Psychosomatic illness 6: the feminist position

I'd like to devote a special post to the feminist objection to the concept of psychosomatic illness. This objection deserves some respect, drawing as it does upon the long and troubled history of women being labelled mentally ill for specious and doubtful reasons. The concept of mental illness is of course a means of social control, and one that has weighed particularly heavily on women. Female eccentrics such as me have often been defined as mad. And of course, women are sometimes called “hysterical” as a pure insult, with no factual content, as when Kamala Harris, the new Senator, was called “hysterical” for her prosecutorial style of questioning a witness. (For more, see Phyllis Chesler, Women and Madness, or Elaine Showalter).

This line of thinking has been popularized in the feminist blogosphere, so that many people have a kneejerk negative reaction to any suggestion that a woman's illness is “all in her head.” Some have gone so far as to conclude that the very word “hysteria” ought to be banned as sexist. These people have never read Breuer.

Because if you read Breuer, or Freud, Charcot, or Janet (okay I've never read Janet), you get the other side of the story of hysteria. Of course mental illness is a means of social control, and I'm generally the first to make that point. But mental illness also causes people to suffer, which is why, even today, most adults who are treated for mental illness undergo that treatment voluntarily. And many of them would still be suffering even in the Feminist Utopia. The vast majority of cases of Victorian/Edwardian hysteria weren't a matter of "she wants a job, she must be crazy," they involved painful and disabling symptoms that any doctor in any era would identify as meaning that Something Is Wrong. Symptoms like paralyzed limbs, weeks of catatonia, hysterical blindness and muteness, inability to eat, seizures, fainting, as well as abilities that some observers saw as supernatural, such as gaining the ability to speak new languages, withstanding needle wounds with no sign of pain, and sustaining bizarre arched postures for hours at a time.

We need, therefore, to treat mental illness, including psychosomatic illness, if we want to help suffering people, but we also need to rein in those who would use mental health care as a tool of oppression. A good rule of thumb is the libertarian principle; let others do what they want with their own minds and bodies as long as they don't harm anyone else. Don't call the police on your suicidal friend; he has the right to die if she wishes. And be very, very skeptical when children, the elderly, or institutionalized people have “treatment” forced upon them by their keepers.

I rate this objection: Half-right.

Poetic Meter and Poetic Form

I'd like to recommend the book Poetic Meter and Poetic Form. This should not be your first book on poetry; it's for the person who already knows that the Petrarchan sonnet differs from the Shakespearian one, but doesn't quite see why it matters. The book was written in a modern age, but with a traditionalist spirit. Some quotes:

The art of poetry is the art of knowing language and people equally well. To do something to the reader is the end of poetry; a poem is less a notation on a page or a sequence of uttered sounds than a shaped and measured formal effect that impinges upon a reader or hearer.

The approximation of structures of reasoning to the shape of the rhyme scheme is one of the most difficult acts in English poetry: indeed, only a few masters of the sonnet in English have managed always to avoid meaningless rhyming.

The notion that convention shows a lack of feeling, and that a poet attains “sincerity” by disregarding convention, is opposed to all the facts of literary experience and history. The individual talent is speechless without the conventions. And without an almost equal understanding of them, the audience, for all its intelligence and good will, hears nothing. “The innocent eye sees nothing.”

And it includes good lessons for the prose writer as well

 A principle governing all events which occur in time is that the middle of the event is the least interesting part, the beginning the next more interesting, and the end the most interesting. Instead of “He is a fool, in my opinion,” say, “He is, in my opinion, a fool.”

But it's true!

BUT IT'S TRUE!

--Me, all of my life

People think that Donald Trump denouncing "violence on both sides" in Charlottesville means he's secretly a Nazi. BUT IT'S TRUE!

We know there was violence on both sides. (Some) leftist counterprotestors showed up to Charlottesville armed and masked. Others bragged about attacking and harassing the other side. I know this from:

---Reputable media sources, such as the Washington Post
---Eyewitness statements, collected by me, Citizen Journalist
---General truths about human nature, i.e., people are stupid and evil, and when you tell them political violence is okay as long as it's against The Enemy, some of them will take you seriously.

Okay, I'm being a little autistic here. Yes, statements by politicians are motivated by more than "is it true." And I realize that empathetic people, who are wrong but numerous, care more about expressing the right feelings than about truth. So call him callous and unempathetic, accuse him of wanting to keep the support of the alt-right...

BUT IT'S TRUE.

People should be allowed to tell the truth without penalty. When you penalize people for speaking the truth, it becomes harder to arrive at the truth.

