Psychosomatic illness: final post

Physical manifestations of unhappiness are something we all experience; they are not personality flaws or signs of weakness, they are a part of life. Life is hard sometimes. It is harder for some than for others. We all manifest that hardship in different ways.

Each of these diagnoses is considered either entirely medically unexplained or only partially explained and with a large psychological component:
 
Amalgam poisoning, irritable bowel syndrome, candida syndrome, chronic fatigue syndrome, fibromyalgia, chronic Lyme disease, Morgellon's syndrome, formication, electromagnetic poisoning, environmental or chemical sensitivities, food intolerance.

 I recently went to a dinner party where every person bar two, at a table of ten, reported that they had an intolerance of or allergy to at least one foodstuff. Most had developed the allergy in middle age, which is not how an allergy typically behaves...People look for explanations for changes in their bodies, something to account for every unpleasant feeling. There is an unwillingness to accept behavioral or emotional factors, or the effects of aging, as an explanation. Society and the media are often available to provide a more agreeable answer and to add to the symptom pool available

The question that we, the unaffected, must answer for ourselves is, can we give a disability that has its roots in behavioral or psychological factors the same respect that we offer to a physical disease? If the answer is yes, then none of the other controversies matter any longer.

The placebo effect is another illustration of the mind-body connection--you might call it the psychogenic cure. Also widely and deeply misunderstood. Did you know, for instance, that the placebo effect works even if you are aware of it? Understanding this makes me skeptical of some of the self-experimentation people sometimes do. "Try X, it worked for me!" is a terrible, terrible argument. And it remains terrible no matter how much useless precision the author gives you about so many milligrams of whatever at whatever time of day immediately after exercise. I'm looking at you, Tim Ferriss! (Scott Alexander is also guilty of this to a lesser extent.) Did you do a randomized double-blind study on yourself? I don't fucking think so. You have no idea whether a given treatment worked on your body or your mind.

This doesn't mean that you should never try unproven remedies. My personal conclusion is that we should pay a lot more attention to the costs of the treatments we choose. Lots of home remedies are acceptable for this reason. If you think that valerian tea helps you sleep or ginger ale alleviates nausea, go ahead and use it without worrying too much about randomized controlled trials—your cost is only a small amount of money and trouble. In other words, the cost-benefit ratio is more likely favorable when the cost is negligible.

But with treatments that are much more costly, such as surgery, medications with serious side effects, and any involvement with the mental/behavioral health system, you need to be a lot more careful in assessing the likely benefits. For example, do you think the doubtful benefit of antidepressants is worth the 40-60% chance of loss of libido, to name just one of their costs?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/

I have my own answer to this, of course (sex is great), but my real message is to pay attention to the costs, and to be skeptical of the success stories you hear.

The Victim/Villain Fallacy

There are two sides to every question: Red Team and Blue Team. You get to pick which side you're on, but you have to be on a side. You can't be neutral and you can't be for or against both sides.

What if I really, really hate them both? Well, if you're not on the Red Team, all the Red Teamers will assume you're a dirty Blue Teamer. And, if you're not on the Blue Team, all the Blue Teamers will assume you're an ignorant Red Teamer.

He was constantly defending his Communist friends to his right-wing enemies and his right-wing friends to his Communist enemies, and he was thoroughly detested by both groups, who never defended him to anyone because they thought he was a dope.

—Catch-22

Can I be on Team Blue and still think their coach sucks? No. Picking a team means you are endorsing everything they currently do and everything they've done in the past, even before you were born.

One team is 100% innocent, the other team is 100% guilty. I say, "Red Team cheated!" This reveals I am on Team Blue. What if Red Team really did cheat? Doesn't matter. My saying something bad about Red is enough to establish I am Blue. The truth value of what I said, or whether I believe it to be true, doesn't matter.

Another way to play this game is the "How can you compare?" tack.

Me: "Red Team Player got arrested for beating up his girlfriend. They should fire him!"
Response: "That's nothing! Blue Team Player murdered six women! How can you compare them?"
Me: "Murder is indeed worse than assault. Okay, fire Blue Team Player too."
Response: "Good. I'm glad we agree Red Team Player did nothing wrong."

What if I try to say something nuanced, like "Red Team has a great goalie but Blue Team has better offense"?

Two possible responses: you can choose not to remember part of this statement. "She said, AND I QUOTE, "Red Team has a great goalie." Therefore, she's on the Red side."
Or, you can assume bad faith. "She's trying to sound fair and balanced, but she can't really believe Blue has good offensive players; if she did, she'd be Blue, and we know she's not Blue, because she said something good about Red."

It's easy enough, for leftists, to imagine confronting a mob of racial bigots, McCarthyites, or religious fundamentalists. The harder test is resistance to public opinion in one's own camp.

--Hitchens

I don't know how to win this game. So far I just settle for pointing it out.

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.