Later On

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Archive for the ‘Mental Health’ Category

Free and confidential crisis line

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From the newsletter Recomendo:

If you’re in the United States and need someone to talk to you can text 741741 any hour of the day and be connected with a crisis counselor (For Canada text 686868, and for UK text 85258). My sister-in-law volunteers for the Crisis Text Line, and she said counselors go through continuous training and are always supervised by mental health professionals. I tested it out to make sure it works and the first text was automated, but I was connected with a live person in less than 2 minutes. I hope I don’t need it, but I’m relieved to know that it’s there. For more info check out their website: crisistextline.org

Written by LeisureGuy

25 August 2019 at 5:35 am

If Trump Were an Airline Pilot

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James Fallows writes in the Atlantic:

Through the 2016 campaign, I posted a series called “Trump Time Capsule” in this space. The idea was to record, in real time, what was known about Donald Trump’s fitness for office—and to do so not when people were looking back on our era but while the Republican Party was deciding whether to line up behind him and voters were preparing to make their choice.

The series reached 152 installments by election day. I argued that even then there was no doubt of Trump’s mental, emotional, civic, and ethical unfitness for national leadership. If you’re hazy on the details, the series is (once again) here.

That background has equipped me to view Trump’s performance in office as consistently shocking but rarely surprising. He lied on the campaign trail, and he lies in office. He insulted women, minorities, “the other” as a candidate, and he does it as a president. He led “lock her up!” cheers at the Republican National Convention and he smiles at “send them back!” cheers now. He did not know how the “nuclear triad” worked then, and he does not know how tariffs work now. He flared at perceived personal slights when they came from Senator John McCain, and he does so when they come from the Prime Minister of Denmark. He is who he was.

The Atlantic editorial staff, in a project I played no part in, reached a similar conclusion. Its editorial urging a vote against Trump was obviously written before the election but stands up well three years later:

He is a demagogue, a xenophobe, a sexist, a know-nothing, and a liar. He is spectacularly unfit for office, and voters—the statesmen and thinkers of the ballot box—should act in defense of American democracy and elect his opponent


The one thing I avoided in that Time Capsule series was “medicalizing” Trump’s personality and behavior. That is, moving from description of his behavior to speculation about its cause. Was Trump’s abysmal ignorance—“Most people don’t know President Lincoln was a Republican!”—a sign of dementia, or of some other cognitive decline? Or was it just more evidence that he had never read a book? Was his braggadocio and self-centeredness a textbook case of narcissistic personality disorder? (Whose symptoms include “an exaggerated sense of self-importance” and “a sense of entitlement and require[s] constant, excessive admiration.”) Or just that he is an entitled jerk? On these and other points I didn’t, and don’t, know.

Like many people in the journalistic world, I received a steady stream of mail from mental-health professionals arguing for the “medicalized” approach. Several times I mentioned the parallel between Trump’s behavior and the check-list symptoms of narcissism. But I steered away from “this man is sick”—naming the cause rather than listing the signs—for two reasons.

The minor reason was the medical-world taboo against public speculation about people a doctor had not examined personally. There is a Catch-22 circularity to this stricture (which dates to the Goldwater-LBJ race in 1964). Doctors who have not treated a patient can’t say anything about the patient’s condition, because that would be “irresponsible”—but neither can doctors who have, because they’d be violating confidences.

Also, a flat ban on at-a-distance diagnosis doesn’t really meet the common-sense test. Medical professionals have spent decades observing symptoms, syndromes, and more-or-less probable explanations for behavior. We take it for granted that an ex-quarterback like Tony Romo can look at an offensive lineup just before the snap and say, “This is going to be a screen pass.” But it’s considered a wild overstep for a doctor or therapist to reach conclusions based on hundreds of hours of exposure to Trump on TV.

My dad was a small-town internist and diagnostician. Back in the 1990s he saw someone I knew, on a TV interview show, and he called me to say: “I think your friend has [a neurological disease]. He should have it checked out, if he hasn’t already.” It was because my dad had seen a certain pattern—of expression, and movement, and facial detail—so many times in the past, that he saw familiar signs, and knew from experience what the cause usually was. (He was right in this case.) Similarly, he could walk down the street, or through an airline terminal, and tell by people’s gait or breathing patterns who needed to have knee or hip surgery, who had just had that surgery, who was starting to have heart problems, et cetera. (I avoided asking him what he was observing about me.)

