Unawareness Versus Denial

Grim's recent post Blindness put me in mind of things I wrote years ago.  This was the first post in what eventually became the series "May We Believe Our Thoughts." I don't think I'm going to reprise much of that, but I thought I would put this in anyway, partly because of the comments there.

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Because of the neurological research coming out over the last decade or two three, psychiatry is increasingly making a distinction between denial and unawareness. Some of the research is being done up at Dartmouth MS by folks I admire and used to work with, so I keep up with this more than other areas.

Everything has been in the "denial" category since Freud, or before: the idea that mentally ill people really do know, at some level, what reality is, but hide it from themselves. Therapy was a way of developing insight, and having the courage to accept the unpleasant.

Unawareness, in contrast, is the idea that certain brain dysfunctions make the owners of those brains unable to see their illness, no more than a blind person can see, or even more exactly, than a color-blind person can distinguish colors. Like an amputee who feels a phantom limb, or like Oliver Sacks, losing the sense of ownership of a limb after injury, they cannot perceive their illness, regardless of the evidence submitted. Dr. Flashman gave the example of the patients who believed he had implanted chips in their brain, shown their chipless MRI's. The responses were varied - my sort of chip doesn't show up...that's not my MRI...you doctored the photo... but none were able to muster even a 0.1% acceptance of the no-chip idea. Not even in theory. Not even as a "what if" scenario.

We are moving lack of insight from the "denial" pile into the "unawareness" pile, for psychotic disorders certainly, but even for mood disorders when they are untreated. How far will this go? Will it turn out that no depressed people ever respond to any offered advice or insight, but only to the intervention of attention, of exercise, of medication, of practicing agency? Lincoln's comment that people are about as happy as they make up their minds to be might turn out to be completely untrue, and useful only for the reminding the folks outside the depression that nothing, absolutely nothing they advise is going to have the slightest effect.

I am increasingly convinced of this for many illnesses, and it makes me feel shame at the conversations I have had over the years with patients, attributing (usually, but not always, unconsciously) their lack of insight to some stubbornness or cowardice on their part - a refusal to engage reality rather than a biological inability to perceive it. It's not just a waste of time. It's thirty-plus years of unnecessary cruelty.

If you absorb this, you will see that it makes things both better and worse. If the patient is not going to be convinced, whether you explain for two seconds or two hours, why bother to give any explanation at all? Or if you listening to her for two hours will make no more difference than listening for two seconds, why listen at all? Isn't it just a waste of time and ultimately cruel, pretending to a patient that her opinion makes the slightest difference when if fact it doesn't? So let's just ignore everything she says until we get a guardian then, and hold her down and give her medicine and be done with it. Why any charade?

I don't think it takes much imagination to see that as a chilling scenario, and an enormously bad precedent to set.

But is badgering a deaf person because they can't hear any better? Because even if the mental health practitioner is speaking in the kindest tones, is really rooting for the patient to "get it," and has the best intentions, if we really think that underneath it all they are denying reality, that some trick or intervention on our part will help them turn the corner and begin to see, then badgering is what we are actually doing.

It gets worse. It may apply to a high percentage of all beliefs, not only to mental illness.

Update: Roper's comment reminds me that I have at least a half-dozen professionals reading here, so I should provide some links. Xavier Amador looks like he'd be pop psych, but he is not. His books cover a fair bit of the brain research. (as of 2011)

Laura Flashman

Thomas McAllister

Dependence

This must be oversimplified.  It can't actually be the truth, it must only be a cynical wisdom. Yet doesn't it seem that the best way for a government to make its populace dependent on it is to mistreat them? That way their their only relief is to petition another part of the government to make it stop. Wages, housing, civil liberties - each is now the government giving with one hand and taking with the other.

Suricata suricatta

I used to post meerkat pictures, partly to drive traffic in the early days and partly because I just like 'em. I think this was the best one.

