Archive for the science Category

Weaponry

Posted in health, mental health, philosophy, science with tags on February 20, 2013 by theweirdphilosopher

Since apathy didn´t work, I will now try reason.

1.) Haley makes it clear that the entire point of psychoanalysis is that the patient can´t get it right. This means that I´m not really inadequate and stupid. I was set up for failure, but I am none.

2.) This technique punishes every kind of human behavior. Therefore, I don´t need to be particularly flawed or vulnerable to be punished by it. The punishment has nothing to do with me in particular.

3.) Haley gives a couple of typical patient reactions, and I´ve seen similar lists in other books on psychotherapy. This indicates that the number of possible reactions is relatively limited. Therefore, it would seem that the choice of behavior is not particularly unique to the respective patient and doesn´t say much about his personality.

Comparison 1: There are three possible reactions to life-threatening situations: Fight, flight and freeze. If you categorize people according to those reactions (ethical concerns set aside, I mean, how are you going to find out?), you´ll get groups which are still very mixed otherwise.

Comparison 2: One hundred people are supposed to choose between three kinds of ice cream: Vanilla, chocolate, and banana. Of those one hundred people, 51 choose banana indepently of each other. Each of those 51 believes this choice is particularly unique to him and an indicator of his very own personality style. The researchers observing the experiment know, however, that more than half of the subjects chose banana and that, other than this, they barely have anything in common. The psychoanalyst who was invited, too, believes that the choice of ice cream is the only meaningful way to describe human beings and comes to the conclusion that there are only three kinds of personalities.

4.) If all possible reactions are punished, the fact that your behavior is punished doesn´t mean it is pathological, evil or otherwise undesirable. If all behavior is punished, the fact that you are punished shouldn´t discourage or otherwise bother you. You may calmly walk away, knowing that psychoanalysis cannot show you whether you are normal or not since it has the same effect on everyone.

5.) In order to prevent people from calmly walking away, psychoanalysis cultivates the myth that there is a way to get it right, but that it is hard to explain and you cannot understand it without undergoing thorough analysis. Please mind that this is how cults work. Such a promise gets people hooked on the hope that one day they´ll stumble onto this right way and get their therapist´s approval. Remember that one person´s approval is not very strong proof that you are doing or thinking the right thing.

6.) If the behaviors people choose in psychoanalysis aren´t particularly unique to them, they don´t say much about who they are. Essentially, this means that ironically you don´t learn all too much about yourself in psychoanalysis. This, of course, also means that people who have been analyzed don´t necessarily know themselves better than people who haven´t.

7.) Psychoanalysis is a borderline situation that can be rarely found in real life (that is: outside the treatment room). As such, it provokes behaviors which the patients will likely not exhibit in real life, especially regressive behaviors. At best, therefore, it can teach the patient how he reacts (emotionally and otherwise) to the analytical setting, and it would seem like the range of reactions is too limited for any reaction to be unique to or specific for a certain patient. It might be an interesting experience for morbidly curious people, but claims that what surfaces in such a setting is who the patient “really” is seem unfounded. Remember that “really” in this context and terms like “true self” have never been properly defined.

Summary: How we react to the analytical setting does not say much about us personally. Therefore, we don´t need to let it affect our self-image, leave alone self-esteem. The negative effect it has on the latter nonetheless stems from the fact that due to the therapist´s manipulation we persistently experience feelings of inadequacy, confusion and impotent rage. Psychoanalysis is designed as a constant blow to the ego.  Those feelings, however, are not indicative of any tangible, relevant inferiority or inadequacy on our part; nor are they proof of the therapist´s hypothetical superior knowledge. They are merely the result of a few simple, but effective rhethorical tricks to which there are no answers yet.

 

 

Reflections on various theories – The recovered memory debate, part II

Posted in health, mental health, personal, science, Uncategorized with tags , , , on July 13, 2012 by theweirdphilosopher

Like I promised, I´ll try to clarify my own position in the memory wars. Let me first say that I don´t have a definite opinion. All that I have to evaluate the different positions floating around out there – are my own experiences. And the stuff I read for my paper. There are many different opinions and positions, and I cannot deal with all of them. So what I will do first is look at the two extremes.

Two extreme positions

Extreme No. 1) It is impossible to recover any accurate memories of traumatic events, repression doesn´t exists, dissociative disorders are iatrogenic. There are no hidden memories secretly influencing us.

Extreme No. 2) All our memories are still somewhere there in our unconscious, but they might not be accessible due to repression or dissociation. If you feel like you might have been abused as a kid (and repressed the memories) it is probably true. Every image that comes up is taken at face value.

I feel that my experiences contradict both extremes. It is very obviously possible to develop false memories (and even worse: They don´t necessarily have to be iatrogenically induced!) – but it is also possible to forget about bad experiences only to suddenly remember them years later.

