Seems like some people liked my Iraq post.

Other people hated it, of course, keeping in check my gigantic ego.  Thanks!

 

6/5/07 Addendum: But wait: PsyBlog has decided I have the "Best Psychiatrist's Blog." Take that, Lisa's beliefs!

Have you heard about the nut who, after being diagnosed with a rare tuberculosis, takes two transatlantic flights?  Putting everyone at risk?  Especially after doctors managed to track him down in Europe to tell him his tuberculosis strain was "extensively drug [isoniazid and rifampin] resistant" and very dangerous, and ordered him into isolation?  Why would this nut do it?

The man told a newspaper he took the first flight from Atlanta to Europe for his wedding, then the second flight home because he feared he might die without treatment in the U.S.

He wasn't in the Sudan, or Kazakhstan-- he was in Italy. And he went to Prague to catch a plane to Canada SO THAT HE COULD DRIVE TO THE U.S.

I suggest everyone think long and hard about this, before we take any further steps down the road towards universal healthcare.   You can't give away what you didn't pay for.

 

5/31/07 Addendum:  AK (see comments) discovered that the guy is actually a personal injury lawyer.  That's irony.  And his new father-in-law is a CDC doc specializing in... go on, guess... 

 

 

 

 

Don't ask me about Iraq.

But I do know something about our collective response to the Iraq war, to the Bush presidency, and to our times, and it says a lot about our cultural psychology.  And it helps predict the future.

It's sometimes easier to evaluate one's personality, and thus make predictions about it, by examining the defense mechanisms the person uses.  In difficult situations, specific people will use a small set of specific defenses over and over; so much so that we often describe people  exclusively by that defense, e.g. "she's passive aggressive."

Taking Iraq and President Bush as starting points, and examining the defense mechanisms we use to cope with both, yields the unsurprising conclusion that we are  a society of narcissists.

While this discovery is familiar to readers of my blog, what might be a surprise is what this heralds for our society politically and economically.  It isn't socialism, or even communism, as I had feared.  It's feudalism.  It's not 2007. It's 1066.

Let's begin. 

 

http://www.youtube.com/watch?v=F_tkar2rLEQ

Oh, get over yourselves.  That's hilarious.

 

As the thesis of this blog states: psychiatry is politics. 

I'd like to offer an idea for consideration.

The reason there's so much give and take about whether Cho was ill or not, and whether he was culpable or not, has to do with what psychiatry actually is: the pressure valve of society.

Our society does not have a good mechanism for dealing with poverty, frustration, and anger.  I'm not judging it, I'm not a left wing nut, I'm simply stating a fact; ours is not a custodial society, and it does little to "take care of" (different than help) these people.

So it has psychiatry, it fosters psychiatry, and it creates a psychiatric model in which these SOCIAL ills can be contained.

The inner city mom who smokes daily marijuana to unwind, with three kids who are disruptive, chaotic in school, etc-- society has really nothing to offer her.  But it can't let her fester, because eventually there will be a full scale revolution.  So it funnels her and her kids and everyone else like her into psychiatry.

Whether she "actually" has "mental illness" or not is besides the point.  Without the infrastructure of psychiatry, hers would be an exclusively social problem with no solution.  But with the infrastructure of society, her problem is no longer a social problem, and no longer the purview of the government (or fellow man, etc)--it is a medical problem.

Consider that one of the fastest ways for this woman to get welfare-- and ultimately social security-- is for her to go through psychiatry. 

So, too, the angry, the violent, the frustrated... 

Hence, discussions about whether mental illness reduces culpability are red herrings. It's about reducing culpability, it's about reducing society's obligation to deal with it.

Society is basically saying this (I'll quote myself):

...if they're poor or unintelligent, we will never be able to alter their chaotic environment, increase their insight or improve their judgment.    However, such massive societal failure can not be confronted head on;  we must leave them with the illusion that behavior is not entirely under volitional control; that their circumstances are independent of their will; that their inability to progress, and our inability to help them isn't their (or our) fault; that all men are not created equal.  Because without the buffer psychiatry offers, they will demand communism.

