one of those days…

Posted on Saturday 15 December 2012

Harry Stack Sullivan was an American Psychiatrist in the first half of the 20th Century. His Interpersonal Psychiatry wove in and out of the psychoanalytic movement of the time, but there were substantive differences now little discussed in this era of pharmacology. One of those differences had to do with Freud’s concept of the unconscious. Sullivan’s concept was selective inattention – closer to don’t look at than don’t know. In everyday usage, it’s a much more reasonable way of looking at how the mind works. When I first read it, I immediately thought of my own childhood growing up in the US South in the 1940s and 1950s. There was something terribly wrong. It’s not that the impossibility and impact of segregation wasn’t known or knowable, it just wasn’t looked at – decried when it came up, but mostly not looked at. And when it was finally impossible for me personally not to look at it, it was all I saw – defining the entire culture of my youth, my place. I recall to this day the cognitive dissonance of those moments as if it happened yesterday, knowing something you’ve always known in a different light. I tried to keep that discomfort in my mind later when I had a patient who couldn’t move forward without looking at something they’d spent a lifetime not looking at. Selective inattention is a powerful adversary.

When something like the school shooting in Connecticut happens, at least for a time we can’t not look at the problems of living in a lethal, armed society or not look at the inadequate and dwindling services available for the permanently mentally afflicted, but the magnitude of the problem produces a weighty dysphoria that’s hard to bear and fades too quickly into a more tolerable selective inattention with the passage of time. If we can’t see how to fix it, we go back to not looking, but the feeling doesn’t go away. It lingers as a background gloom – a shame that discolors our morale and tarnishes our pride as a nation. There’s something terribly wrong and it takes its toll not to see it. It was the bombing of the 16th Street Baptist Church in Birmingham on September 15, 1963 that killed four little girls that abruptly woke me up, moved me from sympathizer to a street marcher. And it actually woke up the country, with the passage of the Civil Rights Act in the following year – something that would have been inconceivable earlier. The problem was imponderable then and is still only slowly resolving, but the vector finally started pointing in the right direction that day. And as bad as this shooting feels right now, hopefully this is another one of those days…
  1.  
    December 15, 2012 | 12:16 PM
     

    I wrote my opinion at my site, and just curious if you agree or have a different take: why is it psychiatry lists Antisocial Personality Disorder in the DSM, when it has no real likelihood of treatment interventions. As far as I am concerned, it just drags us as providers into the slime the “disorder” creates in the conflict and mayhem such individuals create. Do you agree it is dangerous to work with people who just prey on others’ empathy and caring?

  2.  
    December 15, 2012 | 1:27 PM
     

    I share your thoughts about this, Joel and am practicing responses to my fellow liberals who mistakenly think that being labeled with a mental illness reduces the stigma of mental illness, and that whenever mass murder occurs it could have been prevented if only the “mental illness” had been treated beforehand (as if medications taken as prescribed by any doctor always works and the diagnoses are always correct). They are wrong to attribute these mass murders to mental illness writ large, and are dangerously near approving of increased suspicions of any one labeled as mentally ill and diminished protection under the law.

  3.  
    anonymous
    December 15, 2012 | 1:48 PM
     

    Seeing how the overlords are reacting to unfortunate tragedy; I’m reminded of these words.

    “Of all tyrannies a tyranny sincerely exercised for the good
    of its victim may be the most oppressive. It may be better to live
    under robber barons than under omnipotent moral busybodies.
    The robber baron’s cruelty may sometimes sleep, his cupidity may
    at some point be satiated, but those who torment us for our own good
    will torment us without end for they do so with the approval
    of their own conscience.” – C. S. Lewis

  4.  
    December 15, 2012 | 1:56 PM
     

    As Thomas Szasz said, “Behavior is not a disease.”

  5.  
    Bernard Carroll
    December 15, 2012 | 2:30 PM
     

    Sorry, Becky… some behavior is not a disease and some behavior really is. Like when a patient in a manic episode prevents passengers from boarding a plane because he plans to fly his entire family to Europe, claiming he has precedence over everybody else. That is a real event from my past practice. Security was called and he was, rightly, hospitalized, which is when I met him.

  6.  
    Stan
    December 15, 2012 | 3:09 PM
     

    Dear Bernard:

    Mania is only a disease if you perceive “behavior” to be disease. To use your analogy; any behavior deemed to not fit into the context of the social norm could/would constitute a disease being present.

    Yet, you know as well as anyone that there is no confirmed pathological, biological test, or verified genetic component that can be used to verify the very broad & subjective diagnosis of “bipolar”.

    If we are to use/accept your definition of disease; then each of us are very much diseased to one extent or another. If that is the case, then what does being “diseased” really mean?

    At best you can make a statement that a person is demonstrating a psychological affliction (“behavior”) that may impede normal functioning within the scope of expectations being presented in a particular society. It might be wise sticking to the terms like “psychiatric diagnosis”, and leave “disease” to doctors that actually practice medicine. 🙂

  7.  
    Bernard Carroll
    December 15, 2012 | 4:45 PM
     
  8.  
    Stan
    December 15, 2012 | 5:59 PM
     

    That was a nice deflection link Bernard; Of course it comes as no great surprise or awakening that medicine has followed psychiatry’s lead in creating NEW so called “diseases” to directly fit a profitable treatment. After all, Greed is the new Hippocratic oath of medicine & related practices/industries.

    Quite obviously there are always some medical exceptions were a “disease” has physical effects (sometimes devastating/debilitating) where no direct causation/test has yet been determined.

    Yet, that is really a straw-mans argument when your comparing the world of psychiatry, to the world of actual physical medicine; since psychiatry has a whole diagnostic manual full of subjectivity without a single proven direct biological/pathological cause or correlating test to verify anything more than mere theory and unsubstantiated hypothesis. As it’s been said: that’s a Grand Canyon sized chasm that has to be filled with mountains of bullshit…

    Again, The psychiatry “disease” defense you are presenting would include everyone in some degree as suffering from a psychological “disease”. Since psychiatry’s criteria are based upon the always fluctuating social/societal norms of particular culture, environment, & time. This is why psychiatry is often referred to as the Pseudo-science, or the coined bastard step child of medicine. 🙂

  9.  
    jamzo
    December 16, 2012 | 12:09 PM
     

    Wikipedia offers a useful description of the concept of disease

    http://en.wikipedia.org/wiki/Disease

    Disease
    From Wikipedia, the free encyclopedia

    “Medical condition” redirects here. For medical condition terminology, see Medical state.
    For other uses, see Disease (disambiguation).

    A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs.[1] It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, “disease” is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one’s perspective on life, and their personality.”

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