Adherents of Extreme No. 1 might argue that me not thinking about my experience for years was nothing more than ordinary forgetfulness. We cannot be conscious of all our memories all the time, after all. It seems to make a difference to me, though, if you don´t think about the fact that you liked chocolate ice cream in fifth grade for years, or if you think nostalgically about your childhood friend without being remotely aware that, aside from being your best friend, she was also quite a bully. I was thinking of her, I hadn´t forgotten her, but my image of her was remarkably distorted or at least very one-sided. Now that I have my memory back, I don´t think about the incident every day. I rarely think about it at all. But when I think about Chasey, my memory of the incident plays a crucial part in how I think of her. There is a difference between not thinking about something and not being aware that it ever happened.

Another thing is that even while I was still idolizing her, the lessons I had learned from the incident I had forgotten were influencing me. A while before I remembered it I was sitting in a park with some friends. I had taken off my shoes because it was a hot day. A guy our age started to yell insults at us, then came over. I immediately grabbed my shoes – in order to protect them. I didn´t question my action, it was just something I did. I felt a rush of anxiety when he approached us and my reaction was: “Don´t let him take your shoes, or you cannot insult him back anymore.” The fear that he could take something that belonged to me as a “hostage”, thus leaving me at his mercy, seems to be very much in line with my experience of being blackmailed into saying stuff.

So, judging by my experiences, both extreme opinions are not tenable. Our memories are not all hidden somewhere in our unconscious, crystal clear and complete. They can easily be conflated with false memories. Some memories can be entirely false. But we can be unaware of ugly past experiences and still be influenced by them while having a completely distorted picture of the people involved in these events; and we can regain memories of those experiences.

How memories might be “forgotten”

So how are memories of bad events forgotten? There are basically two theories: 1) Repression. 2) Dissociation.

Both concepts are frequently conflated, which is unfortunate, because from what I´ve read I conclude that they are actually quite different things. My thoughts about this are based on Henri Ellenberger´s The Discovery of the Unconscious and German psychologist Lydia Hantke´s essay Trauma und Dissoziation (Trauma and Dissociation). Hantke traces back the theory of dissociation to Pierre Janet, a contemporary of Freud.

From what I have gleaned through these works, Janet believed that we are constantly busy integrating everything that happens to us (also emotions) into our consciousness. Sometimes, though, certain emotions like intense fear might overwhelm our capacities of integration.

Now, there are two slightly different options again. As far as I understood Janet, he thinks that our memories of the event that overwhelmed us are split off, meaning that our future consciousness is narrowed. Dissociation, in his view, means that the parts split off develop an ability to integrate experiences as well.

Another theory I frequently encounter is that in a state in which we are overwhelmed, we can no longer process all the information; which means that much of the information about the overwhelming situation never enters our consciousness. In this theory, this process is what is called “dissociation”.  The result is that we have no explicit memory of the event. We do, however, pick up information unconsciously which is stored as implicit memory. The implicit memory, however, is not a little piece of consciousness. It simply isn´t conscious.

Now for repression. The way Ellenberger and Hantke describe it, Freud seems to have seen shame as the driving force behind repression. We push events or feelings out of our consciousness when we feel ashamed of them or cannot accept them as part of our self-image.

So where is the big difference?

The big difference is that in the two dissociation theories the ugly event/feeling never fully entered our consciousness. The splitting off happened during the event. In the case of repression, however, we are fully aware of the event until we decide to repress the memory of it. At least in the second dissociation theory, a memory is never even formed

So what do those theories imply for recovered memories?

In the case of repression, an explicit memory of the event has been formed at some point, though, according to repression theory, it is inaccessible due to resistance. This theory is compatible with the idea that one might recover an explicit memory, that is, a narrative.

In the second case of dissociation, no explicit memory has ever been formed, which suggests that any narrative or memory suddenly popping up would be false. I´m cautious to judge that, though, because we do not know terribly much about how the brain works. Which is also why I´m stunned at the militance found in the memory debate.

So, how about Janet´s version of dissociation theory? It seems to be a bit different from the theory that says that our consciousness gets cut off from information during trauma. Janet is talking about a splitting of consciousness during overwhelming events. The result of this is that our normal consciousness is narrowed, and the memory, or the information collected during the event, carries a little bit of consciousness of its own.  So – is this memory, too, merely an implicit one, or is there an explicit memory stored somewhere that never entered our consciousness? This model does differ from the repression theory, since in the case of repression, the memory has originally been part of our consciousness, and it is not split off, but it is stored away into a different entity, the unconscious. I guess in the case of repression, our consciousness is not narrowed, but that is just me trying to distinguish the two theories. So, basically repression means to actively push away an uncomfortable memory, and dissociation by Janet´s definition means that your consciousness is shattered and that you develop, if not a multiplicity of selves, then at least a more than one consciousness, though there is still one main consciousness and one or more fragments.