Recognizing patterns is the heart of most professional skills, and mental health professionals usually know less about an individual patient than all of us now know about Donald Trump. And on that basis, Dr. Bandy Lee of Yale and others associated with the World Mental Health Coalition have been sounding the alarm about Trump’s mental state (including with a special analysis of the Mueller report). Another organization of mental health professionals is the “Duty to Warn” movement.

But the diagnosis-at-a-distance issue wasn’t the real reason I avoided “medicalization.” The main reason I didn’t go down this road was my assessment that it wouldn’t make a difference. People who opposed Donald Trump already opposed him, and didn’t need some medical hypothesis to dislike his behavior. And people who supported him had already shown that they would continue to swallow anything, from “Grab ‘em by … ”  to “I like people who weren’t captured.” The Vichy Republicans of the campaign dutifully lined up behind the man they had denounced during the primaries, and the Republicans of the Senate have followed in that tradition.


But now we’ve had something we didn’t see so clearly during the campaign. These are episodes of what would be called outright lunacy, if they occurred in any other setting: An actually consequential rift with a small but important NATO ally, arising from the idea that the U.S. would “buy Greenland.” Trump’s self-description as “the Chosen One,” and his embrace of a supporter’s description of him as the “second coming of God” and the “King of Israel.” His logorrhea, drift, and fantastical claims in public rallies, and his flashes of belligerence at the slightest challenge in question sessions on the White House lawn. His utter lack of affect or empathy when personally meeting the most recent shooting victims, in Dayton and El Paso. His reduction of any event, whatsoever, into what people are saying about him.

Obviously I have no standing to say what medical pattern we are seeing, and where exactly it might lead. But just from life I know this:

  • If an airline learned that a pilot was talking publicly about being “the Chosen One” or “the King of Israel” (or Scotland or whatever), the airline would be looking carefully into whether this person should be in the cockpit.
  • If a hospital had a senior surgeon behaving as Trump now does, other doctors and nurses would be talking with administrators and lawyers before giving that surgeon the scalpel again.
  • If a public company knew that a CEO was making costly strategic decisions on personal impulse or from personal vanity or slight, and was doing so more and more frequently, the board would be starting to act. (See: Uber, management history of.)
  • If a university, museum, or other public institution had a leader who routinely insulted large parts of its constituency—racial or religious minorities, immigrants or international allies, women—the board would be starting to act.
  • If the U.S. Navy knew that one of its commanders was routinely lying about important operational details, plus lashing out under criticism, plus talking in “Chosen One” terms, the Navy would not want that person in charge of, say, a nuclear-missile submarine. (See: The Queeg saga in The Caine Mutiny, which would make ideal late-summer reading or viewing for members of the White House staff.)

Yet now such a  person is in charge not of one nuclear-missile submarine but all of them—and the bombers and ICBMs, and diplomatic military agreements, and the countless other ramifications of executive power.

If Donald Trump were in virtually any other position of responsibility, action would already be under way to remove him from that role. The board at . . .

Continue reading.

Written by LeisureGuy

24 August 2019 at 7:32 pm

Alzheimer’s Meeting: Lifestyle Factors Are the Best—and Only—Bet Now for Reducing Dementia Risk

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Karen Weintraub reports in Scientific American:

Samuel Gandy became an Alzheimer’s disease researcher in part to help his own family. He watched his mother spiral downward as she lost her memory and then her ability to care for herself.

After that, Gandy, now director of the Center for Cognitive Health at the Icahn School of Medicine at Mount Sinai in New York, thought his research might help prevent a similar fate for himself. Now in his 60s and having watched every single promising drug trial for Alzheimer’s fail, he’s had to give up on that idea, too.

Gandy is now focused on helping the next generation of young scientists who work in his lab and others. “Now I just want to contribute to the eventual eradication,” he says. “As long as I feel like I’m moving the ball down the field in the right direction, that’s worthwhile.”

The repeated failures of Alzheimer’s drugs in late-stage, hugely expensive trials, have forced Gandy and other researchers to recalibrate any optimism about finding a cure. With the annual Alzheimer’s Association International Conference currently finishing up in Los Angeles, scientists are still hopeful about the future—but that future now seems a lot further away.

For three decades, most researchers assumed that the cure for Alzheimer’s lay in getting rid of the build-up of a protein called beta-amyloid in the brain. Eliminate that bad actor, and the disease would be vanquished, the thinking went. Then, when that failed, researchers thought they had to get rid of the beta-amyloid earlier—let it spread too far and clog up too much and there was no way the brain could bounce back, researchers assumed.

