Says the Dr. Thomas R. Insel, director of the National Institute of Mental Health. From the NY Times:
While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.
“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”
Insel describes the problem of all psychiatric diagnoses:
“Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”
It's interesting, a lot of people will come on here and baldly assert, "sociopaths don't do this" or "that's not what borderline personality disorder is." And that's fine. I understand the flaws and ambiguities in my own working definitions of psychiatric disorders. And I also understand that despite the fuzziness of the definitions, it's still useful to acknowledge that there seems to be commonalities between certain categories of people that deserve further explanation. But I do believe that people have used the DSM unquestioningly for far too long, taking it to the level of being DSM apologists rather than accepting new information with an open-mind, and I'm glad that there is now more pressure to provide actual science behind the various assertions.
For more on the DSM-5's explicit rejection in one instance of actual scientific proof of a separate psychiatric disorder, see this New Yorker article's discussion of melancholia:
[T]he inclusion of a biological measure [for melancholia] would be very hard to sell to the mood group." Coryell explained that the problem wasn’t the test’s reliability, which he thought was better than anything else in psychiatry. Rather, it was that the D.S.T. would be "the only biological test for any diagnosis being considered." A single disorder that met the scientific demands of the day, in other words, would only make the failure to meet them in the rest of the D.S.M. that much more glaring.
***
This notion—that the apparent mental condition is all that can matter—underlies not only the depression diagnosis but all of the D.S.M.’s categories. It may have been conceived as a stopgap, a way to bide time until the brain’s role in psychological suffering has been elucidated, but in the meantime, expert consensus about appearances has become the cornerstone of the profession, one that psychiatrists are reluctant to yank out, lest the entire edifice collapse.
"What can be asserted without evidence can be dismissed without evidence."
Friday, May 10, 2013
Thursday, May 9, 2013
Song: Use Me
I have been swimming to this song recently and have been loving the lyrics. People always wonder why someone might choose to be in a relationship with a sociopath: "I want to spread the news that if it feels this good getting used, oh you just keep on using me until you use me up."
My friends feel it's their appointed duty
They keep trying to tell me all you want to do is use me
But my answer yeah to all that use me stuff
Is I want to spread the news that if it feels this good getting used
Oh you just keep on using me until you use me up
Until you use me up
My brother sit me right down and he talked to me
He told me that I ought not to let you just walk on me
And I'm sure he meant well yeah but when our talk was through
I said brother if you only knew you'd wish that you were in my shoes
You just keep on using me until you use me up
Until you use me up
Oh sometimes yeah it's true you really do abuse me
You get in a crowd of high class people and then you act real rude to me
But oh baby baby baby baby when you love me I can't get enough
I and I want to spread the news that if it feels this good getting used
Oh you just keep on using me until you use me up
Until you use me up
Talking about you using me but it all depends on what you do
It ain't too bad the way you're using me
'Cause I sure am using you to do the things you do
Ah ha to do the things you do
My friends feel it's their appointed duty
They keep trying to tell me all you want to do is use me
But my answer yeah to all that use me stuff
Is I want to spread the news that if it feels this good getting used
Oh you just keep on using me until you use me up
Until you use me up
My brother sit me right down and he talked to me
He told me that I ought not to let you just walk on me
And I'm sure he meant well yeah but when our talk was through
I said brother if you only knew you'd wish that you were in my shoes
You just keep on using me until you use me up
Until you use me up
Oh sometimes yeah it's true you really do abuse me
You get in a crowd of high class people and then you act real rude to me
But oh baby baby baby baby when you love me I can't get enough
I and I want to spread the news that if it feels this good getting used
Oh you just keep on using me until you use me up
Until you use me up
Talking about you using me but it all depends on what you do
It ain't too bad the way you're using me
'Cause I sure am using you to do the things you do
Ah ha to do the things you do
Wednesday, May 8, 2013
Famous sociopaths: Amanda Knox?
