Lisa Loren: Catalysis

Recent research by Australian researchers shows that, in the context of strategic video games, neurotic AI may do better than rational ones. From Mind Hacks:

They used the popular strategy game Age of Mythology and created four software ‘bots’ to play the computer which were loosely based on the ‘big five‘ personality traits.

When they compared their successes, the version designed to simulate ‘neurotic’ personality traits came equal first in number of games won, but was the clear winner when the average time to victory was compared.

This AI was programmed to distort the its own perception of resources and flip between aggressive and defensive styles of play unpredictably. In trials, the neurotic AI beat Age of Mythology more often than any AI except the ‘aggressive’ bot, and won faster than even the agressive one did.

This study doesn’t prove much of anything, at this point, except that Age of Mythology favors a slightly uneven playing style, but the implications fascinate me. Against humans, perhaps in a poker game, it’s easy to see how a bit of unpredictability could make for a better game. It’s pretty easy to confuse and blindside a person. However, I don’t think Age of Mythology’s program is intelligent enough to develop complex thoughts about what strategies a player is using. (I could be wrong, of course.) I don’t think machines are susceptible to the cognitive traps that humans might fall into. In light of this, I’m not sure how the neurotic AI managed to win. Reason dictates that a well-informed person will have better strategy than a misinformed person, right?

If mild neuroticism really does allow people to win more often then their purely rational counterparts, it could provide a great deal of support for theories arguing that mental illnesses are more severe forms of adaptive habits.

Shoma Morita founded Morita therapy in 1919 to treat shinkeishitsu, a Japanese culture-specific anxiety disorder characterized by hypochondria and social phobia. Since then, its use has expanded to anxiety, depression, bereavement, shyness, and some inconclusive trials for schizophrenia. In addition to cognitive-behavioral therapy, it is one of the primary therapies used in China.

Morita therapy encourages its patients to accept their feelings as natural, without trying to change them. According to the Morita framework, feelings cannot be controlled. Patients learn to focus their attention away from their emotions and simply act without trying to change how they feel. The focus is on a “reality-oriented attitude”, which is less self-centered and more in touch with the external world. According to the ToDo Institute:

Cure is not defined by the alleviation of discomfort or the attainment of some ideal feeling state (which is impossible) but by taking constructive action in one’s life which helps one to live a full and meaningful existence and not be ruled by one’s emotional state.

Morita is called a “psychology of action”, because it trusts that the actions people take will improve their moods and feelings, while introspection will not.  It greatly resembles modern-day behavioral therapy in this regard - startling for a therapy pioneered when B.F. Skinner was barely fifteen.

Do you know that old question about what might have happened to Van Gogh if he’d had antidepressants available? It’s a stupid question, in a lot of ways. He killed himself, probably as a result of the same mental illness that shows up in his work. If he’d had Prozac, he might he might have lived to see his own work become famous.

And yet, people ask. Didn’t he gain something? Didn’t we?

There’s no glory to a life lost to mental illness, whether through time wasted away in sickness or through suicide. There’s nothing romantic about depression. (I write this a few days after hearing about Heath Ledger’s possible suicide.) We, as humans, have lost too many people to mental illness, to early death, to unbearable pain. We have lost brilliant people to psychotic worlds of their own creation. No amount of creativity will ever justify the raw cost of mental illness. No benefit can justify this degree of human suffering. So, maybe Van Gogh never would have painted The Starry Night, and the world would go on without him. Maybe he would have become a better painter, tempered by age and experience. Maybe he would have prevented World War I. We will never know.

I’m going somewhere with this, actually. There’s an article up on The Guardians’ Joe Public blog asking, Would you vote for an MP with mental health issues? The attached poll, at this moment, is resoundly in favor of doing so, but I’m inclined to wonder if Americans would so easily say the same thing. Americans seem to like strong leaders, and I can imagine the fear that someone with a history of depression might break under stress. But I think of Winston Churchill (depression), and Abraham Lincoln (also depression), and I know that these people made spectacular leaders.

Here’s where Van Gogh comes in. People with mental illnesses are, above all, people; some are full of wisdom and some seem stuck in their own minds. However, I think that people with mental illness must derive some advantage from it. I don’t honestly believe that depression has an evolutionary advantage, but as we see in Van Gogh, it does have some connection to creativity. Various studies have found that people with depression tend to gravitate towards creative professions.

I think, also, that depression makes people more aware of the pain of others. Suffering builds compassion, and the pointless suffering of depression helps us to feel for people who have gone through things without actually enduring them.  On a fundamental level, this means that people who have gone through depression and overcome it are more equipped to help those in trouble, tend to those in pain, and console those living with grief.  Where depressive episodes make people less sociable, depression in life can make people better social animals.