I hope I have correctly depicted the respective theories. I´m merely an interested layman with some personal involvement.

I believe some of the recovered memory skeptics hold the opinion that repression and splitting of consciousness does not exist while believing that there can be a blockade of information during trauma, leading to memories never being formed. I wonder if, under circumstances like these, it would be possible to not know the trauma has ever taken place. They might argue that while a person might have amnesia for certain parts or even all of her car accident, she would always know she´d been in one. It would be part of the narrative, the plot of her life, just the way I knew I had somehow walked from my home to Chasey´s place even though I don´t remember how (which is quite normal because it is probably fairly insignificant)? Would she wake up in hospital and be aware that she has had a car accident even though she doesn´t remember any of it?

That type of knowledge is possible, I believe. I remember having an alcohol blackout three years ago. I only remember bits and pieces, obviously, but I was never unconscious. I lost the plot several times throughout the blackout, but whenever I came to, I knew exactly where I was and what was going on, even though I had no memories of the immediate past.

But what, though, if the person woke up in hospital knowing nothing? She will be told she has been in an accident, she´ll be shown the car wreck, but for all she knows she might as well have been abducted by aliens. Nothing about the story feels familiar to her. Still, though, that way she´d always know something has happened to her. She would wake up in hospital knowing something is wrong, and she would later remember that moment, it would be part of her personal history. How about it, though, if the trauma had never been acknowledged or noticed for whatever reason? If we´re talking about a kid, aren´t there possibilities that the disorientation, the confusion, the fear could somehow be excluded from the personal narrative? Exist as some confused, strange fragments of memory that sometimes, rarely come up and somehow just don´t seem to fit the picture?

I have no idea. Basically, I´m just trying to sort out the various thoughts I have about this subject. I might go on at some other point, I feel I´m getting stuck here at the moment.

True or false – The Recovered Memory Debate, Part I

Posted in health, mental health, personal, science with tags , , on July 10, 2012 by theweirdphilosopher

***Sexual Abuse / Rape Triggers********

I want to write a post on the issue of dissociation and recovered memories and I know that the moment I press “Publish” I´m guaranteed to have a shitstorm coming my way. The debate about whether or not recovered memories are real or not is a goddamn mine field.

I´m no neuroscientist. I´m not even a psychologist. I´m a philosopher who also studies history and who has written an essay on the rise and fall of Freud´s “seduction theory” last semester, which provided me, if nothing else, with a painfully clear view of how much different concepts such as repression and dissociation are being conflated and how much definitions (such as definitions of the term “trauma”) tend to vary. Moreover, I´m a mentally instable person who has experiences both with false and real recovered memories and who still believes that she ought to be remembering more of her childhood.

I will first outline my experiences with recovered memories, so you see where I´m coming from.

True Memories

So. I´m roughly sixteen years old, I´m sitting in my room and thinking about a childhood friend, let´s call her Chasey. I have been thinking a lot about her lately, with a sense of nostalgia. More than nostalgia. I´ve been acutely sentimental, thinking about what a pity it is that we lost touch after fifth grade, and how special and awesome she was. And as I sit there, out of nowhere I remember a fairly ugly incident; a situation in which Chasey wasn´t nice and awesome at all. On some summer day she and a mutual friend locked me out of their flat (parents were away). I asked them to at least give me back my backpack, which was still in there. They emptied my backpack on the balcony and started to throw down its content piece by piece. In the end, they actually made me say things in exchange for my stuff. Thankfully, they got this idea only when they had just one piece left.

I knew straight away that this memory was accurate. I never had the slightest doubts; I even remembered some of my thoughts and feelings at the time. I cannot really tell you what makes me so sure. It might be very hard to scientifically prove that this something that made me so sure exists and is valid. It sounds like I´m appealing to mysticism, but all I can do is describe my experience.

My memory of the day and the follow-up of this situation is incomplete. My memory starts with us being somewhere outside, they already display a certain hostility towards me. Next memory is us standing in front of my house. I know the key is in my backpack at Chasey´s place; they are pissed off and tell me to get it. Next memory is me standing in front of Chasey´s home, nobody´s there. I know what happens next, but I have no images of it in my mind. I try to climb the balcony, because the door up there is open, but I fail. The next image is that Chasey and her friend are there, too. They climb the balcony, but they don´t bother helping me climb it, too. They start throwing down my stuff. I only notice now, but the entire memory is silent. I don´t remember what is being said for the most part; I just remember me yelling at them something like  “Are you crazy?” when they threw down my key, and I remember what they made me say, verbatim. I remember what must have been said, like that they forbade me to cross my fingers when I say what they want to hear; but I don´t remember them saying it. I don´t remember walking home alone, but I know I did.