Yet all the recent trials of early-stage patients proved that idea wrong, too. Amgen, Novartis and the federal government announced at the conference that they were ending their latest anti-amyloid trial, because the drug harmed more patients than it helped. Nearly everyone has now given up on the idea that fighting amyloid will be enough to combat Alzheimer’s on its own once damage has begun.

There are 102 drugs being tested right now in patients, according to the Alzheimer’s Drug Discovery Foundation. Most are in mid-stage trials, meaning they’ve already been shown to be safe in a small group, but have not gone through the rigorous testing in patients to determine whether they are effective. Maybe one will turn out to make a big difference. Yet few researchers believe in the prospect of a magic bullet. Scientists think that it’s more likely that a combination of approaches will be needed to prevent, treat or cure Alzheimer’s, similar to how a drug cocktail is needed to treat HIV.

Two research pursuits seem to hold the most promise—though both might need to be used in combination with each other, perhaps along with anti-amyloid approaches. The first is addressing a protein called tau. Tau causes tangles of material in the brain that clog it up, compounding the problems of beta amyloid. Getting rid of tau is looking more and more promising as part of a cocktail of approaches, says Kenneth Kosik, a professor of neuroscience, and co-director of the Neuroscience Research Institute at the University of California, Santa Barbara.

The second area focuses on inflammation. There’s some indication that an immune reaction—perhaps from something as seemingly benign as the microbes that cause cold sores or gum disease—could be a spark that launches a series of events that ultimately lead to an Alzheimer’s diagnosis. . .

Continue reading. There’s much more.

Written by LeisureGuy

22 August 2019 at 5:57 pm

The First Inside Report from an Ice Mental-Health Facility

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Ken Silverstein writes in the New Republic:

As reports exposing the shockingly brutal conditions at immigrant detention centers have drawn comparisons to ethnic detention compounds under authoritarian regimes, it becomes ever more pressing for the country’s vast immigration bureaucracy to lean on whatever prestige it can muster at the height of the Trump border crackdown. And like everything else connected with this deranged chapter in our national nativist culture war, the present administrative charm offensive is steeped in gruesome irony: As U.S. Immigration and Customs Enforcement (ICE) implements policies all but certain to engender lifelong trauma in detained children separated from their families at the border, it is simultaneously promoting an initiative designed to demonstrate compassion and competence toward adult detainees, particularly those diagnosed with mental illnesses. That’s right: An agency now sowing the conditions of mass traumatic stress among child detainees has been trying for years to set up shop as the caregiver of first resort for psychically traumatized undocumented immigrants.

ICE’s crown jewel in this initiative is a Miami facility called the Krome Service Processing Center, which is administered in conjunction with a host of private contractors. Krome was founded in the 1960s as a Cold War military base designed to protect the nation against the threat posed by Fidel Castro’s Cuba. Beginning in 1980, the U.S. government began transitioning it to hold immigration detainees.

ICE officials have previously bragged in the press about facilities at Krome. To hear them tell it, Krome is a state-of-the-art treatment facility for immigrants (documented and otherwise), housed at its nationwide complex of more than 200 detention facilities. It provides stellar medical services, agency officials say, and especially so in the pivotal realm of immigrant mental health.

For a crown jewel, though, Krome is awfully hard to find and access, if you’re not taking part in a prearranged press junket. I went out to see conditions there in June as part of a reporting trip funded by the Project on Government Oversight. The Krome complex is in a vast dead zone on the outskirts of Miami, just on the border of the Everglades. The gigantic Dolphin Mall is nearby, as is a resort and gambling complex run by the Miccosukee Tribe, but the facility sits at the end of an unmarked road off a major freeway. If you don’t have a detained relative or some other reason to know it’s there, it’s out of sight and out of mind. Locating detention camps in such isolated spots is not uncommon for ICE. For all the official hoopla surrounding the level of care supposedly available to suffering detainees in its ambit, Krome, like most other detainee facilities, operates far out of range of sustained public and media scrutiny.

In the years prior to the Trump presidency, this strategy worked like a charm. ICE’s carefully massaged narrative placing Krome on the vanguard of mental health care has gone largely unchallenged—while Krome garnered some press coverage over several decades, only a few outlets ever mentioned its mental health facilities at all, and most that did referenced them positively. A 2015 Miami Herald story, published after the newspaper got an official ICE tour, reported that the former military base—the “only visible remnants from that tense time are three diamond-shaped pads where Nike missiles once stood, ready to thwart an attack from Cuba”—was now “a fully renovated detention center.”

