This has nothing to do with psychiatry, except that it's about my jet-setiing ways, and that's what psychiatry is really all about, after all.

A while ago I read an article in Wired called "The Great No-ID Airport Challenge," and I finally mustered the courage to try it.

There are two checks at security.  At the first, they simply look to see if your ticket matches your ID.  If it does, they send you off into one of the several metal detector lines, where you wait to place your belongings on the belt, take off your shoes, etc.

I hid my ID in a magazine, and talked myself out of my main worry: what's the worst that could happen?  I mean, I can't be the first guy in LAX to not have an ID, right?  Surely, there must be some system to handle these occurrences? 

So I wasn't worried about being turned away so much as being extremely delayed; my fantasy was that they'd take me to the "back room" and I'd have to "con" my way through, i.e., verbally convince them I was not a terrorist.

Well, none of that happened.  What did happen paralleled the Wired story: the security lady said, "no ID?" and I said, "I lost it and--" and she cut me off.  And sent me over to a closed security lane, which was promptly opened and staffed.  They gave me the SSS treatment-- they x-rayed and manually went through my bag, waved the wand over me, patted me down-- and that was it.  I walked to my gate.

Here's the important part, in case you missed it: by not having ID, I totally bypassed the long lines in the regular security lanes.  I saved myself-- what,  30 minutes?

It then occurred to me that I could have bypassed the line going to the first security lady-- another 10 or so minutes-- by walking directly up to her and telling her I was panicked because I had lost my ID, what should I do?  My money says that instead of telling me to get back in line, she would have simply sent me to the empty security lane. 

For those who don't know: SSSS on your ticket means you have been "randomly" selected for additional screening.   It can appear on your printed ticket, or a screener can write if if they don't like the looks of you.

 

 

 

Surprising results from the study, "Magnetic resonance imaging of male and female genitals during coitus" in BMJ:

We did not foresee that the men would have more problems with sexual performance (maintaining their erection) than the women in the scanner. 

There is so much wrong with that sentence.

This is the most important part: most pedophiles aren't sexually attracted to kids.

So Spitzer, et al have passed a law that allows  courts to involuntarily commit sex offenders to psychiatric hospitals until they are "no longer" dangerous-- even if they have not actually committed a crime, or have served their sentence. 

Said Spitzer:

 "...protecting the public from those individuals whose mental abnormalities cause them to make sexual attacks on others."

"Mental abnormalities?"  That they are bad people I can see; but what, precisely, is the nature of this mental abnormality?  And it "causes" violence?  Causes? 

The ACLU of course opposes such an obvious violation of civil liberties-- but they make the same mistake:

"...locking someone up indefinitely because he has a mental abnormality and may commit a crime in the future creates a constitutional nightmare," said Bob Perry of the New York Civil Liberties Union.

"...because he has a mental abnormality."  Why the qualification?  Is that relevant?  And why does everyone agree that there is a "mental abnormality?"

Blame Kansas v. Hendricks, the 1997 decision in which it was decided that dangerousness + a "mental abnormality" is sufficient to involuntarily commit someone (in that case, a violent pedophile) indefinitely-- even after he has already served his sentence.  Here's the trick: there would be no other justification for this violation of substantive due process except some mental abnormality that forces you to do things. The only way we can justify indefinitely locking up pedophiles is to call them psychiatric patients.

What's a "mental abnormality," exactly?  The Court left the definition up to the states, but it suggests some dangerous synonyms, like  "personality disorder." 

Here's another: mental retardation.  Is mental retardation-- now a exclusion for execution-- sufficient for indefinite civil commitment?  They're not going to get better, are they?

There are two main problems with this law.  The first is constitutional: you simply cannot lock up a person, indefinitely, unless they committed a crime. 

Exactly what is the difference between the Guantanamo terror suspects and pedophiles incarcerated further after their sentence has been completed?  Both are being held under the (likely accurate) presumption they're going to cause trouble in the future.  Both are driven by an inner and virtually unalterable desperation to commit their respective offenses.  Hell, you can even use the same battery of questions to screen for both ("God has given you an odd gift: a schoolbus full of docile 8 year olds.  What do you do?")  And both are equally explained and treated by modern medicine and psychiatry (i.e. not at all.)