A friend recently posted something on Facebook, claiming that racism explained why the police were more active in their response to "nonviolent" protests, such as in Ferguson, than in their response to the white nationalist protestors in Charlottesville. I pointed out that the "nonviolent" protests in Ferguson actually involved one person dying, many people being beaten, and many businesses burned and looted. But in my friend's mind, Ferguson was still "nonviolent" because the protestors had good intentions, and the white nationalists were inherently violent because they had bad intentions.

This is what happens when we penalize people for speaking the truth. We lose track of what really happened, and of what words really mean.

Matal v. Tam and offensive speech

This week's case of Matal v. Tam was a challenge to U.S. Patent and Trademark Office rules brought by a California rock band known as The Slants.

• The US PTO will not register trademarks that are “disparaging” to “persons,” because of a rule in the 1946 Lanham Act. What this means is largely left to the discretion of the individual patent examiner. There is, however, a policy that it doesn't matter if the person seeking to register the trademark is a member of the disparaged group of persons. The Slants's schtick is “reclaiming” stereotypes about Asian-Americans; doesn't matter to the PTO, who denied their trademark application as disparaging.
• Simon Tam (frontman of the band) claimed this was a violation of his free speech rights. Conspicuously missing from this case, as with many such test cases, is an explanation for how a minor rock band can afford to go all the way to the Supreme Court. (Amicus brief by the Redskins.)
• I guess some people are just really passionate about protecting their rights, not that I would understand that.
• Query what “disparaging to persons” means. Tam attempted to argue that the regulation should be interpreted to prohibit only trademarks that disparage individual persons. Under this interpretation, you can disparage groups like Asian-Americans, but you can't name your hardware store “The Anti-Walmart,” or your bar “Trump Sucks.” The court found that there was no evidence either in the text or legislative history for this reading.
• Isn't this whole issue why defamation law exists? Should the government really be in the business of protecting people's hurt feelings? Several cases in this area about people who want to use religious trademarks for wine, such as Agnus Dei wine or Madonna wine. Is preventing blasphemy a legitimate function of our government? I of course think not.
• Anyway. The government's best argument is that trademark registration is not individual speech, but government speech, meaning that the First Amendment doesn't apply. No one is putting The Slants' members in prison for using that name; they just can't have a registered trademark.
• It sounds odd to say that the First Amendment doesn't apply at all to government speech, doesn't it? But if you think about it, it would make no sense otherwise. The government speech doctrine is why the government can fund anti-smoking messages without also funding pro-smoking messages, or why the National Endowment for the Arts can fund some artworks but not others. So far so good.
• More debatable cases of government speech: can the government allow certain monuments but not others in a public park? Can the government allow certain messages and not others on license plates? In both cases, yes.
• But the Court is concerned about “dangerous misuse” of this doctrine. License plates and public parks are under the control of the state and identified in the public mind with the state; not so trademarks.
• If trademark registration is government speech, it's incoherent. There are both pro- and anti-abortion trademarks, pro- and anti-capitalist trademarks. How can the government intend to send both messages? I think this is a weak argument. Why can't government speech be incoherent? Private individuals certainly speak incoherently at times.
• Does private speech become government speech just because the private speech benefits from a government program? Think of copyright law. Can the government refuse copyright protection to books it doesn't like on the grounds that copyright registration is mere government speech? Surely being unable to copyright books would be a still infringement of speech rights, even if writers retained the ability to publish uncopyrighted works.
• Another problem here is the amount of discretion given to the patent examiner. One reason The Slants's trademark application was denied was “ the fact that several bloggers and commenters to articles on the band have indicated that they find the term and the applied-for mark offensive.” Dear God, please let's not make free speech rights dependent on what people on the Internet find offensive. If this were the law, I'm pretty sure staging Othello would be a felony.
• Therefore, trademarks are private speech, and banning disparaging trademarks is unconstitutional viewpoint discrimination. “Giving offense is a viewpoint,” and--I say this at every opportunity--speech may not be prohibited merely because it is offensive.

Psychosomatic illness 5: how do you pick your symptoms?

What determines the type of psychosomatic symptoms a person experiences? Why is it that one person shows up with seizures, another with a numb leg, another with a paralyzed hand?

Personal life experience is a great molder of psychosomatic illness. People learn, probably in childhood or young adulthood, what sort of symptoms get people attention and care. In addition to genetics and environment, this is why certain families tend to be robust or to be sickly. One family's culture is to downplay sickness and keep a stiff upper lip; another family dwells on, analyzes and magnifies every twinge of pain, and gives the sick person a great deal of deference and respect. Children who experience the serious illness of a sibling or a parent are more likely to develop psychosomatic illness, and tend to develop symptoms similar to those of the physically ill relative. Parents pass on strategies that make life easier, whether that means embracing illness or turning to alcohol, drugs or food for comfort.