I would never wish Van Gogh’s life on anyone. Whatever benefits depression may offer, they aren’t worth hurting innocent people for. I believe, however, that the people out there with mental illnesses can find some benefit in what they’re experiencing, instead of letting themselves suffer for no reason. What differentiates Van Gogh from so many others is that he used his illness to give something to the world.

Paragraphein has a beautiful post about the new PBS documentary, The Lobotomist:

The common practices, the reactions to anyone “deviant…”, they’ve all evolved over the years. All products of their times.

What tends not to change, though, is the voices of the people who’ve lived through the basic, core experience: losing a child to adoption; suffering from a mental illness.

You’d think, this being the case, that whenever the “experts” have the next great idea, whenever they want to implement a new practice, they might thus stop to consult us–you know, the people who live it, and the people who–across the ages–tend to use the same metaphors for our experiences.

But too often, the “experts” don’t listen. Too often, they don’t even ask. And too often, it doesn’t even occur to them to ask.

Imagine a world where psychiatric medication works 100% of the time, relieves 100% of symptoms, and causes no side effects. In this world, we all agree on the precise differences between mental illness and personality. It’s easy to tell the difference between someone who tires easily and someone who has the flu, right? Why should mental illness be any different? Imagine that drugs work perfectly, and they don’t alter who the “real” person is. In the world I’m describing, there are no rational reasons to refuse treatment - unlike in this one. Do people with mental illnesses still have a right to refuse pills, or inpatient commitment, or whatever we find works well?

In the real world, this world that we live in, there are no absolute cures for mental illness. Up until pretty recently, scientists considered brutal procedures like the lobotomy acceptable treatments for mental illness. Today the lobotomy has been replaced by drugs that can cause permanent facial ticks and neurological symptoms, drugs that cause massive weight gain, diabetes, and heart disease. Electroconvulsive therapy, which can cause permanent memory loss, is coming back into fashion. In addition to whatever personal objections they might muster to treatment, often patients only have the option of treatments that stand to cause them significant, lasting harm.

This confuses the issue of the right to refuse treatment. It makes perfect sense to refuse a treatment that could destroy your memory, right? It seems reasonable that people might rather hallucinate than have a heart attack. Unfortunately, this leads us to focus on medication only as a heath decision, weighting the health benefits versus the health costs. Given that side effects generally don’t show up in the medical community’s consciousness, this leads doctors to feel safe in trying to force newer medications on their patient. But, more than that, it ignores the fact that these kind of decisions ought not to be based on a simple balancing of the possible heath benefits and risks. The right to refuse treatment is a human right, the right to sovereignty over one’s own mind. We cannot deny people their rights simply because we think we know what would benefit them.

It doesn’t matter, then, how close to the ideal our world may be. We don’t abstain from medicating people against their wills because we think that they understand the risks and benefits better than their doctors. While occasionally, as compassionate human beings, it may be necessary to stop the sickest among us from destroying themselves, for the most part we cannot ethically interfere with the way people chose to live their lives and deal with their illnesses. The law allows people to make their own choices about what they do to their bodies and minds because we respect their autonomy as human beings.

In the afterword to her book, The Center Cannot Hold, Elyn Saks mentions that a psychiatrist friend cautioned her to use a pen name, lest she be known publicly as “the schizophrenic with a job.” Her descriptions of psychosis are so lucid that it’s easy to see why friends would want her to hide it. Saks has been crazy in the worst sense possible, paranoid and raving and threatening violence. In this memoir, I feel like I’ve been given a window into what schizophrenia looks like from the outside and feels like from within. If this written had been written by someone who didn’t suffer from schizophrenia, I would call it “compassionate”, but the word doesn’t quite seem to fit in this case. Saks wastes no time in self-pity. This is a brave book, at the heart of it, filled with the hope that one day we all can get the help we need to live.

I admit, I came to the book already in awe of Ms. Saks. Only one out of ten schizophrenics manages to hold a job, let alone win awards or publish books. Forty years ago, Saks would have been confined to an institution for life, without the hope of treatment. Her CV is inspiring. This book is less a motivational speech than a window into another world, where beings from the sky control people’s thoughts and someone can die ten times a day and still be around to worry about it happening again. That she built herself a sane life, however fragile, is a testament to her doctors, her friends, and her own iron will.

Highly recommended.

The issue of individual civil rights for the seriously mentally ill is a major controversy today. Do you feel that schizophrenic patients should ever be institutionalized against their will? If you answer yes, under what conditions should the decision be made and who should have the authority to make this decision?