I was going to say that the next thing I remember is being at a sports club we all attended that evening, but I just remembered that I had been very unsure if I wanted to go there. I wanted to, sure, but I was scared they could take away my stuff again. So I decided to not take anything with me. It is interesting that little things can still be added after such a long time. I have to say, though, that once again I have no concrete images. I just know it happened, the way you remember the plot of a movie even though you don´t remember the exact images and scenes.

And this is how the plot continues: At the sports club we get along splendidly; so splendidly, indeed, that we all want to have a sleepover at Chasey´s place. My next vivid memory, however,  is us standing in front of my door, imploring my mother that I can stay at Chasey´s and our cheering when she says yes. Now that I think of it, it might be we pulled the same thing when talking to that friend´s grandmother, but I´m not sure. It would be so easy to contaminate this real, accurate memory with false pictures which, although in line with the plot, are pure fabrications my mind is producing right now.

There is a hole in the plot, now. All that I am left with is images. It is dark, we are in Chasey´s living room, it´s past our bedtime. For some reason there is a tent propped up in the room. I guess we somehow persuaded the grown-ups we could sleep in there. Now I´d really love to tell the story, but I am clueless. I know I´m in that tent, worried that they might somehow lock me in there. So apparently we´re not getting along anymore, once again. I´m pretty sure they must have said mean things to me.

Next hole in the plot, and it is morning. We are outside, walking to the playground. They get on the swings, I have to wait. They walk on before I have had time on the swings. There´s a few sparse images and feelings, not much plot. So I´m at a huge risk of constructing a story here. I believe I remember walking behind them and understanding that they really didn´t want me around, so at some point I must have gone home. The end.

So, back to age sixteen. I know this happened. Remembering it has completely turned around my view on Chasey. I wonder why I idolized her so much all the time. Because now that the floodgates are open, I also start to remember other incidents when Chasey was mean to me, or at least didn´t stop her clique from being mean to me. Most of those memories are just shreds and images, or some sentences spoken. I might remember us being at a specific playground, but I don´t remember exactly who was there aside from the persons who play a role in this specific memory. I remember what was being said; I remember single thoughts, feelings and motivations I had, but I don´t remember when in my life it happened. Those memories might have a plot which I somehow know;  but I cannot fit them into the larger plot that is my life story. I can only conclude, construct that it must have happened towards the end of fourth grade. Also, if I want to get those memories into an order, I need to use circumstancial evidence. Even though they are basically part of the same plot, that is, being bullied by my best friend, they are disconnected from one another.

False Memories

The typical false memory story goes like that: Girl sees therapist over random issue, therapist convinces her she has been sexually abused as a child, she starts to see creepy images of child abuse and penises in her head, he tells her those are all real memories and that her doubts are mere resistance, eventually she believes it and loses her family over that.

My story was a bit different. I managed to develop false memories without the “assistance” of a therapist. That fact still frightens me (which might explain my snappy tone in the paragraph above), since I apparently became crazy without any external, crazy-making factors. When I read about false memories I only ever encounter stories where the therapist convinced the patient that she was abused. I seem to be a special brand of either crazy or evil if I managed to convince myself I was raped as a child all on my own.

I don´t want to go into the possible reasons for my false memories right now. I want to bring out the difference between the experiences of recovering real and false memories. So I will try to suspend judgement and leave out my ugly feelings about what happened. Okay then.

I´m still sixteen. It´s just a few weeks after I remembered the nasty incidents involving Chasey. I have a nightmare in which I am at home and get raped by an intruder. I will go into that dream at some point because I still believe it was meaningful, but right now is not the time. So when I woke up I was already convinced that this dream had to be important in some way. There are reasons for that, but it´s a fairly long story I will tell at some other point. The important thing here is that I started out with a bias: This dream is important.

I might not have been wrong. I still believe something about this dream was significant. My bias, however, also covered what part of the dream had to be important: The man who had raped me, and the fact that he had raped me.

I spent some time wondering who that man could be, I arrived at absurd, delusional ideas like that I was actually an orphan from an Eastern European war zone whose parents had been killed by that man. I did not seriously believe in any of those ideas, I was merely letting my thoughts wonder, toying with tragic plots, a bit like I was deciding which character I wanted to be in a video game or a role play.

Again, a few weeks later: I´m on holiday with my father and I start to toy with the idea that I might have childhood amnesia. That I might have forgotten some real bad traumatic event.

The idea didn´t scare me. It electrified me.

I was desperately eager to get back my memory. I felt like I was close to resolving the riddle that was my life. Finally everything would make sense! I felt a strange, deep yearning for something long lost, and I felt like I was about to get it back. I can still feel that yearning, it´s almost physical, and the allure of digging and digging until something has to come up is still just as strong. And I still feel that very same excitement when I stumble upon something that looks like evidence; when I feel that things are finally falling into place.

I don´t remember (how ironic) how it transpired, but I quickly had a plot in place: Some time when I was a kid I went to an abandoned ruin where my mum had told me not to go. I was alone, I encountered a man who looked like the guy from my nightmare, he raped me and I went back home and didn´t tell anybody because I had been to the ruin against my mother´s will.