As reporter Alfonso Chardy noted at the time, the facility’s mental health treatment center—known in placid bureaucratese as the Krome Transitional Unit (KTU)—had never before been shown to the media. It had “30 beds where detainees deemed to have behavior problems are monitored and treated before they can join or rejoin the general detainee population,” Chardy wrote. “As part of the treatment, detainees are given group therapy sessions. In one of the day rooms in the transitional unit, a small group of detainees watched Pope Francis’ address to a joint session of Congress … in which he urged lawmakers to help immigrants.”

A digital news outlet, Statnews.com, was pleased to report in 2016 that even though ICE facilities “have reputations for neglecting mental health”—in some cases, consigning mentally ill detainees to solitary confinement “against the advice of prison doctors” and negligently leaving “immigrants at clear risk of suicide”—Krome was making great strides. The Florida facility had “set up a dedicated mental health wing,” Statnews writer Max Siegelbaum marveled, noting that its staff “works closely with local health professionals, attorneys, and immigration judges with expertise in the field to address the needs of detainees with psychiatric disorders.” This assessment was largely based on observations made by Elizabeth Hildebrand Matherne, “an attorney who has represented detainees.” Matherne, whose now-closed immigration practice was based in Georgia, and who currently works for a civil rights group in Alabama, appears to have little direct experience with Krome detainees. She could not be reached for comment.*

An ICE spokesperson, contacted about the quality of detainee treatment at Krome, replied with a statement citing the facility’s high standards of care for detainees facing both routine and emergency health issues. ICE seeks to ensure “timely and appropriate responses to emergent medical care requests” for all detainees “regardless of location,” the statement read in part. It also cited the Krome center’s high marks in both scheduled and unannounced inspections conducted by third-party contractors: “the facility has repeatedly been found to operate in compliance with federal law and agency policy. Krome was most-recently inspected in February and found to be fully compliant with the agency’s 2011 Performance Based National Detention Standards in each of the 41 categories the inspectors reviewed.”

My own trip to Krome came at the behest of Friends of Miami-Dade Detainees(FOMDD), which got me inside the camp as a community member. I thus became the first journalist to get unsupervised interviews with detainees. What emerged from the visit, along with months of additional reporting, was a far darker and more sinister picture than the one painted by the Trump administration, ICE, and the immigration system’s many media enablers.

Krome, a male-only facility, is designed for 611 detainees but, numerous detainees interviewed allege, is routinely overcrowded. Most detainees are held in about a dozen “pods,” a word that has a more pleasant ring to it than “cells.” Pods are single-room, enclosed rectangular units, roughly the size of a high school gym, where detainees sleep in row after row of steel bunk beds with thin mattresses, according to multiple accounts. Fiberglass chairs are bolted to the floor. Toilets and showers offer no privacy. TVs blare in Spanish and English, and the “pods” emanate an enormous, steady din.

As at detention camps elsewhere around the country, Krome’s broad medical care is horrendous. In addition to being fed terrible food—high-calorie-and-starch institutional fare with little to no nutritional value—detainees face long waits to see doctors and are rarely provided medicines other than Tylenol or other over-the-counter painkillers. What’s more, ICE officials—and the private contractors who run most of the agency’s facilities—have a long record of cost-cutting, avoiding spending that might eat up budgets and profit margins. Because of that, they sometimes refrain from sending detainees in their charge to outside hospitals until their health has deteriorated to a critical point. “You have to wait so long to be seen, you’ll get better or die first,” an advocate at Adelanto—the country’s second-largest detention camp, near Los Angeles—told me when she took me inside there last year.

While some media outlets have covered allegations of abuse and corruption at Krome, they’ve mostly failed—aside from some local publications like the Miami New Times—to seriously investigate the facility’s grotesque charade of providing high-quality mental health care . . .

Continue reading.

Written by LeisureGuy

19 August 2019 at 4:35 pm

“Dying the Christian Science way: the horror of my father’s last days”

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Religion, as a genus in the meme-sphere, evolves in some surprising directions (just as do lifeforms—cf. the peacock). In the Guardian Caroline Fraser describes one variant and the real-world consequences:

When I was a baby, my grandfather delighted me by playing a game. He made a fist sandwich, fingers laced together and hidden in his palms, showing me his thumbs closed upon them. Slowly, he would say, “Here’s the church, and here’s the steeple,” raising his index fingers together to form a peak. Then, throwing his thumbs apart, he flipped his interlaced fingers over, wriggling them and crying out, “Open the doors and see all the people!”

My grandfather was a Christian Scientist. His mother had been a Scientist. His only child, my father, was a Scientist. I was raised to be a Scientist.