 

Hi.  Not surprisingly, many peoples have not liked my Cho comments.   Here's an example from a psychiatrist, and I responded with a comment there that I might as well put here.

As background, most people are yelling, "how the hell can you say this guy wasn't crazy?  He was talking to imaginary friends, he thought he was an Ax, etc."  As point of fact, these weren't delusions because he knew they weren't true, but that's a side point. 

Psychiatric pathology exists on a spectrum. It's not binary  "ill" or "not ill," and impairment in one realm doesn't explain impairment elsewhere. A diagnosis does not define all of your existence, or even all of your actions.

I should not, however, have said he wasn't mentally ill. What I should have said was he was not insane: he knew what he was doing, he knew what he was doing was wrong, and he had the ability to control himself. So he is entirely to blame, i.e., the mental illness, even if substantial, is incidental.

You might  say, ok, he's not insane, but only someone with a mental illness would do this.  It  doesn't lessen his culpability, however.

Well, actually, it does: you can't execute the mentally ill, for example.  Forget about your personal stance on the death penalty.  Fact is, mental illness is rapidly becoming an exclusion to a sentence that everyone else is subject to.  I know, it seems so righteous to say the mentally ill shouldn't be executed.  Ok, here: it would mean you can be sentenced to death, but he can't.  Does that make any sense, moral or legal?

Clearly, maladjusted and sexually frustrated college kids don't often go on rampages, so there was something in him that moved him to this.  Perhaps that was the mental illness.  But add up the body counts in the past twenty years. What's in common in mass murderers isn't mental illness, but frustration, impotence (metaphorical) and anger. Or are all those suicide bombers in Israel bipolar?

You'll say, "but he wasn't a suicide bomber."  His mental framework had much more in common with a suicide bomber than with John Wayne Gacy.

But let's put this aside and ask a different question, about us, not him:  why do so many people want him to be mentally ill?  Because its an explanation that doesn't implicate society, or themselves.  It means the world can be divided into "us" and "them," which is always fun.  It's the easy scapegoat that seems to be so obvious as to be unassailable.

And if it is mental illness, what do we intend on doing about it? My bias implies harsher sentences, societal changes, etc-- we can debate that later. But if it is all mental illness, then what? Do we lock up the "mentally ill" like we do pedophiles and terror suspects, before they even commit a crime, just on suspicion? And who decides who is suspicious?  Psychiatrists?  Do you trust every psychiatrist to be good at this? Or should it be the government?

Would you have been happy-- I mean this in all seriousness-- if George Bush had Cho arrested last year for being a terror suspect? Which part of that bothers you? It would have been legitimate, because he was dangerous. So is it that he was arrested before he committed a crime, or that George Bush did it?  See?  This is what you'll have to contend with with these policies. 

Oh yeah.  Treatment.  You want to make "treatment" mandatory? Great. Tell me exactly who should decide who needs treatment, and for how long, and what kind. And tell me how this treatment is going to work-- what is the specific end point?--  and for how long, and tell me what we should do when the treatment doesn't work.

You can't just make this stuff up as you go along, enacting policies which are politically expedient   but destroy the society.  Ask Vladimir Putin.  Oh, wait, bad example.

While preparing the post on the unusual characteristics of the suicides at MIT, I looked up university shootings and found, well... draw your own conclusions: 

Dec. 6, 1989: Gamil Gharbi, 25, engineering student at the University of Montreal, kills 13 women and wounds others (he released the men.) 

Nov. 1, 1991: Gang Lu, 28, physics grad student at the University of Iowa, shoots his dissertation advisor and five people and himself.

Aug. 15, 1996: Frederick Davidson, 36, grad student in engineering at San Diego State, shoots three professors at his dissertation defense. 

Aug. 28, 2000: James Easton Kelly, 36, a grad student at the University of Arkansas, dropped from the PhD program and shoots his dissertation advisor and himself.