It is the kind of story which, though it might happen in reality, too, could be straight out of a Hollywood movie. This is the first thing that distinguishes it from my memories of Chasey: It is pure drama material. The memory about Chasey, on the other hand, is incredibly mundane. There is no classical conflict, no misgivings, no innocence destroyed, not even a coherent storyline with intriguing twists, turns and escalations. Just a shabby blue children´s backpack, a key tied to a black shoelace, some clothes and a bit of pre-teen cruelty. Some aspects are even bizarre, they stick out like a sore thumb. If you made a movie about this experience, the first thing you´d do is throw out the tent because nobody would find it plausible. And yet it was there, even though it doesn´t make for a good story. Can´t help it. The false memory, though, was as plausible and coherent as it gets.

The most important thing that distiguished the true and the false memory, though, is the one that´s hardest to prove: In the case of the true memory, I knew straight away it was true. I didn´t even question its accuracy. I cannot really say it was recognition. I was just convinced it had happened, like you are convinced that there is a computer screen in front of you without further questioning. I knew it the way you know that the sky is blue.

With the false memory, though…this was missing. I didn´t feel that sense of belonging, the sense that this experience had been part of the sum of my experiences. So what I tried to do was remember the event, now that this obsessional idea had entered my head. I was basically trying to prove that this story had happened to me.

And immediately pictures came up. Pictures of the ruin, pictures of a sunny, lonely day. Even pictures of that guy walking into the ruin. No pictures of the rape, which lead me to the conclusion that I had zoned out. Later, when I believed I had Dissociative Identity Disorder, I assumed “an alter had taken over”.

I did have an emotional connection to those pictures. To the atmosphere in that ruin, to the atmosphere of a lonely sunny day. Which might not be entirely surprising, since I had been at that ruin on a sunny day. I hadn´t been alone, though. Chasey had been with me. The sense of fear and danger that accompanied those pictures does not come as a surprise, either. We had been forbidden to go there, after all.

It could also be that the pictures can be explained in an entirely different fashion. It doesn´t really matter, to be honest, interesting as it may be. The point is that I was producing visual evidence for a pre-fabricated plot. That is not to say I made up the plot on purpose and then deluded myself that it was true. The plot merely popped up in my head. I have a knack for dramatic stuff. It was a typical writer´s thing, I guess, just that it wasn´t an idea for a future novel, but for my past life. I guess it would be a good idea to investigate that dreamy state in which every crude tale (see the war story) can seem plausible for a moment, and why, at this point of my life, I tried to merge fantasy and reality. I cannot do that in this post, though.

Ironically, those false memories spured a whole lot of real, previously forgotten memories. Half of yesterday´s laundry list is owed to the memories that came up when I was starting to search for evidence of childhood sexual abuse in my past. Before I had started to dig I had believed that my childhood had been idyllic and happy and that I had only started to experience problems when puberty had set in. And that was simply wrong. I had had severe misconceptions about my childhood, and the truth was brought up because of my zealous attempts to prove the accuracy of a false memory. It doesn´t get much more ironic than that, really.

Those real memories appeared just like the one about Chasey. I suddenly just recalled stuff and knew it was true. Take the underpants thing. I remembered both a plot (there was a lengthy time in my childhood when I complained about my underpants not being comfortable) and there were pictures or scenes (I am on holiday with my mother and I rage and want to cry because I´m so uncomfortable.). They were associated with each other already; thinking about one brings up the other, even though I cannot consciously perceive the associative mechanism. When I got fixated on the false plot, though, it took a bit of a mental effort (though not too much since I´m quite good with fantasy) to produce images. It still does.

Another difference I would like to point out is my reaction to people questioning the accuracy of my true and my false memories.

When my parents claimed they “did not remember” the episode where my father hit me, I thought: “Come on you guys, who do you think you´re fooling? I know it happened, and I´m pretty sure so do you!” I´m so sure it happened that if it really isn´t true – I must batshit insane.

When somebody questioned my false memories, I would get extremely defensive, often aggressive, and I´d frantically try to provide evidence that they had to be true. You might find that behavior in people who know something happened and who are upset that nobody believes them. In my case, though, I didn´t know it had happened. My anger did not come from certain knowledge, but from a sense of deep insecurity, and, in a way even from a hidden, buried knowledge that my memories were not real. I do not fully understand why I needed them to be real so bad, but I did.

Another thing I notice is that I was incredibly unflexible when it came to the false plot. It had to have transpired in just the way I thought. When looking through childhood pictures I concluded from remarkable changes in my facial expression between two holidays that the rape must have had taken place between those dates. They were only a month apart, so I placed it in November in early fourth grade. The false pictures had given me the idea that it had been a sunny day, though, and from some other source I had taken the idea that it had been a Saturday. I actually looked up old weather data to confirm if there had been a sunny November Saturday in the year I was looking for. Thankfully that was the case. I don´t know to what lengths I would have gone to explain the discrepancy if there hadn´t. In retrospect my behavior reminds me of the desperate attempts of schizophrenics to stick to their delusions despite all contrary evidence. I wonder if what happened to me was related in some way.