Now I’m delighted by a different kind of game: counting the churches as their doors close. In 20 years, drastic changes have taken place, but the most arresting is the church’s precipitous fall. It’s getting harder and harder to see all the people, because they’re disappearing.

The early popularity of Christian Science was tied directly to the promise engendered by its core beliefs: the promise of healing. The overwhelming majority of those attracted to the movement came to be healed, or came because a husband, wife, child, relative or friend needed healing; the claims of Christian Science were so compelling that people often stayed in the movement whether they found healing or not, blaming themselves and not the church’s teachings for any apparent failures.

The teachings were radically simple. The founder and leader of the church, Mary Baker Eddy, taught that disease was unreal because the human body and the entire material world were mere illusions of the credulous, a waking dream. Those who awoke and knew the “Truth” could be instantaneously healed. (Eddy was big on capitalised generalities; “Life”, “Love” and “Spirit” were among her other “synonyms” for God.)

What was the “Truth”? We memorised it in Sunday School, the “Scientific Statement of Being”, which assured us that “there is no life, truth, intelligence, nor substance in matter”. Eddy’s definition of man was even more stark: “Man is not matter; he is not made up of brain, blood, bones, and other material elements.” We were instructed to repeat as needed for whatever ailment came along, from canker sores to cancer. The trick lay in the application: allow no hint of doubt, neither aspirin nor vitamin, a dogma so dire it was taken to absurd lengths. During the height of the London fad for the faith, in 1911, novelist VS Pritchett was indoctrinated into the mysteries by his father after “dying Cousin Dick” leapt from his deathbed, “miraculously cured”. Soon after, Pritchett, a lad of 11, was forced to walk to school on a sprained ankle.

As Pritchett discovered, Cousin Dick’s results were impossible to replicate in the real world, and the consequences of Eddy’s strictures – she demanded “radical reliance” on her methodology to the exclusion of all else – quickly caused havoc. Newspapers and prosecutors noticed the casualties, especially children dying of unreported cases of diphtheria and appendicitis. In the early years of the church, this touched off battles with the American Medical Association, which tried to have Christian Science healers, or “practitioners”, arrested for practising medicine without a licence. Since practitioners did nothing but pray, however, their activities were protected by the US constitution. Reacting with righteous zeal, Church leaders doubled down for decades, furtively slipping protections into the law and encouraging insurance companies to cover Christian Science “treatment”. Since it cost very little, the companies cynically complied.

As a result, by the 1970s – a high-water mark for the church’s political power, with many Scientists serving in Richard Nixon’s White House and federal agencies – the church was well on its way to accumulating an incredible array of legal rights and privileges across the US, including broad-based religious exemptions from childhood immunisations in 47 states, as well as exemptions from routine screening tests and procedures given to newborns in hospitals. The exemptions had consequences: modern-day outbreaks of diphtheria, polio and measles in Christian Science schools and communities. A 1972 polio outbreak in Connecticut left multiple children partially paralysed; a 1985 measles outbreak (one of several) at Principia College in Illinois killed three.

In many US states, Scientists were exempt from charges of child abuse, neglect and endangerment, as well as from failure to report such crimes. Practitioners with no medical training (they become “listed” after two weeks of religious indoctrination) were recognised as health providers, and in some states were required to report contagious illnesses or cases of child abuse or neglect, even as their religion demanded that they deny the evidence of the physical senses. Practitioners, of course, have no way of recognising the symptoms of an illness, even if they believe it existed, which they don’t.

A whole system of Christian Science “nursing” sprang up in unlicensed Christian Science sanatoriums and nursing homes catering to patients with open wounds and bodies eaten away by tumours. There, no medical treatment was allowed to interfere with prayer. Assigned only the most basic duties – feeding and cleaning patients – Christian Science “nurses” are not registered, and have no medical training either. Instead, they engage in bizarre practices such as leaving food on the mouths of patients who cannot eat. They provide no assistance for those who are having trouble breathing, administer no painkillers, react to no emergencies. “Do not resuscitate” is their default. But some of these facilities, and the incompetent care they provide, are covered by Medicare, the US’s national healthcare insurance programme.


Still, by this point, few people know or care what the Christian Scientists have been up to, since the average person can’t tell you the difference between a Christian Scientist and a Scientologist. The decline of the faith, once a major indigenous sect, may be among the most dramatic contractions in the history of American religion. Eddy forbade counting the faithful, but in 1961, the year I was born, the number of branch churches worldwide reached a high of 3,273. By the mid-80s, the number in the US had dropped to 1,997; between 1987 and late 2018, 1,070 more closed, while only 83 opened, leaving around a thousand in the US.