O'Sullivan says, Early exposure to chronic ill health can inadvertently encourage illness behavior and, as we have seen, shape how psychosomatic illness presents, with patients often suffering from symptoms they have come across before in others. The tendency to respond to every bodily sensation, rather than ignore them as the majority of us do, may be learned at a very young age. They are reacting to symptoms that others might dismiss, and these reactions serve to heighten the symptoms and awareness of them.

Psychosomatic illness 4: Why denial?

What does it look like (and feel like) when someone refuses to accept a diagnosis of psychosomatic illness?

Often, the person denies the possibility of psychosomatic illness, not just because they want to avoid lowering their status, but because they are consciously not aware of any of the stress or trauma that outside observers can identify in their lives. Psychosomatic symptoms are themselves evidence of denial.

Last year I got sick right after graduating from law school; another illness hit me a few weeks later, after my first triathlon. The second illness was pretty bad, and I had no choice but to spend weeks resting, physically and mentally, something I hardly ever do. No more studying or eating or going to the gym or leaving the house; even a visit to the art museum exhausted me. My husband suggested that law school, the triathlon, and studying for the bar might have stressed me out. Ridiculous, I said. Sure, *other* people might find those things difficult, but not me. Look at the statistics. What do I have to worry about?

This is common. When a person denies the possibility of psychosomatic illness, it may be because they fear lowering their status, but it may be because they are consciously not aware of any of the stress or trauma that outside observers can identify in their lives. Psychosomatic symptoms are themselves evidence of denial.

[Patients say] “I had the most wonderful life until I fell ill. I hardly ever had a reason to feel stress.” And I think, how could that be? I have not had a day in my life with no stress at all. In the absolute rejection of stress in these sufferers is there something for us to learn? Ask somebody with dissociative seizures how they feel, and you may get the answer “tired” or “cold”--neither answer containing anything of their emotional state. Perhaps those who deny stress do so because they do not feel stress, having converted it to something else.

Psychosomatic illness 3

How can you tell if someone's suffering is psychogenic?

You can do tests and give the patient a list of normal test results. But tests are imperfect, and “when a person is paralyzed or blind or suffering from convulsions, it is not difficult to see why they find that a very unsatisfactory explanation.“

Very often you can't prove that a person's distress is psychosomatic, especially with vague symptoms like fatigue, pain and weakness. This is one reason why symptoms like these are often undertreated: I thought for years that my daily headaches were the result of the stress I was under, and so did everyone else; turns out I just needed glasses.

There are some facts that tend to suggest that an illness is psychosomatic, however. You can figure out whether the patient is under unusual stress, and if so, whether she is able to consciously acknowledge it. You can look at the patient's history of mental illness or other unexplained symptoms. This is of course a controversial and inaccurate technique; a person's past mental illness doesn't make it impossible for them to later develop physical illness, and what it can seem like to the patient is “you think I'm lying because I had a mental illness”---the standard experience for people labeled mentally ill.

Another technique is to look at the nature of the symptoms--is the symptom consistent with anatomical and biological facts? What treatments does the symptom respond to? O'Sullivan is lucky in that neurological symptoms can be assessed more easily than most.

Conversion disorders are usually a poor mimic of neurological disease. Symptoms that arise through stress or anxiety are produced in the mind and are dependent on what the sufferer understands about the body and disease. The subconscious mind reproduces symptoms that make sense to the individual's understanding of how a disease behaves. In the absence of detailed knowledge of the body, disabilities that arise in the subconscious rarely obey anatomical rules. Aspects of the examination can be assessed objectively, without the participation of the patient.

So, for example, one patient, worrying about a harmless lump on the right side of her head, developed numbness all done the right side of her body. Because she didn't know that the right brain controls the left side of the body, her subconscious had imagined her symptoms wrong.

Another person was unable to straighten his leg when sitting on the exam table. But he was able to use the same quad muscle to stand up from a chair without using his hands, establishing that the muscle weakness was not physically caused.

A third patient was given an injection of botulinum to treat a painful muscle spasm which had incapacitated her hand. Immediately, she reported she was cured--even though the botulinum only takes effect days later.

In the case of psychosomatic seizures—horrifingly common—the cause of the symptoms can be assessed through monitoring the patient's brain waves 24/7 until the person has a seizure. Normal brain function while a seizure is going on rules out epilepsy.

None of these techniques, however, will convince a patient who is firmly in denial. If I don't have epilepsy, maybe I have some previously unknown seizure disorder. Or my subconscious might come up with a new set of symptoms as soon as the previous symptoms have been found psychogenic. And there's always that old standby, “Medical science doesn't know everything, does it?” Even an experienced and tactful doctor like O'Sullivan finds a number of patients walk away, refusing to accept the diagnosis.