I will continue these reflections another time, because, to be honest, I´m quite exhausted. I want to write about why I still feel like I don´t remember enough of my childhood, and I want to clarify my own position in the memory wars.

I´d be curious for my readers´experiences with memories, forgotten, recovered or normal, and how they feel their memory process works. I never know how many or detailed memories you are “supposed” to have, or if I have few or many memories compared to others, so any contributions are welcome.

 

 

Dr. Psych(o) – the weird psychiatrist

Posted in college, health, mental health, morbid, science with tags , , on November 6, 2011 by theweirdphilosopher

I don´t want this title to sound derogative – actually, I like Dr. Psych, precisely because she is so “weird”. As a reminder, Dr. Psych is the lady who gives the psychiatry lecture I currently attend. It deals with psychopathology (not psychopathy!), that is, with defining and recognizing all sorts of pathological mental symptoms such as “hearing voices”, “derealization”, “anxiety”. I believe this lecture will be very useful in understanding how mental health professionals form their opinions on their patients and how they reach their conclusion, that is, a diagnosis. Maybe it will also help me in deciding if I really have a symptom or if it is pure hypochondria.

The first session was three weeks ago. The lecture is held in a mental institution where they do not just treat patients, but also conduct research. It was the first time I went into that building and I felt very strange. First of all, I wasn´t sure if it was legitimate for a person who studied neither medical science nor psychology to attend that lecture (turns out it is). Then, I didn´t know where the classroom was. I didn´t know if I was supposed to be there at all, so I didn´t want to ask anybody (and besides, I feared that I could be mistaken for a patient…oh dear), but as I randomly entered one hallway because other people were going down there as well, I worried that I might accidentally end up in a room full of patients who would show some completely crazy reaction, like starting to yell at me. At the same time, it annoyed me that I was so bigoted and prejudiced – it´s not like I have any reason to see mental health patients as the “absolute other” or as people or, horribile dictu, beings completely different from me. Luckily, though, the other people in that hallway were students as well, and they finally worked up the nerve to ask someone for the way, so eventually we made it to the classroom.

So what is Dr. Psych´s lecture like? Thankfully, it greatly differs from what Dr. Bla delivers. The students are fairly quiet (and Dr. Psych has the necessary authority to make them shut up if necessary). Dr Psych herself is easy to listen to because 1) she has a loud enough voice and 2) she talks about interesting things, not just statistics, and 3) she actually bothers to structure her lectures and she sticks to her schedule.

First of all she handed us all a piece of paper which read like a checklist. It actually was. Listed on there were all possible psychopathological symptoms a psychiatrist needs to look for when first talking to a new patient, particularly when the patient is being admitted to an institution. Items on this list were, for example, suicidal tendencies, formal thought disorder and others. Dr Psych explicitly told us that this checklist does not yet lead up to a diagnosis. It is just used as a preliminary evaluation of the patient´s mental state. She said that the mission of her lecture was to acquaint us so intimately with these symptoms that we immediately see them in a patient while talking to him.

She started out by showing us a video of a manic patient. That patient was an old lady who was upset and angry at one moment, and next she would be cheerful and offer her interviewer a cigarette. She was talking all the time, and in a fairly loud voice.  Afterwards, we were supposed to tell Dr. Psych what we observed in that lady. I had the impression that most people talked about her “inappropriate” affect, or her body language, but few people mentioned what that old lady had been talking about. She had, essentially, been ranting about her domestic situation. Seeing the discrepancy between what was important to that lady and what was important to the interviewer and the psychiatry students made me feel quite low. The lady probably felt like her “manic” rage was perfectly appropriate, and she was happy that finally somebody listened to her. When you blindly trust your interviewer and let yourself go and pour your heart out only to realize that they don´t empathize with you, but take notes on how inappropriate your behavior is and in what way – don´t you feel incredibly fucked over? I cannot think about a concrete example right now, but something about that scenario felt depressingly familiar to me. I often perceived a lack of empathy, a lack of concern, a lack of interest in the things that I said from my former psychotherapists. And given that this approach is actually taught at college, I cannot assume that my experiences are exceptions. I would go on philosophizing about this approach and whether it is acceptable or useful or not, but I wanted to talk about Dr Psych´s lectures.