At least the Guantanamo detainees are not U.S. citizens-- they are not entitled to our constitutional rights.  For better or worse, American pedophiles are.

If you are against one, you're against both.  They're the same. 

The law's second problem is social and categorical: these laws interpret certain violent behaviors as psychiatric in nature, without any scientific or even descriptive basis.   In other words, it medicalizes behavior simply because it does not know what else to do with it.  It says, "only someone whacked out of their skull would be a pedophile."

And some will say, and what do you expect from a culture that so sexualizes youth?  Actually,  humanity has been sexualizing its youth for thousands of years; it's only in modern times that we've placed an absolute prohibition on acting on it.  As I recall, teens getting married was the norm in the Renaissance; the ancient Greeks had institutionalized a form of pederasty-for-education trade.

I bring this up not to justify having sex with kids (duh), but to show that it is quite obviously not a psychiatric disorder.  It is a crime that you choose to commit.

There is too much emotion around sexual predators, and it confuses the issues.  For example, why do we register them?  We don't register serial killers, con artists, unabombers, etc.  The argument, "well, wouldn't you want to know if a sex offender was living in your neighborhood?" isn't valid: I assume everyone is a sex offender. Seriously.  Especially around my kids.  And wouldn't you want to know the Zodiac killer moved in?

Don't misinterpret my support of civil liberties as permissiveness; if you're really worried that a sex offender will offend again, make his criminal sentence longer, harsher. If society wants  to make pedophilia a capital offense, fine.  But for the love of God, don't turn sex offenders over to the psychiatrists, the two have nothing to do with each other.  You may as well send them to the sociologists, they have about as much to do with them.

This is an extremely bad law, and by bad I mean bad for everyone except the bad guys.  It sets up the argument that certain "behaviors" are so a part of one's identity that they cannot be altered or prevented, and therefore culpability is reduced while dangerousness is magnified.  It allows the government yet another avenue to lock people up without crime.  And worst of all, the penultimate decision about who should be locked up for society's benefit is made by the absolute worst group to make this decision: psychiatrists.  Psychiatry becomes a tool of the state.

The last major country that ran this way was the USSR.  But things are different now, I know.  I know.

 

 

So you think you might be dating a pathological liar?  No, you're not.  He's just a big jerk.

The popular stereotype of a pathological liar-- a chronic liar, deceiver, who lies to get out of things, or into things; who tries to con you into something, or control you; who cheats on you and then denies it, makes up stories about where he was-- all this is wrong.  It's malingering, but it isn't pathological lying.  He's a tool, but he's not psychiatric.

"Pathological lying" is often interchanged with "pseudologia fantastica."  (NB: many psychiatrists use pseudologia fantastica interchangably with confabulation-- this is also wrong, as will be described below.)  Pathological lying was originally defined as complex lies which are internally consistent, that may drag on for years and-- and this is the key point-- do not have an obvious  purpose or gain. They're not trying to con you into or out of anything.  They're just making crap up.

The lies are unplanned, spontaneous.  Once told, they generally stick (for years)-- but it's fair to say the pathological liar doesn't know what he's going to say until he says it.  He is a bullshit artist who makes it up as he goes along, and who then semi-believes his own crap.

And the lies aren't even useful lies.  You ask him what he did last Saturday and he tells you he went to the museum; and maybe he says at the museum he saw a guy try to rob the gift shop, but he got caught by two off duty cops wearing blue hats.  And later you learn he was really at a movie with his girlfriend and you think, why the hell did this freak make all that up? 

That's why it's called pathological. 

A pathological liar is like a 4 year old kid, who tells you what happened to him down by the lake. Meanwhile, there's no lake.

The important question here is this: does the pathological liar know he is lying?  Or does he believe his stories?  Is he lying, or is he delusional?

The answer is: both.  Sort of.

