call "making conversation."

As discussion progressed, the picture of a rather remarkable woman became more and more distinct. Here was evidence of high intelligence and of considerable learning without discernible bookishness or consciousness of being "an intellectual." Her manner suggested wide interest, fresh and contagious enthusiasms, and a taste for living that reached out toward all healthy experience. Having a cup of coffee with her or weeding a garden would somehow take on a special quality of fun and delightfulness. Something about her over and beyond her looks prompted the estimate that she would be very likely to elicit romantic impulses, strong sensual inclinations, from most men who encountered her. Here, it seemed, was natural taste without a shadow of posed estheticism, urbanity without blunting of response to the simplest of joys, integrity and good ethical sense with the very opposite of everything that could be called priggish or smug. She showed nothing to suggest she meant to give such an impression or that she had any thought as to how she seemed.

I've never read Mask of Sanity all the way through, only read snippets, but I have actually been enjoying it more recently.  I probably like it best out of all of the books about sociopath.  It is glaringly anecdotal, biased, and suffers from a pretty clear lack of objective, systematic research, but so is this blog, and there is something about his writing style that I enjoy. I like the Anna story because you can tell that he was taken in by her, and I think it is sometimes much better to see source material of people who are taken in rather than hear the same old "superficially charming."  I like the description of her idiosyncrasies: the accent, her artlessness, her eternal youthfulness, her attractiveness that seems to be something more than mere beauty, her intelligence, her charm, even a reference to the Brothers Karamazov (interestingly, later it discusses how she does not have the high brow tastes or prejudices of the typical "intellectual" of her education and breeding, but treats gossip magazines with the same interest as the music of Russian composers).  Later in the chapter on Anna, Cleckley tells how she quite sincerely taught Sunday Schoolvolunteered for the Red Cross, and engaged in haphazard same sex liaisons, one time with a nurse after being universally adored during a hospital stay ("Once while hospitalized for a week or ten days, she left the almost universal impression of being a delightful patient. Courteous, composed, undemanding, and cheerful, she took discomforts and minor pains in a way that elicited admiration.").  It reminded me of my own nearly identical experience charming all hospital staff without meaning to  while stuck there for a week after an appendectomy -- I was a crowd favorite, was called very "brave" and had random nurses ask me to keep in touch.

About this season every year I have a period of introspection and self doubt.  Sometimes I wonder if I believing I am a sociopath is a self-fulfilling prophecy, or distorts the way I see me in the world.  Recently I've been questioning again what I am doing writing this blog or believing that I am a sociopath, whatever that means.  I watch myself interact with others and think, is this what a sociopath would do?  Have I been living a lie these past few years?  It just seems like such a bizarre thing to believe this about oneself, bizarre even to believe that sociopaths exist and aren't just some random assortment of personality traits that occur together solely by chance.  I am sure I never will stop asking myself these questions, but when I read stories like Anna's and see all of the incredible parallels to my own life, including small details or other things I couldn't have known or whose existence in my life predate any awareness of what the term "sociopath" meant, I am just floored.  It's not necessarily the life I would have chosen for myself given an infinite number of options and I sometimes wonder at the improbability of who I am, who I turned out to be, but I really am ok with it.  More than ok, I'm happy.

Monday, June 25, 2012

Young at heart

I came upon this quote from Charles Baudelaire that “Genius is nothing more nor less than childhood recovered at will.”  It made me think of the many ways in which I am inherently childish.  Sometimes I'm childlike in a way that gives me a competitive advantage, e.g. the creative, outside the box thinking to which Baudelaire alludes.  Sometimes I'm childish in less advantageous ways, like being overly reckless and self centered.


They say that sociopaths mellow with age.  The other day I was remembering some of my more stupid escapades, realizing that it has been at least a few years since I have done something whose stupidity is almost wholly due to stunted emotional growth.  I read recently in the New Yorker that even Tucker Max, one of the founding authors of the genre "fratire" and widely known and loved for his immense immaturity, has given up his former partying life, takes yoga classes, and is seeing a psychotherapist in the hopes of finding balance. [Is Tucker Max also a sociopath?  According to his website: I get excessively drunk at inappropriate times, disregard social norms, indulge every whim, ignore the consequences of my actions, mock idiots and posers, sleep with more women than is safe or reasonable, and just generally act like a raging dickhead.] 