It's a boom season for memoirs written by young female sociopaths, or is it? I did not follow the Amanda Knox trial while it was happening but after I heard about her book I was curious to see why why people think she's a coldblooded murderess. Mainly people's opinions of her guilt seem based on circumstantial evidence and the fact that she didn't respond the way that "normal" people (or at least normal, non guilty people) would react to being a murder suspect? But how would you react "normally"? Cry? Suffer some sort of emotional or nervous breakdown? Especially for someone who seems to not quite have a typical emotional palette (her memoir is described as being written with "brutal honesty, clarity, and conviction"), how was she expected to act?
Sometimes I imagine what it might be like to be a young, sociopathic Amanda Knox, who may not have killed her roommate (maybe it was a coincidence?), but now she is a suspect and she knows she's being watched. What sort of show should she put on? What sort of manual is there, or prior experiences to draw upon in knowing how to appropriately respond to be falsely accused of murder? A roommate that you hate and barely know gets killed in a foreign country while you are with some guy you just started dating. Even if she weren't a sociopath, I could see how she wouldn't be that broken up about the whole thing. It would be really hard to fake normal reactions in that situation, even if you were innocent.
In that same vein, "This American Life" features an odd story of an upstanding doctor in a rural town who brutally murdered his father -- Vince Gilmer. Even though he is serving a life sentence for the murder, everyone in the town had glowing stories to tell about him: "Generous to a fault." The show features many people trying to make their own determinations about what is the deal with Gilmer -- cold-blooded murderer? Or a man who finally snapped due to provocation from an incredibly abusive father. It was hard for people to tell because when questioned by the police, he was not manifesting authentic remorse or mental illness, but rather seemed to be "hamming it up." He would start crying, seemingly strategically: "either he was having tremendous mood swings, or he was trying to avoid the question." "So we set up a camera on the rec yard and invited the inmates to play . . . . And then we purposefully sent the officer . . . and Mr. Gilmer saw the officer he immediately began to shake his head and arm" as if he were suddenly sad. When the officer left the rec yard, Mr. Gilmer went back "It seemed as if the victim was exaggerating his symptoms" for the sake of the psychiatrist.
It's sort of odd hearing the people on "This American Life" discuss the Gilmer case or reading the followers of the Amanda Knox trial trying to suss out what is the truth based on what little anecdotal evidence they have to cling to. The judge in the Gilmer trial thought "it was clear" that the murder was premeditated and yet many still have doubts (it turned out that Gilmer had Huntington's disease, a neurological disease which his doctor said would explain his appearance of faking symptoms). Amanda Knox was acquitted, but the Italian appeals court reversed.
"I'm still confused about whether he was good or not."
Gilmer's doctor laments about his patient's poor treatment and why it took so long to get him properly diagnosed: "They have a pre-conceived idea about what's going on and that's it. They're inflexible. . . they have a stereotype . . . and they won't budge beyond that."
Sometimes I imagine what it might be like to be a young, sociopathic Amanda Knox, who may not have killed her roommate (maybe it was a coincidence?), but now she is a suspect and she knows she's being watched. What sort of show should she put on? What sort of manual is there, or prior experiences to draw upon in knowing how to appropriately respond to be falsely accused of murder? A roommate that you hate and barely know gets killed in a foreign country while you are with some guy you just started dating. Even if she weren't a sociopath, I could see how she wouldn't be that broken up about the whole thing. It would be really hard to fake normal reactions in that situation, even if you were innocent.
