Saturday, February 20, 2021

The Precision of Sensory Evidence

A general post on many newer therapies from Scott Siskind at Astral Codex Ten: The Precision of Sensory Evidence.

One of the first things that occurred to me about the sensory input in depression and trauma was manics wearing sunglasses indoors. Many an argument I had with psychodynamic therapists early in my career trying to convince me that this was because of their narcissism and/or desire to feel protected from being seen by others.  It is one advantage of having worked on the units at the beginning of my career, where you could see these guys wince when they had to come out into brighter areas or they had to take the glasses off for some reason.  I was pretty sure it was a largely physical, not psychological response. So now there is evidence that depressed people actually do see things less brightly.  They are grayer.

1.  It looks at first like it could veer into blaming the victim - "Are you sure you didn't just make most of this up and are a touch overdramatic, honey?" Yet I think if you follow it out it actually bypasses it. What actually happened turns out not to matter as much as the schema that was installed. We seldom have contemporary records, video, credible witnesses anyway.  We are never going to know exactly what happened. We only know what we have now.  And really, we don't need to know.  The victim can sometimes get obsessed with knowing, and with proving to the important others that yes they were too abused, and too much of the older intervention focused on this too, as if everyone had to know all the details before anyone could go forward. It might feel that way, but that feeling might itself be a symptom.  Therapy should focus on resolving the now.  Once that is completed the patient may or may not wish to go back and explore.  Yet almost always not. They decide it doesn't much matter.
1A.  So it's not quite the Body that keeps the score, it's the Schema that keeps the score. The body is an imperfect report card.
2. This also nicely gets around all the discussions of whether emotional abuse is worse than physical or sexual worse than all.  The question might matter someday to the patient, but it doesn't have to matter now, and in fact shouldn't matter now.  This is because it gets into all the side questions of what other people think of them, of how much they should trust their own thoughts and feelings, and how they are going to describe all this to others.  Yet we know from the get-go that these are things that are likely impaired in the patient - that's why they have pain and make bad decisions (or are unable to make decisions).  That's what they came into the office to find a solution for. All of those unanswerable side questions should be the student, not the teacher in this classroom.
This is similar to some other treatments.  I had many an addict who wanted to put a lot of time into understanding why they drank. But You won't have any idea why you drink until after you have been sober a while.  You will think you know and will have guesses, but you will be wrong.  And it is a waste of your time, probably an evasion of the pain of facing you.  You won't know why you feel depressed, or anxious, or insecure or whatever until those are largely gone.  And then you might say "Y'know?  I think it was mostly just genetic/food-based/that one incident/my mother's chronic pain/those first school years at the commune." 
My further points are still to come (Points 3 & 4) about the connection to Christian understandings and whether the value of these practices as treatments implies anything about every day use. 


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