Similarities

 I have heard of the show, and there were posters and souvenirs about it all over Northern Ireland, but i don't really know it.

The humor is a little overobvious here, but it's still fun.

 

The Voting Dead

 

Jonathan Adler over at Volokh links to the Ohio report about how many of the dead are still on the voting rolls there. From the comments:

Bob Lipton says:
As a native son of New York City, I find this distrust of the dead to be bigoted and unwarranted. The dead have formed an important voting bloc in New York City and other urban centers for decades. To deprive someone of the the franchise just because he happens to reside in a graveyard instead of an apartment building smacks of an attempted to deprive the majority of control of the government in favor of a small minority, which is clearly undemocratic. It merely favors those who show up at other events.

The dead make little demand on the state. Through specially and perhaps unconstitutionally onerous ‘death taxes’ and ‘estate taxes’ they bear a disproportionate proportion of the burden on the common wealth. They use no public hospitals, draw no pensions, commit no known crimes and have tiny carbon footprints.

Yet despite these marks of good citizenship and, perhaps, oppression, there is a movement about to deprive them of the franchise, spearheaded, no doubt, by the minority of Americans who see them as impediments to their own private goals and who like to show up at camera-covered events to protest the more quiescent fellow Americans.

Perhaps the Necro-American communities scattered throughout this fair land of ours are insufficiently politically active for their own good, but they are, on average, older than the living, less physically able and they doubtless consider it less dignified to be out and about, engaging in unbecoming picketing and shout, preferring to let their voting make their political choices clear for them.

Whatever their privately held reasons are — and who can blame them for not making those reasons public in this modern climate of yellow journalism — we should, as good Americans, support their wishes to remain private individuals without giving up those rights, privileges and duties that we all hold dear, among them the franchise. After all, it is all too likely that many of the people reading this will some day join a Necro-American community, and who among us would wish to lose our vote?

I am told that they should be referred to as "Vitally Challenged" or "Otherly Animate" these days. 

And in seriousness, GKC thought that tradition is the way we give our ancestors a vote.

Two From Aporia

Aporia has a marketing strategy of teasing you with an enticing-sounding bit of research, then giving you two or three different ones with the sexy one behind the paywall.  I can't fault them too much, as the ones they give for free are usually pretty good.

So the Come-On is Do Neurotic People Always Lean Left? Upgrade to paid to find out.

The first article you can actually get to is "Genetic Origins of Utilitarian vs Kantian Moral Philosophy."  The second is "Universities With Most Retracted Scientific Articles." Both worth a bit of a look, I thought.

Zach Lowe

I have been waiting over six months for Zach to come back.  Just in time for the last month and the playoffs. 

BTW this has been my most posts ever in a month by a good margin.  I should fast from the news more often, eh?  This month has been almost half of my full total for 2014.
 

The Moral Economy of Guilt.

 From First Things in 2011.  I concur.  Mercy cannot exist without justice. One guilt and proper consequence have been established, then we can be merciful. Yet without that there is only license. A judge can halve a sentence or even suspend one, and a governor can pardon one, but if there is no possibility of even declaring guilt, why have a court at all? 

Related, perhaps, is that the law has to exist to protect the criminal.  The mob is notoriously dangerous and unjust. It learns from experience that crafting some sort of agreed-upon regulation is better in the long run. When that happens, it is no longer a mob but a social contract.

Cumbered With Much Serving

 We have all been there, Martha.  We have all been there. Sometimes we get a bit snippy.

The Abstract Vs The Paper

 Sometimes Papers Contain Obvious Lies by Cremieux Recueil* 

The authors of scientific papers often say one thing and find another; they concoct a story around a set of findings that they might not have even made, or which they might have actually even contradicted. This happens surprisingly often, and it’s a very serious issue for a few reasons.