In that same vein, "This American Life" features an odd story of an upstanding doctor in a rural town who brutally murdered his father -- Vince Gilmer. Even though he is serving a life sentence for the murder, everyone in the town had glowing stories to tell about him: "Generous to a fault." The show features many people trying to make their own determinations about what is the deal with Gilmer -- cold-blooded murderer? Or a man who finally snapped due to provocation from an incredibly abusive father. It was hard for people to tell because when questioned by the police, he was not manifesting authentic remorse or mental illness, but rather seemed to be "hamming it up." He would start crying, seemingly strategically: "either he was having tremendous mood swings, or he was trying to avoid the question." "So we set up a camera on the rec yard and invited the inmates to play . . . . And then we purposefully sent the officer . . . and Mr. Gilmer saw the officer he immediately began to shake his head and arm" as if he were suddenly sad. When the officer left the rec yard, Mr. Gilmer went back "It seemed as if the victim was exaggerating his symptoms" for the sake of the psychiatrist.
It's sort of odd hearing the people on "This American Life" discuss the Gilmer case or reading the followers of the Amanda Knox trial trying to suss out what is the truth based on what little anecdotal evidence they have to cling to. The judge in the Gilmer trial thought "it was clear" that the murder was premeditated and yet many still have doubts (it turned out that Gilmer had Huntington's disease, a neurological disease which his doctor said would explain his appearance of faking symptoms). Amanda Knox was acquitted, but the Italian appeals court reversed.
"I'm still confused about whether he was good or not."
Gilmer's doctor laments about his patient's poor treatment and why it took so long to get him properly diagnosed: "They have a pre-conceived idea about what's going on and that's it. They're inflexible. . . they have a stereotype . . . and they won't budge beyond that."
Tuesday, May 7, 2013
80/20 rule
The 80/20 rule, or the Pareto principle, states that 80% of the output comes from 20% of the input. In business parlance, it means things like 80% of your customers are coming from 20% of your efforts. For purposes of this blog, it means that 80% of the blog material comes from 20% of my life.The blog is less a accurate reflection and more of an inverse of my life. In real life i act like a normal person, speak about normal things, while having an unspoken, inner dialogue. On the blog I give voice to the inner dialogue, but leave out all the normalcy: hobbies, work, family, friends, birthdays, holidays, funeral, vacations, personal hygiene regimens, and all the banality of everyday life that has little to nothing to do with my unique worldview.
The really interesting thing about this has been interacting and "meeting" people only via the blog. In real life, people see me act normally and try to incorporate any idiosyncrasies they perceive into their idea of normal me. People that only know me on the blog treat me entirely differently. Sometimes they give me an odd deference. Sometimes they are afraid. Sometimes they are rude and judgmental. It's not just that people are making random assumptions about me, that happens in real life all the time. These assumptions are different, though, perhaps because people aren't giving me the benefit of the doubt, or perhaps because they only see 20% of me. Neither set of assumptions seem better or more accurate than the other, but I still prefer one set over the other. In any case, these interactions make me question whether I really want to be "out" with the general populace. I know that has sort of been my (naive) goal, but given my fear of angry mobs, I think I have since thought better of it.
Monday, May 6, 2013
The virtues (?) of victimhood
For a lot of spiritual/religious people there is the interesting issue of theodicy, the problem of evil: “how we justify the existence of suffering with belief in a God who created us, who loves us, and who providentially manages the world.” I've noticed that people (here in the comments and in my real life) seem to want to give meaning to bad things, typically in one of a few ways: (1) that God is testing them (and so presumably as long as they hang in there, the bad thing gave them a chance to prove themselves and is at worst neutral), (2) that they suffer to make them stronger (so the bad thing is really a blessing in disguise), or (3) they suffer as a testament to the evil of other men (and those men are going to be condemned or punished, so a net negative). This last reason is the most troubling to me. A lot of people come to the comment section with judgment on their tongue and calls for blood for the sociopaths that have wrecked their lives and so deserve untold horrors.. For some of these people, this one experience has come to define their existence.