Prized urban branches are being sold off by the score, converted into luxury condominiums, museums and Buddhist temples. The branch I attended, on Mercer Island, near Seattle, is now Congregation Shevet Achim, a Modern Orthodox synagogue.

Worldly erosion eats away at the remainder. New York’s Third Church on Park Avenue is still open for spiritual business, but is leased for events during the week, sparking complaints about blocked traffic, paparazzi and partygoers attending celebrity galas in the four-storey neo-Georgian sanctuary. The phrase “God is Love” is traditionally affixed to an interior wall of every branch, but during secular events the words are concealed behind a faux-slate panel, lest they detract from, say, a runway show of Oscar de la Renta resort wear. Alcohol and coffee, shunned by Church members since Eddy’s day, are brought in by caterers.

The slide into irrelevance has been inexorable. The number of practitioners has fallen to an all-time low of 1,126, and during the last decade the Sentinel magazine has lost more than half its subscribers. The Monitor, the public face of the Church, has become a kind of zombie newspaper, laying off 30% of its staff in 2016. It is now available as a five-days-a-week emailed newsletter, or a thin print weekly that has been bleeding subscribers.

Principia, the Christian Science educational institution (a separate entity from the Mother Church), has shed so many students that its future is in question. Its college enrollment was down to 435 in 2018, the St Louis Post-Dispatch reported, while its school had 400 students, with just eight in the first-grade class. With an endowment of $680m, one official noted, “We are going to run out of kids before we run out of money. There just aren’t enough Christian Scientists on the planet.” . . .

Continue reading. There’s much more, and some of it is grim indeed. Lord, deliver us from “Christian” “Science.”

Written by LeisureGuy

10 August 2019 at 10:35 am

The problems of being a psychopath

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First, a distinction that was not clear to me: the difference between being a sociopath and being a psychopath. With that distinction in mind, Heidi Maibom, professor of philosophy at the University of Cincinnati, has an interesting article in Aeon. Her article begins:

Psychopath. The word conjures up the image of a cold-blooded killer, or perhaps a fiendishly clever but heartless egoist. There’s Ted Bundy, who in the 1970s abducted women, killed them, and had sex with their decomposing bodies. Or Hannibal Lecter from the film The Silence of the Lambs (1991), who cunningly escaped his various confinements and ended up eating the people he despised. In the popular imagination, psychopaths are the incarnation of evil. However, for an increasing number of researchers, such people are ill, not evil – victims of their own deranged minds. So just what are psychopaths, and what is wrong with them?

According to the Hare Psychopathy Checklist – first devised in the 1970s by the Canadian criminal psychologist Robert Hare and since revised and widely used for diagnosis – psychopaths are selfish, glib and irresponsible. They have poor impulse control, are antisocial from a young age, and lack the ability to feel empathy, guilt and remorse. Psychopaths steal, lie and cheat, and have no respect for other people, social norms or the law. In some cases, they torture defenceless animals, assault other children or attempt to kill their siblings or parents. If caught, they fail to take responsibility for their actions, but tend to blame others, their upbringing or ‘the system’. According to some recent calculations, more than 90 per cent of male psychopaths in the United States are in prison, on parole or otherwise involved with the criminal justice system. Considering that psychopaths are thought to make up only around 1 per cent of the general population, that number is staggering. Because of this close link to criminality, psychopathy used to be known as ‘moral insanity’.

This picture of psychopathy has dominated the thinking of both laypeople and researchers. It’s at once sensational and reassuring. Psychopaths are sick, deranged, lacking in moral conscience. In other words, they’re nothing like you or me. But this is false. There’s no major ability that psychopaths lack altogether, and their deficits are often small and circumscribed. They certainly aren’t incapable of telling right from wrong, making good decisions or experiencing empathy for other people. Instead, they suffer from a host of more mundane problems – such as being overly goal-fixated, fearless and selfish. What’s more, perhaps ‘our’ reactions are closer to ‘theirs’ than we realise. Like psychopaths, we can dial our empathy up and down; and for all the praise we heap on empathy, a closer look at this emotion suggests that it’s nearer to a kind of self-preservation instinct than any ‘warm and fuzzy’ fellow-feeling.

Rather than freakish outliers then, psychopaths reveal important truths about human morality. But are we ready to accept what they might teach us?

When debating what’s wrong with psychopaths, researchers typically pitch two competing moral theories against one another. One approach, known as rationalism, holds that judging right and wrong is a matter of reason, rather than feeling. Some philosophers claim that psychopaths show that rationalism is plain wrong. Psychopaths are as logical as you and me – in fact, they outsmart us all the time, hence their everyday depiction as connivers and con artists. So the fact that they’re rational but still capable of inhuman acts shows that moral sensibility can’t be grounded in reason alone.

