Monday, April 23, 2012

Something someone told me once

Some fifteen years ago, when I told a colleague that I was depressed, he explained to me that he was quite sure that my depression was a consequence of my pessimism. If only I would think more cheerful thoughts, I wouldn't be depressed. My colleague's assertion is a common superstition that fails to withstand even modest scrutiny. The motivation and psychological pay-off is suspicious. The belief that our beliefs are causative of other mental states preserves a sense of control. Our mental life ought not appear strange to us. We should not be strangers to ourselves. We ought to be able to maintain a sense of control and safety inside our own skins. I am skeptical of any belief that allows for such unwarranted comfort. My skepticism is not sufficient grounds to consider a belief as unwarranted. It is, however, an expression of mistrust and motivation to think more deeply.



Do our beliefs cause anything? Does a pessimistic outlook cause depression? If only I thought happy thoughts, then would my depression lift? Or are depressive tendencies primary and the pessimistic outlook a consequence of a predisposition? Can this underlying predisposition be changed or at least mitigated? Is what I am calling "an underlying predisposition" better called by the old term "character"? Are there aspects of personality that are unchanging in spite of the vicissitudes of circumstance? And if there are unchanging elements to a personality, would it be possible to know what they are with any degree of certainty?



Before I get ahead of myself, what do I mean by character? It might clarify a little to substitute "limitation" for character. A person has his/her own typical limitations. These can be repetition of the same types of mistakes. A person can have certain beliefs and value judgements that are difficult, if not impossible, to evaluate objectively and with detachment. A belief that women are (somehow) inherently trustworthy for instance. This line of thought strongly suggests that what is often understood as neurosis (doing the same thing over & over but expecting a different result each time) is in some cases at least a matter of character. For what it's worth, there is nothing in the concept of character that requires it to refer exclusively to uplifting moral qualities. Traditionally, along with good upstanding character there were also low and mean characters.



The argument against character is that of what I call eternal optimism. There are no limitations to one's personality, only resignation and not trying hard enough. This brings us back to what my colleague told me. Some mental states, if not all mental states, are causative. They make other things happen, even if only other mental states. Certainly it is the case that mental states seem to engender other mental states. For many people the feeling of certainty that comes with the repetition of the Lord's Prayer brings feelings of peace, calmness, and safety, just as the thought of homosexual acts bring feelings of anger, fear, and loathing to some of these same people. It is also seems likely that there is not any mental state that will engender the same mental state(s) in all people. It does seem that particular mental states in similar circumstances will typically in a given person give rise to the same mental states.



It is tempting here to follow the chain of concepts and reduce mental life to a species of mechanistic determinism. While I can't decisively refute faith in the causal nature of one's thoughts and feelings, I can offer an observation. Thoughts do not come on command. Thoughts and insights come without warning and when they are good and ready. Further we learn from our past, maybe not as efficiently as we would like sometimes. A given thought will often engender the same thought(s), but eventually boredom sets in. Otherwise, a person becomes boring and prone to repetition of the same old tired syllogisms and arguments.



Where do these reflections leave self-knowledge?



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Thursday, April 19, 2012

It's been over six months...

It's been over six months since I last updated my blog. I'd like to say that I've been busy, but I haven't been. Having had much experience with depression, I can say that whatever depressed people do, being busy isn't it. Sometimes depression is synonymous with boredom. Unlike boredom, though, depression leaves me with an inability to help myself out of the depression/boredom. I'm bored but not bored enough. The difference between boredom and depression lies with rewards. One of the key symptoms of depression is, after all, a decreased appetite for pleasure. Pleasure of all kinds: cooking, eating, sex, conversation, sunny weather, etc. No reward seems to be worth the effort.



Explaining this to someone who has never been depressed is like explaining colors to a blind person. The experience is simply lacking to those blessed with good mental health. If the example of colors is too hackneyed, consider the difficulty of explaining the taste of a particular food to someone who has never tried it. There is a qualia to depression that cannot be communicated. Depression is not simply feeling really, really bad, although that is in many cases a prominent symptom. Nor is it merely feeling hopeless. Nor is depression any one thing. There are several symptoms that must be present in order for a case of "the blues" to merit a diagnosis of depression.



Psychiatrists use a list of symptoms, of which a certain number must be present for length of time. My own bias is to believe that no two instances of depression are ever quite the same. There are always differences in the specific symptoms as well as to their intensity, in addition each case's etiology is unique to thye sufferer.



That said, it is also true that cases of depression can be classified, categorized, and analyzed for their commonalities and differences. It is a dirty secret to psychiatry that the diagnosis and treatment of depression is an art and not a science. Part of the diagnostic procedure is questioning the patient about the presence, duration, and intensity of symptoms. Consequently, patience, insight and good listening skills are essential to being a good psychiatrist. These are all qualities in which some competency can be acquired, but more than a mere competency requires qualities of character. This means that there are personality types that cannot acquire more than the most basic rudiments of good psychiatry.

For all that, this doesn't mean that psychiatry is arbitrary in its diagnoses and categories. Psychiatry is properly speaking what psychiatrists do. The categories and criteria for diagnoses are the result of individuals with a certain type of training seeking to make sense of diverse but related phenomena. It is true, though, that a psychiatric diagnosis is because a psychiatrist says it is. The diagnosis, if it is a good diagnosis, will, when explained to other psychiatrists, appear reasonable and justified by the facts of a case. Facts here mean test results, observations, presentation of symptoms, etc.




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