In our country, schizophrenics tend to be disruptive, scary. In a place where we can, for the most part, cordon ourselves off from the unpleasant realities of human poverty and sickness, schizophrenics stick out as reminders of the frailty and eventual decline of the human psyche. They make us uncomfortable; they make us afraid in a way that bears no relation to to harm they may bear us. I cannot talk about institutionalization, about the involuntary confinement of these people, without acknowledging the degree that it makes us more comfortable to have them locked up and put away where we do not need to see them. These people may benefit hugely from treatment, but any “treatment” that makes them docile and calm and non-disruptive also benefits us. When we consider involuntary confinement, it is important to make sure that we are helping the people in question, not merely removing our own discomfort and guilt.

This is what I believe about involuntary hospitalization: it’s wrong. Two hundred years ago lunatics were rounded up in asylum and showed off to crowds, the freaks, animals in cages. To imprison some against their will is to deprive them of their humanity, to reduce them to the status of pets and children. Imprisoning the innocent against theirs wills is barbaric.
This I also believe: when you have to tools to help a person, it is wrong to allow them to suffer and die. Schizophrenia undoubtedly causes anguish, and 15% of sufferers kill themselves. This is an illness that strips people of their reason and drives them to suicide. If they are incapable of comprehending, by reason of illness, that treatment may help them, don’t we have an obligation to force them into reason long enough for them to make their own choices?

Two wrongs, they say, don’t make a right. It is no less evil to imprison someone when they are incapable of comprehending what they’re doing, and it is no less moral to turn your back on someone because they can’t understand that you can help them. Treating schizophrenia, then, becomes a question of picking the lesser of two evils. I believe that it should always e a hard choice to make, to commit someone, and that anyone who doesn’t feel anguish at depriving another human being of their rights shouldn’t be in the position to make that judgment.

Anguish, however, can’t easily be proven in a court of law. The decision to imprison or free a person, them, needs to be made someone who at least has nothing to gain from hiding the patient away. I suggest a judge. Family members may care deeply about the person in question, but they often become the primary caretakers, and therefore have a vested interest in letting someone else take care of their schizophrenic relative. I sympathize with them, hugely, but decisions involving involuntary commitment need to be made purely based on the needs of the sick person, and family members simply aren’t capable of that. I believe psychiatrists ought to be involved in the process, but I believe that they shouldn’t have the final call. In clinical practice and in diagnosis, I think, it becomes too easy to address the symptoms rather than the person. Schizophrenia may be better treated in a confined and easily monitored setting, but Joe, the person, might do better with outpatient treatment. In addition, the psychiatrist who commits a patient often end up caring for him, and so it would be a poor business move to turn patients away.

Given that commitment is a form of imprisonment, it makes sense that only a judge ought to be able to do it, and the need to follow pretty stringent guidelines. First, someone must establish that the person is incapable of making rational decisions. That, I suppose, is where the psychiatrist comes in, as we can only rely on his judgment. Beyond that, I propose that one of two conditions must be met. First, if a person can be proved to be a danger to himself or people around him, he can be confined, and likely medicated in an attempt to restore reason. Seeing as schizophrenics are not actually much more violent than the rest of the population, I’d propose that people be considered nonviolent by default unless proven otherwise. If no one could provide evidence (including statements, therapy transcripts, et cetera) a person could only be involuntarily committed if they had, clearly, under no duress, and in writing, provided directions that they wished to be hospitalized during a schizophrenic episode or psychotic break. That way, those who need and might want help can get it, while those who want nothing to do with psychiatry aren’t forced into hospitals purely by virtue of their illness.

by Pete Earley

In reading about mental illness and treatment, you come across crazy people who think that all psychiatric drugs are poison, and crazy people who thing that all mentally ill people should be forcibly medicated. Pete Earley isn’t a another distinct type of personality; one of those family members who believes that everything would be okay, if only they had the power to hospitalize and drug their family members without their consent. It’s kind of touching and a little sad. If only hospitals were that much better than the prison wards, and everyone could get enough time in them. If only we could cure mental illnesses instead of trying to manage them, and picking up the pieces when out loved ones inevitably fall down.