He is not delusional, but he hovers in that half-world of the narcissist (oh, there's that tie-in), where the lies are believed until he gets caught, but then-- and this is the move that only a few can pull off-- he acknowledges that the "facts" are lies, but not the essence, the spirit.  "Ok, look, I'm not really in the CIA."  But in his mind, he knows that if conditions were right-- if something big went down-- he could be exactly like a CIA agent, and that's close enough.  If he saw a suicide bomber, he'd be able to movie- kung fu him, grab the Sig Sauer and squeeze off a few rounds.  He also knows which wire to clip.  How does he know?  Because he's in the CIA.

If aliens actually did come and attack us, he knows he would actually be able to fly a spaceship.

Pathological lying is not "confabulation."  In both cases, lies are told spontaneously and freely, without clear intent, purpose, or gain-- except that in confabulation, the reason the person lies is to fill in the deficits in his memory; he can't remember what actually happened. Hence confabulation is associated  with dementia ("when I was 18 I went to Paris with my unit and I saw... 8 puppies get eaten by Chamberlain and de Gaulle-- hand to God I saw it"), and especially with alcoholic dementia/hallucinosis ("I don't know what happened to me-- six guys jumped me... yeah... six... Canadian guys, I think they were Satanists, no, wait, Stalinists, yeah, that's right, and they could read my mind...")

What about biological correlates?  There aren't any, because this isn't a disease, it's a description.  Here's an example: an article entitled, "Prefrontal white matter in pathological liars" found massively (20%+) increased prefrontal white matter, and a 40% decrease grey/white matter ratio in pathological liars, as compared to both controls and antisocials.  But before you crack an anatomy book to figure out what that means (more prefrontal white matter= more ability to think and reason), you should know that the subjects they labeled "pathological liars" were really people who purposely and frequently lie to get a gain-- in other words, they were big fat evil scumbag liars, but not pathological liars. What this study found was that people who frequently lie develop a better brain for manipulating information, remembering stories, etc-- which is interesting, but not all that surprising.

My take is that pathological lying is a disorder of identity; the person imagines for himself an separate identity, and then fantasizes experiences and events which may be otherwise ordinary and predictable-- he went to the museum-- but in his mind happen only to "that" person.  The lies hold the clues to that identity, but they may not be obvious.  For example, maybe the part of the lie that's important isn't that he saw a guy rob the gift shop and get arrested, but that he was at the museum by himself-- the point is that he imagines himself a loner, or an artsy type, etc.  Or maybe he's sees himself living in a world where crimes happen frequently.  And maybe he thinks he's a superhero.

The pathological liar doesn't place much value in experience; it's all in identification.  He doesn't need to be in the military to know exactly what it's like, because he's watched enough war movies (e.g. one) or read Tom Clancy. (Aside: that's the huge appeal of Clancy and Crichton-- enough detail to make you think you know the inner workings of the professions they describe.)  It's wrong to dismiss the lies as valueless; like Zelig, these people do have an intuitive grasp of the relevant thought process, emotions, affects, and even consequences of the experiences they describe.  They're just made up.  So when he gets caught in his lie, he secretly blames the other person for not appreciating  that whether it's a lie or not is trivial, irrelevant; it still affected him just the same.

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(It would be interesting to study whether (true) pathological liars are able to provide a better "profile" of criminals, heads of state, etc, than professional profilers, and what supplementary factors might improve the accuracy of the profile.  ("Here are some videos/documents on Vladimir Putin.  Tell us what you think. Then, go out to dinner with this beautiful blonde ex-FSB agent and see if you come up with any further insights.")  I suspect also that pathological liars would more predictably pass the new fMRI lie detectors; these detect binary lies ("are you this or are you not this?") but pathological liars hold contradictory truths simultaneously and thus may not register as deceptive.  (P.S. I think I know how the test procedure can be altered to pick this up; but I also think I know how these tests can be reliably beaten.  If anyone wants to study this, let me know.))

 

 

There's an article making the rounds that I'd like to kill off right now, before it becomes a meme, or worse, another unsupported postulate common among psychiatrists.

The title of the Reuters news story about the article (in Sleep) is this: "Sleepless nights may hinder moral judgments."  And has sentences like this: "[subjects] took a longer time to mull over the morally charged questions when they were sleep-deprived than when they were well rested. This was not the case with the more minor, non-moral scenarios."