When religious people think of someone who really had it rough, they frequently will think of Job. Job not only lost everything, all of his wealth, family, friends, he suffered immense physical pain. Job basically had it about as bad as you can get it. But there was no one for Job to hate except God, which he declined to do. As his reward, God gives him double what he had before. Dostoevsky writes in the Brothers Karamazov:
God raises Job again, gives him wealth again. Many years pass by, and he has other children and loves them. But how could he love those new ones when those first children are no more, when he has lost them? Remembering them, how could he be fully happy with those new ones, however dear the new ones might be? But he could, he could. It's the great mystery of human life that old grief passes gradually into quiet, tender joy.
But I have a feeling that for a lot of the victims that come here, having their lives restored wouldn't be nearly enough for them to relinquish their claims to victimhood. In their mind, giving up their hurt would also mean giving up the meaning and sense of purpose they've assigned to that hurt. Giving up their pain would mean giving up their hopes for justice -- that the wrongdoers will eventually suffer commensurate to their misdeeds. These people would rather live a life of eternal victimhood than they would a world in which things eventually get better.
The Brothers Karamazov is one of my favorite books. One of the characters Ivan struggles with this desire for justice:
I must have justice, or I will destroy myself. And not justice in some remote infinite time and space, but here on earth, and that I could see myself. I have believed in it. I want to see it, and if I am dead by then, let me rise again, for if it all happens without me, it will be too unfair. I want to see with my own eyes the hind lie down with the lion and the victim rise up and embrace his murderer. I want to be there when everyone suddenly understands what it has all been for. All the religions of the world are built on this longing, and I am a believer.
Apart from the established health benefits of forgiving and letting go of past hurts, Ivan's position is simply inconsistent with reality. There is no perfect justice. To keep clamoring for it suggests a significant break with reality. This is particularly true of justice against people like me, who don't really believe in “right.” Everything just is. If bad things happen to me, I wouldn't recognize them as any sort of retribution for past wrongs. I do not believe life is "fair" that way. I wouldn't actually feel like I was being punished, so what's the point?
When religious people think of someone who really had it rough, they frequently will think of Job. Job not only lost everything, all of his wealth, family, friends, he suffered immense physical pain. Job basically had it about as bad as you can get it. But there was no one for Job to hate except God, which he declined to do. As his reward, God gives him double what he had before. Dostoevsky writes in the Brothers Karamazov:
God raises Job again, gives him wealth again. Many years pass by, and he has other children and loves them. But how could he love those new ones when those first children are no more, when he has lost them? Remembering them, how could he be fully happy with those new ones, however dear the new ones might be? But he could, he could. It's the great mystery of human life that old grief passes gradually into quiet, tender joy.
But I have a feeling that for a lot of the victims that come here, having their lives restored wouldn't be nearly enough for them to relinquish their claims to victimhood. In their mind, giving up their hurt would also mean giving up the meaning and sense of purpose they've assigned to that hurt. Giving up their pain would mean giving up their hopes for justice -- that the wrongdoers will eventually suffer commensurate to their misdeeds. These people would rather live a life of eternal victimhood than they would a world in which things eventually get better.
The Brothers Karamazov is one of my favorite books. One of the characters Ivan struggles with this desire for justice:
I must have justice, or I will destroy myself. And not justice in some remote infinite time and space, but here on earth, and that I could see myself. I have believed in it. I want to see it, and if I am dead by then, let me rise again, for if it all happens without me, it will be too unfair. I want to see with my own eyes the hind lie down with the lion and the victim rise up and embrace his murderer. I want to be there when everyone suddenly understands what it has all been for. All the religions of the world are built on this longing, and I am a believer.
Apart from the established health benefits of forgiving and letting go of past hurts, Ivan's position is simply inconsistent with reality. There is no perfect justice. To keep clamoring for it suggests a significant break with reality. This is particularly true of justice against people like me, who don't really believe in “right.” Everything just is. If bad things happen to me, I wouldn't recognize them as any sort of retribution for past wrongs. I do not believe life is "fair" that way. I wouldn't actually feel like I was being punished, so what's the point?
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