I’ll be honest: this book scares me. Pete Earley takes the sickest of the sick, the most violent and disjointed of the mentally ill, and generalizes out from them. He doesn’t come out and say it, I don’t think, but it’s pretty clear that he thinks all mentally ill people should be forcibly medicated, and possibly hospitalized long-term. Thanks, Pete, but I’ve read about the days when family members could lock people away on word-of-craziness alone. Back when women who didn’t want husbands were considered insane and institutionalized? I don’t deny the existence of mental illness, oh no, but I’ve read my history, and I know that it’s subjective. There are no tests for schizophrenia or bipolar disorder, no way to tell for sure if someone ought to be given medication. Our mental health system is pretty horrific for criminals, but Pete Earley doesn’t have any good solutions for fixing it.

I know this man comes from a fundamentally compassionate place, but I feel like I need to read an anti-Prozac diatribe just to get the feel of it out of my head.

There is evidence that depression is associated with biological changes in the brain, for instance dysregulation of neurochemicals. Do you think that depressed individuals who have committed violent crimes against others (case in point: Andrea Yates, the mother who drowned all five of her children while suffering from depression) should be held morally accountable for their actions?

To blame neurochemicals for our actions is, at once, entirely reasonable and horribly misguided. Our minds, our brains, are all neurochemicals and electricity: saying that someone’s neurotransmitters make him want to kill people is essentially the same as saying that his mind makes him want to kill people. Mentally ill people are, in fact, sick, and studying the dysfunction of the brain can help find ways to treat their very real illnesses, but that doesn’t make them separate and uninvolved from their brains. The in mental illness, the brain doesn’t step in and take control; the brain is always the controller. Mental illness may affect the way that people are help responsible for their actions, but mere pathology of the brain does not.

This may sound cruel, but I believe that in a moral sense people are always responsible for for their actions. Always. Regardless of our insanity, or intoxication, or anger, we always have to live with our pasts, and what we’ve done. It’s not fair to blame our illnesses for our crimes, as if we could so cleanly and easily cut our diseased minds of from the rest of us. I’m not saying that people with mentally illnesses don’t deserve more slack and more forgiveness than sane people who kill others, but if a woman kills her children in a fit of psychosis, shouldn’t she be overcome with grief and remorse? Could we call her human if she isn’t?I believe that mentally ill people have an obligation to seek treatment. I believe that if any of us wake up in the morning with a flicker of my children would be better off if I drowned them, we have an obligation to go to an emergency room and check ourselves in for psych evaluation immediately, before letting things get worse. People don’t control or create their mental illnesses, but it is up to us to decide how we deal with our problems. There are always warning signs when psychosis strikes, and there’s usually some way or some place to put yourself where you can’t hurt yourself. If you are foolish to think that, in the face of mental illness, you can carry the lives of other people with your will alone, you deserve to feel responsible when you break. It’s a different kind of responsibility than rationally going out and shooting someone, but it exists nonetheless.

I feel a lot of compassion for people with mental illnesses. I feel that, by saying this, I’m condemning people who are essentially not in control of themselves to suffering. I want to be very clear that I don’t think mentally ill people ought to be shunned for things the do while not in their right minds, and they certainly shouldn’t be held legally responsible for these things. When I talk about moral responsibility, I mean something highly internal and personal. People prone to delusions ought to, even need to doubt themselves when they start thinking things that other people would find crazy. They need to take responsibility for those thoughts, take responsibility for dealing with them in a way that won’t end with anyone dying.

I guess I’m being a little idealistic here, because I’m assuming that anyone who tries will be able to get the help they need, or at least enough help to prevent them from hurting anyone else. I know that isn’t true. If a trip to the emergency room means thousands of dollars that you don’t have, I can see that it would be hard to check yourself in somewhere. If you can’t get someone to take you to the hospital, or if they give you antipsychotics and kick you out the door, that’s a different story than simply believing you could handle it. If that happens? I can’t blame a person who’s tried the best they could to get help, and been rejected by the world.

I believe, and the evidence supports, that people with addictions require treatment to overcome them. Many addictive substances can cause long-term lasting harm, and can have huge financial and relationship-related costs. Addictive substances can physically alter the brain. People may be more prone to addiction due to their genes as well as their personalities. Addiction can be hugely destructive.

That said, addiction is fundamentally a behavior pattern. I believe that behaviors can be maladaptive without being pathological, that is, I believe that people can repeatedly indulge in self-destructive behaviors without having a mental illness. People who regularly go 100mph on the highway don’t have “speed addiction disease”, even though they may be at higher risk of driving-related injuries than people who stay close to the speed limit. People who are physically addicted to coffee don’t consider themselves ill.

I don’t have a problem with people who struggle with alcoholism define it as a disease. If it encourages insurance companies to pay for treatment, in fact, I encourage it. Whatever helps people improve their lives is good, I think. It worries me, though, that in our culture maladaptive behavior patterns are increasingly being defined as diseases.