But something isn’t quite right here. If psychopaths are so smart, why do they constantly get caught up with the criminal justice system? In his authoritative portrait of psychopathy Without Conscience (1993), Hare describes a man who was on his way to a party when he decided to get a case of beer. Realising he’d forgotten his wallet, the man – who scored highly on Hare’s psychopathy checklist – robbed the nearest gas station, seriously injuring the sales attendant with a heavy piece of wood.

So while psychopaths aren’t irrational in the sense of being unable to think clearly, they seem to act irrationally. They struggle with what philosophers call ‘reasons for actions’: considerations that underlie our decisions to act, such as the likelihood that what we’ll do will satisfy our goals and won’t come into conflict with other projects or aims. Although bludgeoning the shop assistant does, for example, serve the goal of getting beer for the party, it frustrates the more pressing and underlying desire to stay out of prison. Psychopaths appear to be poor at integrating all the various factors that go into making good choices, and often have poor reasons for their actions.

The psychological evidence confirms that psychopaths have deficits in reasoning that affect how they make decisions. They usually attend almost exclusively to the task at hand (whatever that might be), and ignore relevant contextual information – although when context doesn’t play a role, they do very well. Other studies have found that psychopaths have problems reversing their responses: when actions that were previously rewarded are now punished – or actions that were previously punished are rewarded – they have problems adjusting. Similarly, Hare and his collaborator Jeffrey Jutai found that, if psychopaths are asked to navigate a maze, they doggedly pursue their initial tactic even if doing so causes them to receive painful electric shocks. Whereas most people desist and find other ways to navigate their way through, psychopaths tend not to. This insensitivity extends to social threats, such as angry faces.

These findings support the rationalist idea that psychopathic immorality comes down to some inability to reason well. But you might have noticed that psychopaths don’t experience fear as often, and in the same situations, as do ordinary people. Last time I looked, fear was an emotion. This brings us back into the camp of people who think that emotion, not reason, is central to ethics. Typically they focus on empathy.

Apart from some notable empathy naysayers, such as the psychologist Paul Bloom at Yale University and the philosopher Jesse Prinz at the City University of New York, empathy is typically held in high regard among theorists and researchers. Part of the reason is its excellent fit with a second major moral theory known as sentimentalism. Dating back to the 18th-century philosophers David Hume and Adam Smith, sentimentalists believe that an ability to tell right from wrong is grounded in a tendency to feel what others feel. Because we suffer along with others, we come to see their suffering as bad or wrong. Thanks to these empathic feelings, we care about what happens to other people even if it doesn’t directly affect us.

One of the best empirical sources for these claims is the social psychological research on empathic concern. Psychologists working in development, such as Martin Hoffman at New York University and Nancy Eisenberg at Arizona State University, maintain that it plays a central role in social competence and moral understanding. Dan Batson argues that empathic concern is a warm, soft-hearted, compassionate feeling for someone in need, which leads to truly altruistic behaviour. Empathy motivates us to treat others well, and it is at the foundation of moral regard for others. Psychopaths appear to validate these ideas, apparently lacking both moral sense and empathy.

However, psychopaths fare strangely well on tests of empathy. Given that these tests are usually based on self-reports and that psychopaths are prolific liars, this is not necessarily surprising. But psychopaths also produce intriguing results on experiments that test physiological and brain responses. Skin conductance, for example, measures how good a conductor of electricity your skin is; it’s a good indicator of your emotional state, since when you sweat in response to stress, fear or anger, your skin becomes momentarily better at carrying electric current. As you might expect, when psychopaths are exposed to pictures of people in distress, they show less skin conductance reactivity than do non-psychopaths. Other tests measure startle responses: if you show a person pictures that they find threatening, they startle much more easily in response to loud sounds. Psychopaths respond normally to direct threats, such as an image of the gaping jaw of a shark or a striking snake, but not to social threats, such as people in pain or distress. Ordinary people react to both.

Neuroscientists have also studied the empathic responses of psychopaths. In typical studies involving functional magnetic resonance imaging (fMRI), the areas of the brain associated with empathy don’t activate in psychopaths to the same degree as in control subjects. But when the neurobiologist Harma Meffert and colleagues from the University of Groningen in the Netherlands explicitly instructed them to ‘feel with’ a hand that is being caressed or shoved aside, the researchers discovered that psychopaths were able to muster a normal response. In other words, when explicitly told to empathise with another, psychopaths could do it.