Interestingly, the people who have fallen in love with me (as opposed to obsession) have essentially fallen in love with the child in me.  People associate childlike qualities with a certain innocence.  And there is something charming about a grown person, brilliant and successful, ruthless and hard, also showing the sometimes naïveté and guilelessness of a child.  There was something about that contrast between the unyielding me that the rest of the world sees versus the soft me that most were blind to that appealed to my lovers' protector/nurturing instincts.

In the book The Little Prince, a pilot, long at odds with the seriousness of the adult world, gets stranded in the desert and meets a boy prince who is able to see past the unimportant details of life that cloud grown up eyes and see what is most essential about the pilot.  In a Scientific American blog post entitled, "The Big Lesson of a Little Prince: (Re)capture the Creativity of Childhood":

Saint-Exupéry’s larger point about creativity and thought is difficult to overstate: as we age, how we see the world changes. It is the rare person who is able to hold on to the sense of wonderment, of presence, of sheer enjoyment of life and its possibilities that is so apparent in our younger selves. As we age, we gain experience. We become better able to exercise self-control. We become more in command of our faculties, our thoughts, our desires. But somehow, we lose sight of the effortless ability to take in the world in full. The very experience that helps us become successful threatens to limit our imagination and our sense of the possible. When did experience ever limit the fantasy of a child?

The article goes on to describe an experiment in which the control group was asked to respond to the writing prompt, "imagine school is cancelled for the day", while the experimental group was asked to respond to the same prompt while pretending they are 7 years old.  Those writing as a 7 year old showed significantly more originality of thought: "Imagining yourself a child, it seems, can quite literally make your mind more flexible, more original, more open to creative input and more capable of generating creative output."

Interestingly the full Baudelaire quote suggests that the ideal is a childlike state of mind with all of the experience and knowledge we have gained as adults: "Genius is no more than childhood recaptured at will, childhood equipped now with man’s physical means to express itself, and with the analytical mind that enables it to bring order into the sum of experience, involuntarily amassed."  I hope this is what is meant by sociopaths "mellowing" as they age.

Sunday, June 24, 2012

Quote: Learning

“Always try to associate yourself with and learn as much as you can from those who know more than you do, who do better than you, who see more clearly than you.”

Dwight Eisenhower

Saturday, June 23, 2012

Modernity and self

A reader sent some of her thoughts and selections from her dissertation on modernity that I found to be interesting, particularly with regard to the modern conception of self.  I edited them, so I apologize if they have lost something in the process:

About the writer Katherine Mansfield: "She was like a lantern with many windows - not octagonal, but centagonal. Each friend had his or her window and Katherine gave generously, gave all to each one, of her light, through that window. That was why so many people thought they were, not just one of her friends, but her only friend. She did not give the lantern (Me, the writer of this post, as Katherine herself, believe there was no such unifying lantern) and no one could touch the flame - and if anything came too close she would withdraw or close the leaves".

Extract from the modernist Katherine Mansfield's "The Dove's House": The main character, about his little son: "a queer thing is I can´t connect him with my wife and myself - I've never accepted him as ours. Each time when I come into the hall and see the preambulator I catch myself thinking: H'm, someone has brought a baby!" And later on: "if the impermanent selves of my wife and me are happy - tant mieux pour nous (...) But I don´t know, I don´t know. And it may be that it's something entirely individual in me -this sensation (yes, it is even a sensation) of how extraordinarily shell-like we are as we are - little creatures, peering out of the sentry-box at the gate, ogling through our glass case at the entry, wan little servants, who never can say for certain, even, if the master is out or in (...)".

Katherine Mansfield herself: "Coleridge on Hamlet. "He plays that subtle trick of pretending to act when he is very near being what he acts"... So do we all begin by acting and the nearer we are to what we would be the more perfect our desguise. Finally here comes the moment when we are no longer acting; it may even catch us by surprise. We may look in amazement at our no longer borrowed plumage. The two have merged; that which we put on has joined that which was; acting has become action. The soul has accepted this livery for its own after a time of trying on and approving (...) And the Hamlet is lonely. The solitary person always acts". 

