November 18, 2009

Reality is that which, when you stop believing in it, doesn’t go away.
==Philip K. Dick

There’s always an easy solution to every human problem — neat, plausible, and wrong.
==Henry Louis Mencken

It is not necessary to understand things in order to argue about them.
==Pierre Augustin
They certainly give very strange names to diseases.

In Defense of Skepticism

November 14, 2009

Skepticism is the chastity of the intellect, and it is shameful to surrender it too soon or to the first comer. George Santayana (1863 – 1952)

Once I wrote an article about making decisions, political and otherwise. The quoted authors, Antonio R. Damasio and Jonathan Haidt, argued that our decisions are partly or mostly emotional and we use rational thinking to justify what has been already decided on a very basic level.

Antonio R. Damasio, David Dornsife Professor of Neuroscience at the University of Southern California, where he heads USC’s Brain and Creativity Institute, states just that. He argues that all our decisions are emotional even if we try to deny it. Damasio introduced “somatic marker” hypothesis and insists that emotions are integral part of our decisions in everyday life and politics.

According to this hypothesis people make decisions by evaluating and comparing various, sometimes competing, goals and outcomes. For example, buying a car, one must consider myriads of variables including the price, model, efficiency, repair records, friends’ recommendations, and many others. Trying to analyze these data dispassionately, as a computer, would take forever and will never lead to satisfactory results. But here come emotions that let us cut through the chase, make a decision to buy the Jaguar and then justify our decision with the best of our rationally abilities.

Jonathan Haidt, associate professor of psychology at the University of Virginia, takes our emotional decision-making analysis even further. His Moral Foundations Theory names five shared fundamental moral values that govern the process:

1. Care for others
2. Fairness and Justice
3. Loyalty to your group family and nation
4. Respect for tradition and legitimate authority
5. Purity of thoughts and actions

In Edge magazine article, What makes people vote Republican? Dr. Haidt contrasts emotions of excitement for the new and openness to experience in voting Democrats with the dread of unknown, comfort of tradition and stability in Republicans. When it comes to politics, according to Dr. Haidt, it’s the battle of emotions and less so of ideas.

That concept was further advanced by Michael Gazzaniga, Ph.D., a Professor of Psychology and the Director for the SAGE Center for the Study of Mind at the University of California Santa Barbara. In his book, The Ethical Brain, published in 2005, he writes about the brain’s  left-hemisphere interpreter , which allows us to take “the inputs we receive every moment and weaves them into stories to form the ongoing narrative of our self-image and our beliefs.”  Our brain turns both, internal and internal events, into a plausible narrative that makes sense.

This phenomenon is particularly manifested in Korsakoff’s Psychosis, also known as amnesic-confabulatory syndrome. Patient with this disorder create fantastic and seemingly coherent stories describing events that never took place. In case of another neurological disorder, reduplicative paramnesia – a delusional disorder resulting from brain injury or degenerative disease – patients believe that a place or location has been duplicated, existing in two or more places simultaneously. These patients’  intact ‘interpreter’ attempts to reconcile erroneous messages from damaged brain.

It is also not hard to envision how we can ‘fool’ ourselves in daily lives by seeing what we expect to see and believing in what we already learned to believe. Reconciliation between observable and learned usually resolves in favor of the latter. Our left brain not only knows how to create the belief but also sticks to it in face of contradicting evidence turning private, scientific and  political debates into futile exercise.
I want to finish this column with another quote, by Bertrand Russell: “The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.”

On Stability

November 10, 2009

“True stability results when presumed order and presumed disorder are balanced. A truly stable system expects the unexpected, is prepared to be disrupted, waits to be transformed.”
==Tom Robbins (American Novelist. b.1936)

Today I want to write about Ilya Prigogine, a Russian-born naturalized Belgian chemist and Nobel Laureate. His Russian roots notwithstanding (Prigogine’s family left Russia when the future genius was only 4), Ilya lived, studied and worked all his life in the West. His most famous work that got him the coveted prize in chemistry in 1977 was on the Thermodynamic Equilibrium.

According to Prigogine, systems are ‘autonomically stable’ – in other words, they exist in a steady state and equilibrium. When a system is ‘perturbed’, it shifts little and quickly returns to its balanced status. Most of the time, structures enjoy stability. Even strong external forces fail to change the system from a steady state. The laws of equilibrium are universal. Or are they?

From time to time, for multiple and various reasons, the systems fall into a temporary state of instability when a mild external influence can cause irreversible changes. Then, the system achieves new equilibrium and never returns back to the way things used to be.

Although written for thermodynamics and quantum mechanics, Prigogine’s theory could be applied to societies. Russian history offers two examples in the last century alone. First, the solid and unshakable Russian Monarchy dropped like a house of cards by a small and not particularly popular Bolshevik coup. Then, in a few short decades, massive and menacing Soviet Union fell to pieces in front of our eyes.

Psychiatrists see daily ‘Prigoginism’ in action. Seemingly solid unions and marriages disintegrate in months, friendships that lasted decades break after one fateful quarrel, long-term partnerships dissolve over a weekend. The process is often irreversible and the new state is nothing like the old.

In our lives and our theories, including Prigogine’s, can appear rock solid only to one day undergo fundamental revisions and never again be accepted by the majority. Let’s find more than a quantum of wisdom in this notion.


November 8, 2009

`The question is,’ said Alice, `whether you can make words mean so many different things.’ Lewis Carroll

Psychiatrists use words like the surgeons scalpels. With words we console and encourage, guide and caution, give hope and set limits. Psychiatrists communicate with other mental health professionals and even occasionally get understood by other medical specialists, bar surgeons.
But do our patients understand what we are trying to convey? In other words, do the words mean the same thing for us and for them?
Many of our patients say antisocial meaning asocial (“my dad is antisocial, he really likes to be alone). They use the word obsession (as in “she is obsessed about moving to Hawaii”) instead of overfocusing, and catatonic in place of stunned.
When one casually says “she is obsessed about her boyfriend”, he doesn’t mean that there1. Recurrent and persistent thoughts, impulses, or images that are experienced during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. 2. The thoughts, impulses, or images are not simply excessive worries about real-life problems. 3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. 4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.
No, the casual observer means “a thought that dominates her thinking”.
People use interchangeably the words obsession and compulsion, addiction and abuse, and call substances of abuse, regardless of their chemical nature, – narcotics. Do we really understand each other?
Journalists casually use the word schizophrenic not to describe a person afflicted with severe psychiatric illness but coexistence of contradictory and incompatible tendencies in a government. As Alice said the “words mean so many different things.”
Let me leave you with a joke, which, in my view, accurately reflects perils of uncritical assumptions of mutual understanding. A little girl goes to her father and asks: “Dad, what is sex?” A bit hesitant the father carefully explains to her various aspects of human sexuality and reproduction. Afterwards he asks: “Do you have any other questions? “ “Yes,” the girl replies, “what is seven?”
`The question is,’ said Alice, `whether you can make words mean so many different things.’ `The question is,’ said Humpty Dumpty, `which is to be master — that’s all.’


November 8, 2009

This blog (that might be named Psychobiological Manifesto) is an ambitious project. I’ll  try putting together a cohesive (not necessarily comprehensive) conceptual model of psychiatric disorders with strong biological basis. Inadvertently, this approach could be on collision course with psychoanalytical orthodoxy. Well, be so. After all, that project is meant to be a pursuit of illusive truth, not an attempt to please anyone or bring together incompatible concepts. I welcome comments, relevant additions, and challenges. Let’s begin.

Doctor Misha