Oct. 21, 2002:  Huan Xiang, 38, senior at Monash University (Australia) uses five 9mms to kill two students and wound others before being subdued.

May 10, 2003: Biswanath Halder, 62, former student, returns to Case Western with two 9mm and opens fire, supposedly over a failed lawsuit against the school.

Oct. 28, 2002: Robert Flores, 40, Gulf War vet and failing out of University of Arizona Nursing College, comes in with 5 guns and shoots three teachers and himself.

Jan. 16, 2002: Peter Odighizuwa, 42, grad student recently dismissed from Virginia's Appalachian School of Law,  shoots the Dean and a few others before getting subdued by students.

Sept. 13, 2006: Kimveer Gill (fun pics here), 25, opens fire with automatic weapons at Dawson College (Montreal), kills 20 and himself. 

And, of course, April 16, 2007: , Cho Seung Hui, 23, the not mentally ill former stalker of two women who shot up Virginia Tech.

So graduate school is so stressful it makes people snap?  Or is that just the Gulf of Tonkin? 

Too old, too disconnected, too-- weird--  to be accepted or acceptable in a closed environment where social life is as important, if not more important, than academic performance; where individuality is really flavored homogeneity ("no, dude-- my iPod is white");  where "what frat?" says more than  "what major?"; riding the internet while everyone gets a lot more sex, with a lot better looking people, than you; and, the last straw, your only claim to university related self-esteem gets forcibly "taken" from you.

And no, it's not the universities' fault, and it's not the media's fault, it's not mental illness, antidepressants, the "permissive society," porn, or lax gun laws.  These are the convenient banalities politicians will use to appeal to a mindless base.  No.  This is what happens when you don't know who you are.  And it is only going to get worse.

 

 

 

I came across this in my regular survey of the internet: a student (?)  listed all the suicides at MIT hung it up in a bus schedule frame.

The suicides' names, ages, method, etc, can be found here.   

But there are a few notable findings:

First, you should know that MIT and Harvard have some of the highest suicide rates. 

But, strangely, almost half of the suicides at MIT were grad students or former grads-- 13/30 since 1990.  (Since 1980 , 16 grads at MIT vs. 8 at Harvard.)

Since 1990, there have been a lot of suicides by jump off a building-- 10/29.  In the U.S., this is extremely rare, while in Hong Kong, 50% of suicides are jumps from buildings.  (None of the jumpers here were even Asian.)  (The only school that comes close is a rash of six jumpers in 2004 at NYU (no Asians.)  The first three happened witin 30 days of each other, and the last two happened in the same week a year later.   Only 1 was a grad student.  As near as I can tell, NYU hasn't had any jumpers before or since-- in fact, they hadn't had any suicides since 1996.)

A lot were women: 7/29 (25%), 8/29 if you count the Wellesely student who was renting on campus.   In the U.S., it's 15-20% females.

8/29 were non-white males;  4/29 were non-white females, so 12/29 were not white. In the U.S., non-whites represent about 10% of all suicides.  And 2/3 of non-white suiciders in the U.S. are black.

February was the most popular month for suicides (6), January second place (4).  

All three suicides that occurred in April (2000, 2001, 2003) were women.  2000 and 2001 were both sophomore women, who died on 4/10 (burning/OD) and 4/30 (cyanide poisoning.)

I don't have the demography of MIT, but it seems that grad students, Asians and women are at higher risk for suicide at MIT.

And if someone asks you how to get to the roof, lie.

 

(NB: MIT students, I know, small samples and statistical significance.  I know.)

(Second NB: I looked into each suicide as best as I could, and I was able to supplement the spreadsheet linked above.  For example, I found two additional jumps from buildings.  But in this process it discovered that one "suicide" (KM) might not have been a suicide; and, even more interesting, he was linked to the suicide of another student at MIT (RG).  I use the initials here, but their full names are clearly public, and already contained in the spreadsheet.)

(Third NB: to the guy who made the suicide schedule-- some of the dates and methods are wrong (for example, April.)  Nothing major, but if you want my list let me know.)