And there's your self-serving, exculpatory imbecility of the day: a sleepless night or two turns us into lycanthropes, or at least hyenas. ("I was so tired I couldn't think straight.")   Fortunately for the existentialists, the Reuters reporter didn't actually read the Sleep article, which doesn't actually say this.

The Army study subjected volunteers to 53 hours of sleep deprivation and presented them with a battery of moral dilemma type questions ("is it morally appropriate or inappropriate to do X if Y is at stake?")

In contrast to the obvious suggestions of the Reuter's title, the study found that it took sleep deprived subjects longer to identify something as morally appropriate, but had no effect on how long it took to label it inappropriate.  In fact, relative to a non-moral issue, sleep deprived subjects were able to label something as morally inappropriate faster.

Quoting the authors:

When tested at rested baseline, participants showed no significant differences between response times for scenarios judged as “appropriate” versus those judged as “inappropriate” .... In contrast, when deprived of sleep for over 53 hours, these same participants showed significantly greater difficulty judging emotionally charged MP  (personal moral) courses of action as “appropriate” relative to judging them as “inappropriate.”

In other words, sleep deprivation made it harder for them to say something was right, but not harder to say it was wrong.  To use a metaphor, you "know" things are wrong; but you may have to judge if they are right.

The study also looked into whether people labeled something as morally appropriate more often if they were sleep deprived, i.e. were they more permissive.  First, if the subject had high emotional intelligence, sleep loss had no effect.  Secondly, having an "average" emotional intelligence lead to an increase in the number of scenarios labeled appropriate:  2/10 when rested vs. 4/10 when sleep deprived.  In other words, people with high emotional intelligence have stable, "unwavering" moral judgments, even in the face of sleep loss.  Or, put another way: if you're clear on what you believe, sleep deprivation isn't likely to confuse you.

This is important because the Reuter's title, and indeed the psychiatric utilization of this idea, puts the ability (or inability) to make moral judgments on external factors-- "he was sleep deprived, and that impacts your judgment."   This is prima facie false; but anyway is not supported even by the very science they themselves use to back the claims. 

We can set aside the debate on whether chemicals and psychosis can alter moral judgments; but I think it's fairly safe to say that if your moral judgments are affected by 53 hours of sleep deprivation, sleep isn't the problem.

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Note: the study also found that caffeine did not reverse the alterations in moral judgments due to sleep loss.  I don't buy it; more later. 

 

 

A quick addendum to my previous post on the "Psychological Uncertainty Principle."

A reader pointed out that some of this is explained by "reciprocal determinism", which basically means that you respond to your environment, but then force a change in your environment which further changes your behavior.  For example:

1. "Girls don't like me. Girls don't like me.   Girls don't like me."  Repeat x 100.
   
2. So a girl thought she liked you, but then met you, and now decided you're a nutter. So she bolts.
3. Now you have proof girls don't like you.

It sounds like reciprocal determinism says who you are affects your environment, which then affects you.  

That's wrong.  In the above example, it wasn't ever true that girls didn't like you.  You made it true.  You changed your behavior, somehow, that made it so that girls don't like you.  You received some gain from making it true that girls didn't like you-- perhaps it helps you avoid intimacy, etc, etc.  

So your identity never enters the equation.  Reciprocal determinism is about behavior, not identity.  Albert Bandura (the originator of this concept) was responding to Skinner's behaviorism.

Wikipedia's article on reciprocal determinism is a perfect example of this exactly wrong use of the concept.  They describe how low MAOA enzyme can cause you to be antisocial.  In fact, it is the opposite:  having low MAO-A does nothing, but having high MAO-A seems to be protective.  The reason people became antisocial (synonymous with criminal) in those studies was that they were abused-- in essence, they imitated the behavior. 

The experiment Bandura is famous for speaks to my point about the absoluteness of your responsibility for your identity:  kids watched adults beat up a bobo doll, and were then put in a room with a bobo doll, and, surprise, the majority then imitated this behavior, even using the same hitting techniques and repeating the same phrases the adults did.  Nothing genetic or even environmental affected this outcome-- almost all the kids did it (and almost none of the control kids who didn't watch the adults beat up the doll).