There are some really redeeming things about Dr. Psych, even though the above-described part of her lecture was depressing. First of all, she is honest and unpretentious. She explicitly told us that judging what is and isn´t normal is a risky and unprecise endeavour, something I wholeheartedly agree with. She also made clear how normal and abnormal are defined: Normal is the kind of behavior shown by the majority of people within a certain culture/society. It has nothing to do with good and evil. She even said that being abnormal is not necessarily bad (think about gifted people, for example). The question how you seperate sane and healthy from insane and ill is something that has been bugging me for a long time. When I confronted one of my former therapists, let´s call him Dr. Stoneface, with my opinion that normal and abnormal were no real scientific categories, but just judgements made by society, he replied: “Well, of course!”, as if that was a good thing. My opinion, naturally, was: If they are just man-made judgments, then they are only there to oppress people who are different! I´m not entirely sure of that opinion anymore, because some people simply suffer, and by saying that their suffering is not normal they can or at least might successfully make the case that they need help – and actually get it. I guess for now I can live with Dr. Psych´s take on this: “Normal and abnormal are not ideal categories and they must be handled with a lot of care and self-awareness, but right now they are the best thing we have.”

Another thing I like about her is that she shows us a lot of videos with patients who suffer from the symptoms on the checklist. That way we understand what those symptoms look like in real life. Dr Bla, if you remember, preferred to bother us with statistics. And Dr. Psych definitely goes to some lengths to make us understand what it is like to have a mental illness. Last session she told us she was going to show us a video about panic and anxiety. Everybody expected yet another patient talking about his symptoms. Instead, we got this:

It is hard to recognize anything because the hand holding the camcorder must be shaking madly. Eventually, you recognize a beach. There is a loud, undefinable noise in the background, and people are screaming in terror. Suddenly there is something dark moving into the upper part of the picture. As the camera angle changes, you see what it is: It is an airplane that is about to crash. It takes a turn, seems to head straight for a multistorey building behind the beach, then takes another turn and eventually crashes into the sea – directly in front of the beach.

“Well,” Dr. Psych said after a short pause, “what did you experience upon watching this?” People reluctantly started to describe an increase of heartrate, or holding their breath…and I was simply amazed. I applauded Dr. Psych for this nearly perfect mindfuck. As someone who suffers from “fear diseases”, I couldn´t help but feel a little mischievous as well. See what it´s like? I guess the most ironic thing is that in me, this video didn´t even trigger a fear response. Since 9/11 I have a morbid  fascination for plane crashes. It´s not like I don´t pity the persons involved. But watching that amateur video was exciting rather than scary.

Anyway, to sum up a few things: Independently of their personal differences, Dr. Psych and Dr. Bla are also teaching us very different things. Dr. Psych is teaching us which psychopathological symptoms there are and what they look like. She doesn´t talk about diagnoses like, for example, Histrionic Personality Disorder. This is what Dr. Bla is talking about. He acquaints us with more or less well-defined mental disorders (and unfortunately fails to acquaint us with their symptoms). He is also supposed to tell us how to treat these disorders.

It can be fairly confusing that someone can have a symptom  (like depersonalization),  without having the disorder named after that symptom (Depersonalization Disorder). One symptom can be part of a great variety of disorders (you might suffer from depersonalization when you have DD, but also if you have depression). This is good to know when you are a cyberchondriac like me and diagnose yourself with another mental illness every week.

 

A psychology lecture through the eyes of a former mental health patient

Posted in college, health, mental health, science with tags , , on November 4, 2011 by theweirdphilosopher

Though I´m actually a philosophy student, in my current semester I am attending two lectures unrelated to my subject. Both of them deal with mental illnesses. It´s a topic I´m interested in, but I also aim to find out how the mentally ill are seen by professionals, and if my own experiences with psychotherapists were unfortunate exceptions or the rule.  One of these lectures is held by a psychiatrist, the other one is held by a psychotherapist. (The general difference between the two professions is that in order to become a psychiatrist you have to earn a medical degree, whereas you can become a psychotherapist by earning a degree in psychology and later train as a therapist. There are some other ways of becoming a psychotherapist that don´t involve studying psychology, but I won´t go into that now.) For future reference, I will call the psychiatrist Dr. Psych, and the psychologist Dr. Bla. You will soon see why.

Dr. Bla´s lecture, which I attended yesterday, deals with clinical psychology. That means he introduces several kinds of mental illnesses, like depression, personality disorders, PTSD and so on, and then he tells us how they can be treated. At least that is the plan. Trouble is, his plan doesn´t seem to work out. Yesterday was the third session and already we are behind schedule. There are several reasons for this.

1.) The students. The lecture is attended by at least 500 students, mostly girls, and unfortunately they have zero discipline. They keep on babbling among themselves throughout the lecture. If I didn´t sit in one of the first five rows I probably wouldn´t understand a word Dr. Bla says. I find it quite ironic that these students, the precise people who might become psychotherapists and get paid for listening to people all day long – are unable to even listen to a professor for merely 90 minutes! Maybe he should offer them a fee? Admittedly, I´m having trouble listening to him either, but at least I just scribble strange faces onto the sides of my notebook and keep my mouth shut. Being a loner has benefits.