The neuroscientist Jean Decety and colleagues at the University of Chicago unearthed something similar. He showed psychopaths pictures of limbs in painful situations, such as a hand stuck in a car door, and asked them to either ‘imagine this is happening to you’ or ‘imagine this is happening to someone else’. When psychopaths imagined that they were in the painful situation, they showed something very close to the typical empathic brain response – but when they imagined someone else was in that very same situation, their empathy-related brain areas didn’t activate much.

If psychopaths have an empathy deficit, then, it is a very puzzling one. A different way of measuring brain activation throws further light on the puzzle. Electroencephalograms (EEGs) measure . . .

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Written by LeisureGuy

7 August 2019 at 3:22 pm

Why speaking to yourself in the third person makes you wiser

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David Robson, a science journalist specialising in the extremes of the human brain, body and behaviour and a feature writer for the BBC, whose first book is The Intelligence Trap: Why Smart People Do Stupid Things and How to Make Wiser Decisions (2019), writes in Aeon:

We credit Socrates with the insight that ‘the unexamined life is not worth living’ and that to ‘know thyself’ is the path to true wisdom. But is there a right and a wrong way to go about such self-reflection?

Simple rumination – the process of churning your concerns around in your head – isn’t the answer. It’s likely to cause you to become stuck in the rut of your own thoughts and immersed in the emotions that might be leading you astray. Certainly, research has shown that people who are prone to rumination also often suffer from impaired decision making under pressure, and are at a substantially increased risk of depression.

Instead, the scientific research suggests that you should adopt an ancient rhetorical method favoured by the likes of Julius Caesar and known as ‘illeism’ – or speaking about yourself in the third person (the term was coined in 1809 by the poet Samuel Taylor Coleridge from the Latin illemeaning ‘he, that’). If I was considering an argument that I’d had with a friend, for instance, I might start by silently thinking to myself: ‘David felt frustrated that…’ The idea is that this small change in perspective can clear your emotional fog, allowing you to see past your biases.

A bulk of research has already shown that this kind of third-person thinking can temporarily improve decision making. Now a preprint at PsyArxiv finds that it can also bring long-term benefits to thinking and emotional regulation. The researchers said this was ‘the first evidence that wisdom-related cognitive and affective processes can be trained in daily life, and of how to do so’.

The findings are the brainchild of the psychologist Igor Grossmann at the University of Waterloo in Canada, whose work on the psychology of wisdom was one of the inspirations for my recent book on intelligence and how we can make wiser decisions.

Grossmann’s aim is to build a strong experimental footing for the study of wisdom, which had long been considered too nebulous for scientific enquiry. In one of his earlier experiments, he established that it’s possible to measure wise reasoning and that, as with IQ, people’s scores matter. He did this by asking participants to discuss out-loud a personal or political dilemma, which he then scored on various elements of thinking long-considered crucial to wisdom, including: intellectual humility; taking the perspective of others; recognising uncertainty; and having the capacity to search for a compromise. Grossmann found that these wise-reasoning scores were far better than intelligence tests at predicting emotional wellbeing, and relationship satisfaction – supporting the idea that wisdom, as defined by these qualities, constitutes a unique construct that determines how we navigate life challenges.

Working with Ethan Kross at the University of Michigan in the United States, Grossmann has also looked for ways to improve these scores – with some striking experiments demonstrating the power of illeism. In a series of laboratory experiments, they found that people tend to be humbler, and readier to consider other perspectives, when they are asked to describe problems in the third person.

Imagine, for instance, that you are arguing with your partner. Adopting a third-person perspective might help you to recognise their point of view or to accept the limits of your understanding of the problem at hand. Or imagine you are considering moving jobs. Taking the distanced perspective could help you to weigh up the benefits and the risks of the move more dispassionately.

This earlier research involved only short-term interventions, however – meaning it was far from clear whether wiser reasoning would become a long-term habit with regular practice at illeism.

To find out, Grossmann’s latest research team asked nearly 300 participants to describe a challenging social situation, while two independent psychologists scored them on the different aspects of wise reasoning (intellectual humility, etc). The participants then had to keep a diary for four weeks. Each day, they had to describe a situation they’d just experienced, such as a disagreement with a colleague or some bad news. Half were prompted to do so in the first-person, while the others were encouraged to describe their trials from a third-person perspective. At the end of the study, all participants repeated the wise-reasoning test.

Grossmann’s results were . . .

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Written by LeisureGuy

7 August 2019 at 12:36 pm

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