Yeah, I'll bet. I am guilty of being one of those people who reads the abstract and trusts it, skimming the rest of the paper, especially graphs and charts. So I would be one of the easiest to be fooled in this way. Bsking has mentioned a few times followup up on a paper, usually a link in a text, to see exactly what it says, only to find that the linked paper is nearly irrelevant to the claimed result, misleading, or even pointing in the opposite direction.

I had never heard of an Everest Regression, but it is easy to get the concept from the explanation in the article. Cremieux discusses a paper he dissected that claimed that students got lower test scores in rooms with higher ceilings.  He found, sure enough, that they actually got slightly higher scores.

 This paper’s abstract, title, text, and the public remarks to journalists from the authors all implied that was what they found, but their actual result—correctly shown in a table in the paper and reproducible from their code and data—was the complete opposite: higher ceilings were associated with higher test scores! Making a viral hubbub about this managed to get the paper retracted—eventually—but the retraction notice barely mentioned any of the paper’s problems and, instead, said that whatever issues warranted retraction were examples of good ole “honest error.”

But he doesn't confine himself to "gotcha" criticism over odd and unimportant experiments - he never does - but focuses on large issues where legislation and policy hinge on what authorities falsely believe is true.  For example, he went over a paper from Germany which found that the presence of more foreigners in a region did not affect the crime rate.  This is what many people of authority would like to believe, or at least like you to believe, because pretending to reduce crime with the tried-and-untrue methods is politically safer than trying to fix the real problem, which has something to do with (gulp) foreigners. The Everest Regression in action.

 this is just controlling for altitude and declaring Everest is hot, or stating that stadiums make people run fast!

*A particularly good example of the letters in a French word not having anything to do with pronunciation.

Autism Theories

Sometimes I try too hard to give you one-stop shopping on an idea...

 Autism Is Bad by Sebastian Jensen, recommended by Aporia. I dislike the title, but it is clearly in reference to mythbusting the idea that autism is an intellectual advantage that makes geniuses.

Both of these mythical views of autism are wrong: autistic people are not more likely to be right wing and the link between genius and autism is overblown.

I had not heard of "dimensionality" but the concept is discussed in a internal link and took only a little pondering to pick up.  I will not fully define it here in order to encourage you to go on the essay "Autism as a Disorder of Dimensionality," but it has to do with neuronal branching and complexity of brain architecture. And Johnson thinks the intelligence link is quite possible.

Neuronal density is a plausible candidate for the strongest factor underlying both genius and madness: it both drastically reduces canalization (normalcy), allowing the brain to be wired in strange ways and pointed in odd directions, and offers many more parameters — the raw stuff of achievement. This can lead to madness, genius, or both.

Also included is a chart of where various diagnoses are associated along the political spectrum. Spoiler alert: Most cluster around the center on both the social and economic axes. Both essays go into controversial territory, particularly the one at Opentheory.net. Some of it rather took my breath away. "Are you sure you want to go there?" Sometimes I get the feeling that they just don't like autists, and are trying to get back at someone. OTOH, sometimes they seem to defend them too much. All of this in a package of neurological research and solid grounding. 

This links in turn to  'Just Emil Kirkegaard Things ' A theory of Ashkenazi genius: intelligence and mental illness.

Perhaps I should have started with something more reliable: Autism And Intelligence: Much More Than You Wanted To Know by Scott Alexander at ACX (then Star Slate Codex).  I am surprised I have not linked this before.  At least, I can't find it at present. Plenty of theories there as well.

These numbers should be taken with very many grains of salt. First, IQ tests don’t do a great job of measuring autistic people. Their intelligence tends to be more imbalanced than neurotypicals’, so IQ tests (which rely on an assumption that most forms of intelligence are correlated) are less applicable. Second, even if the test itself is good, autistic people may be bad at test-taking for other reasons – for example, they don’t understand the directions, or they’re anxious about the social interaction required to answer an examiner’s quetsions. Third, and most important, there is a strong selection bias in the samples of autistic people. Many definitions of autism center around forms of poor functioning which are correlated with low intelligence. Even if the definition is good, people who function poorly are more likely to seek out (or be coerced into) psychiatric treatment, and so are more likely to be identified.