2.) The second problem is Dr. Bla himself. He does not sound like a teacher giving a lecture, he sounds like a student giving a presentation. And a student who is not well prepared, mind you. He appears to be improvising most of the time. It is difficult to listen to someone who constantly skips parts of his lecture because “we are running out of time”, but, despite running out of time, answers each and every question, even if they are totally out of context. And I don´t understand his priorities!  He bothers us for ages with useless statistics about how frequent which type of depression is among the male and the female population, but he skips large parts of what depression is actually like for the person who suffers from it! But isn´t that much more important to know for someone who wants to help people with depression? I feel strange sitting in that classroom at times. Dr. Bla talks about all these subjects as if they had nothing to do with us. He assumes that we are all normal, healthy, sane people who never experienced firsthand anything he talks about. Well, I did, and quite often I feel like an alien from outer space in his lectures.

Anyway, yesterday´s lecture dealt with depression, and how to heal it. Dr. Bla said several things that astonished me quite a bit. First of all, he spend a lot of time on talking about possible causes. Other than one might have expected, he dealt with biological causes a lot more than with psychological causes. According to him, there were certain physiological changes visible in depressive persons. He emphasized, of course, that these changes merely correlated with the depression, they could not be pinned down as the cause. He also explained that these physiological changes could be influenced not just by medication, but also by psychotherapy. Instead of “psychotherapy” he frequently used that term “that useless babbling” – and at some point it really started to annoy me. Yes, we all know that you poor psychotherapists are constantly being bullied by those evil psychiatrists and their Frankenstein methods! Really, like psychotherapists were persecuted outcasts!!! The way things are, you are more likely to become an outcast when you are skeptical towards psychotherapy.  Psychotherapy has an almost immaculate public image (though your average bloke on the street might call it bullshit), and as long as psychotherapists can become college professors and their lectures are crowded there is no reason for them to present themselves as martyrs!

Another thing I noticed is that he mentioned certain “protective elements”, that is, things that might protect you from developing depression or any other mental illness. He said that one of the protective elements was intelligence. I felt a bit taken aback by that one. So is that to say that if I become depressive it´s just because I´m dumb?! Nooooo, of course not! That´s just “dysfunctional thinking” if you´re depressive, or “black-and-white-thinking” if you are borderline, or “being ego-centric” if you are a narcissist. All he did was stating a scientific fact, and if I cannot deal with it, then something is wrong with me, right? Nope. Not right. First of all I want to know how psychologists came to that conclusion. The way I know them, they did an IQ test on mental health patients and compared the results to results of people who are not diagnosed with any mental illness. Uh huh. First question: How do they know that those not diagnosed with any illness are really all that healthy? Maybe they are insane geniuses who are clever enough to stay the fuck away from psychotherapists (pardon my embitterment). Second question: Did it ever occur to them that being mentally ill might have adverse effects on a person´s performance in IQ tests – and not the other way round? I remember my performance at school deteriorating severely when I was depressed. When you think about suicide, you just can´t be bothered to solve equations. Third question: What type of intelligence did they test? Fourth question: How about people with Asperger syndrome? There is a possibility, of course, that they found a more useful approach and that I am just too dumb to recognize it.

Another thing I wanted to highlight was some stuff he said about therapy. He emphasized how important it is to not tell a depressed person to “get her act together”, or that she is not all that miserable after all. I second that. He also said how important it was to structure therapy sessions because depressed people tend to lose the plot. I found that quite ironic, given how well structured his own lectures are. And then he said something I found both funny and sad. He told us to tell a depressed person that depression is very well treatable, and that it is a common illness. Dear Dr. Bla – maybe you should spend more time learning about what it is like to be depressive. Because when you are depressive, you might just not care about the possibility of happiness. Being happy seems just as void, meaningless and empty as not being happy. You might not even believe that what you have is an illness. It feels as if you are seeing the truth; life and humanity and yourself in all its ugliness. You might be suspecting that happy people are just harboring illusions, and that they are trying to infect you with them. At the time I was depressive, I refused to accept that what I had was an illness – and at the same time I dreaded the idea that how I felt might be normal. I was distrustful towards anyone who told me to have a more positive outlook, or to be kinder to myself; but the idea that feeling low and never being really happy might be normal, and that, as for example my mum suggested, I was “just expecting too much” from life, drove me towards wanting to kill myself. I think what I would have needed most would have been someone to truly empathize with me – but that never happened. Being told that I was ill was invalidating, and being told that I was just spoiled was equally invalidating. And somehow those seemed to be the only two perspectives out there. I wonder if I will one day manage to create a third one.

 

Related Posts:

The Nutjob among the Neurotics – a psychology lecture through the eyes of a former mental health patient, part II

Feeling like scum – a psychology lecture through the eyes of a former mental health patient, part III