So watching the Matrix causes kids to go Columbine?  Bandura would have said yes.  But oddly no one ever wonders why then the cooking channel doesn't result in more pies, or why porn hasn't prompted rampant depilation.  Bandura's theory of reciprocal determinism required a key element: reinforcement.  There has to be a gain in the imitation, in the identification.  You may have "learned" the violence by watching it, but you won't display the violence unless there is some reward-- it isn't just a reflex, some part of your core identity.   You decide to imitate it, because it rewards you.  How?  "I want to be just like my Dad" (except he beats Mom.)  "Neo is so cool." (Didn't he kill all the human security guards?)  "Thug life!"  Etc. Note that no one ever imitates the violence of, say, Gollum. Want to know why?  Because Gollum never scores any chicks. 

So once again, you pick who you are.  Or: you picked who you are, how you behave, whether you know this or not. So now ask: why did you pick this person, this identity?  And what is preventing you from changing any or all of it?

 

 

 

 

A commenter, who I believe is a physics undergrad (his blog here) emailed me some of his thoughts on narcissism, and wrote:

...those studies where people rank each other in a room for different attributes having never met them... I think what's going on is we assign people personalities based on how they look and force them to become a certain thing, creating a whole custom world for them...

which puts the idea of "profiling" on its head.  Do we actually ever "figure people out," or do we change them into what we think they are by the act of engaging in a relationship (on any level) with them?  It sounds a lot like a psychological version of quantum entanglement:

When two systems, of which we know the states by their respective representatives, enter into temporary physical interaction due to known forces between them, and when after a time of mutual influence the systems separate again, then they can no longer be described in the same way as before, viz. by endowing each of them with a representative of its own... By the interaction the two representatives have become entangled.

Which, unfortunately, sounds a lot like this (p. 236):

The unreflective consciousness does not apprehend the person directly or as its object; the person is presented to consciousness in so far as the person is an object for the Other.  This means that all of a sudden I am conscious of myself escaping myself, not in that I am the foundation of my own nothingness but in that I have my foundation outside myself.  I am for myself only as I am a pure reference for the Other.

You can't know who a person is without relating to them, and once you do that, you irrevocably change them.

Only in relationship to another do you get defined. Sometimes you can do it with your God; but either way, any adjective has to be placed on you by someone else.  Are you brave?  Strong?  funny, stupid, nervous?  All that comes from someone else.  So when someone relates to you, they define you.  You can try to control this-- hence the narcissist preying on the borderline to get her to see him the way he wants to be seen-- but ultimately it's up to the other person.

So we're are, or become, whatever a person thinks we are?  No, it's worse than that-- we want to be what they think we are. That's why we maintain the relationship, otherwise we'd change it.  ("I divorced her because I didn't like who I became.")

We do it because it is easier, and it serves us.   You're kind because he sees you as kind-- which in turn allows him to be seen as someone who can detect kindness.  And you accept that you're kind-- or mean/vulnerable/evil/brilliant-- because it serves you-- there's some gain there.  But a strong person accepts that on the one hand the other person gives you definition, and on the other hand you are completely undefinable, free, at any moment, to redefine yourself.  You can defy him, biology, environment and be anything.

You say: but I can't be a football star just because I want to.  But that's wanting someone else to see you in a certain way.  Do you want to play ball?  Go play ball.  "But I won't get on the team."  Again, that's wanting to change someone else.  Change you first. 

But what about-- identity?  That's the mistake, that's bad faith.  Thinking that our past is us; what we did defines us.  Our past can be judged-- what else is there to judge?- but it can't-- shouldn't--  define us, because at any moment we are free to change into something, anything else.  And so, too, we can be judged for not changing.

Ultimately, you are responsible for everything you do and think.  Not for what happens to you, but for how you choose to react.  Nothing else made you be.  Nothing else made you do.

Trinity said it best: The Matrix cannot tell you who you are.