Fanfare For the Common Man

A half-dozen titles were suggested before Copland settled on this one.  Vice President Henry Wallace wanted the piece to debut just before income tax time in 1943.  Copland replied "I am all for honoring the common man at income tax time."

 

Non-Opioid Painkiller

The FDA approved a non-opioid painkiller. Journavx, developed by Vertex Pharmaceuticals, targets a protein called the NaV1.8 voltage-gated sodium channel, which transmits pain signals from sensory neurons to the brain. No other drugs on the market target this protein; existing painkillers instead bind to several other different NaV channels at once. In a phase 3 trial with 2,000 patients undergoing surgery, Journavx reduced pain as effectively as hydrocodone plus paracetamol and had fewer side effects. It also does not appear to be addictive. But the drug will cost about $233 per week; opioids cost about $12 per week.  (From Works in Progress)

Ruxandra Teslo and Lyman Stone

I like them both.  They are batting the ball back and forth on substack about fertility, quite respectfully, from what I have seen. Some of the cross-purposes seems to be that Lyman is focused on overall societal fertility and finding interventions that encourage women to have more children, while Ruxandra is focused on women not being punished in the marketplace for having children. She introduced the idea of "greedy" careers: Not that women are greedy for wanting to go into them, but that there are careers such as law and entrepreneurship that are greedy for your time if you want to succeed.

One can see how there would be overlap but disagreement.

My own view is that finding ways for ambitious women to also have children may be a good thing in itself - they are our wives and sisters, after all - but it is not going to change the overall fertility much. I don't see that there has been a cultural shift of women suddenly wanting to imitate Amy Coney Barrett. Therefore, the question becomes how much should a society try to accommodate or compensate each other for differences in biology. The inequality inherent in childbearing, and possibly even -raising, was not set forth in the Constitution or any institutions of humankind. They just is.

DOGE and Chesterton's Fence

Having worked for a government that was nowhere near as wasteful as the Federal Government and seen the problems even there, I have leaned toward approving of DOGE activities even when scare stories are circulated.  I expect that those stories may even be true, and the justification for getting rid of agency A or department B pretty shaky. Yet I also know that we are only hearing one side of the incident, highly dependent on the source. Now more than ever. And the horrified do not seem willing to come to grips with how far the family is already in debt. Yes, a Mercedes is a great investment but...

Yet I also know the wisdom of Chesterton's Fence, not to remove something until we understand why it was put there to begin with. Am I abandoning some of my principles for others, and have I chosen correctly? The first defense for DOGE would be that the field is full of fences, and when we try to evaluate each one cautiously, two more spring up before we are done. 

But still, Chesterton's Fence...

In that spirit, I give you In Defense of Weird Research.

Lord, Show Us A Sign

 

I get what sermon a pastor might draw from a YIELD sign, or a STOP sign.  The addition of the CROSS TRAFFIC part seems a bit more obscure.  Challenge your pastor to derive a sermon from BRIDGE FREEZES BEFORE PAVEMENT, or BREAKDOWN LANE TRAVEL ALLOWED 6AM-10AM WEEKDAYS. That's when you know you've got yourself a real first-class preacher.

Vegetables of the Spirit

Galatians 5:22. But the fruit of the Spirit is love, joy, peace, longsuffering, kindness, goodness, faithfulness, gentleness, self-control.

I have heard people make a big deal about this being the fruit of the spirit, not the fruits of the spirit.  This strikes me as a rather fussy distinction without a difference. "No, because the fruit grows out of obedience to the spirit and takes some time, while you can just buy fruits at the market." Hmm, yes. 

Vegetables, now, those are actually different. Isn't it important to have your Vegetables of the Spirit?  Or be a vegetable of the spirit, or something? Inquiring minds want to know.