And then you've got the anthropologist René Girard, who bases his whole theory on the idea that Humanity desperately NEEDS identity, and has an innate fear of indiferentiation (aka lack of a well differenced personal identity), giving totally crazy examples like the fear of twins in many cultures. People saw them as a subconscious menace to DIFFERENCE, and so a personification of chaos (they apparently used to sacrifice them). Chaos leading to violence. So lack of identity, or indifference, leads to  violence in human societies. A socio with no identity is a potential danger. A normal person with no identity is a potential danger. The problem is that we do find trouble in defending the SELF nowadays. Hard work if you really have some sincere insight. Tell it to Nietzche and all the others forerunners of the unexisting reliable self. 

Simone Weil also said: "I see the world as if I were not in it." this type of distance supreme and contemplation, which is in the antipodes of indifference, perhaps looking at the infinite and original world and man's purity and of which we have grown wary? This is an effort to free the world from the opaqueness of our presence, of that barrier between the object and a clean, truthful eye.

And then you've got that in modern writers:
From Katherine Mansfield:

"... a self which is continuous and permanent; which... thrusts a scaled bud through years of darkness until, one day, the light discovers it and shakes the flower free and - we are alive-  we are flowering for our moment upon the earth. This is the moment which, after all, we live for - the moment of direct feeling when we are most ourself and least personal". 

I could go on and on... We are playing on the league of the great thinkers of last century as well as our own. I'm sick of it. I wish I had been born an uber-empath in some hidden village of France five hundred years ago. A cow to milk, a husband to love and an early dead. 

Or I wish I was a little less pretty: less power, less thrill for life, a boring, early, happy marriage, and (fingers crossed) and EARLY DEAD. 

Friday, June 22, 2012

The modern psychiatric diagnosis: DSM

This was an interesting NY Times op-ed about the DSM, its origins, and questioning its continuing role in society, written by a former contributor to the DSM.

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

Psychiatric diagnosis was a professional embarrassment and cultural backwater until D.S.M.-3 was published in 1980. Before that, it was heavily influenced by psychoanalysis, psychiatrists could rarely agree on diagnoses and nobody much cared anyway.

D.S.M.-3 stirred great professional and public excitement by providing specific criteria for each disorder. Having everyone work from the same playbook facilitated treatment planning and revolutionized research in psychiatry and neuroscience.

Surprisingly, D.S.M.-3 also caught on with the general public and became a runaway best seller, with more than a million copies sold, many more than were needed for professional use. Psychiatric diagnosis crossed over from the consulting room to the cocktail party. People who previously chatted about the meaning of their latest dreams began to ponder where they best fit among D.S.M.’s intriguing categories.

The fourth edition of the manual, released in 1994, tried to contain the diagnostic inflation that followed earlier editions. It succeeded on the adult side, but failed to anticipate or control the faddish over-diagnosis of autism, attention deficit disorders and bipolar disorder in children that has since occurred.

Indeed, the D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence. It has become the arbiter of who is ill and who is not — and often the primary determinant of treatment decisions, insurance eligibility, disability payments and who gets special school services. D.S.M. drives the direction of research and the approval of new drugs. It is widely used (and misused) in the courts.

Until now, the American Psychiatric Association seemed the entity best equipped to monitor the diagnostic system. Unfortunately, this is no longer true. D.S.M.-5 promises to be a disaster — even after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription. The association has been largely deaf to the widespread criticism of D.S.M.-5, stubbornly refusing to subject the proposals to independent scientific review.

Many critics assume unfairly that D.S.M.-5 is shilling for drug companies. This is not true. The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role.

There were a couple things I thought this this piece did a good job of illustrating.  First, that the history of the DSM wasn't Allah speaking directly to his prophet who then immortally inscribed these truths into the first issue of the DSM, but that it was largely just an attempt to assemble what most people thought about things out of the primordial ooze that was mainstream psychology as recently as a few decades ago.  Second, that despite these somewhat inauspicious origins, most people believe the word of the DSM like it is the bible, including decisionmakers like courts and legislatures.  Third, that there will never be a perfect DSM because of fundamental disagreements and the accompanying political machinations amongst the experts that write it.  So, in a word, the DSM is not the most reliable system in the world.

The conclusion:

Consumers should play an important role in the review process, and field testing should occur in real life settings, not just academic centers.Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots.

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