mentallill

The July 22 attacks were so carefully planned and executed that it would be difficult to argue they were the work of a delusional madman, said Dr. Tarjei Rygnestad, who heads the Norwegian Board of Forensic Medicine.

Oooh, ooh, I now, that's because "delusional madman" doesn't mean anything, right?

No, of course:

In Norway, an insanity defense requires that a defendant be in a state of psychosis while committing the crime with which he or she is charged. That means the defendant has lost contact with reality to the point that he's no longer in control of his own actions.

The Norwegian insanity defense might require a psychotic state, but a psychotic state is not equivalent to no longer being in control of one's own actions, at least not in the sense of actually being dangerous: psychotic patients are harmless, but obviously very ill and emotionally vulnerable. They might not state their names, or make up a name, or claim to share the name of whoever they're talking to (you might think this is funny, but it really isn't, even when the name's gender-specific). They might not be wearing much. If they're female, they might be worried about pregnancy even if there's no risk of that. Sometimes, they arrive at hospital dangerously underweight, not because they're anorexic but because buying and consuming food are difficult tasks (of course, the police doesn't pick them up because they're confused and in need of help, they get picked up because their clothes fall off and people are complaining of the indecent exposure). Their state is not one which justifies anger, except at the mistreatment they experience from strangers, or fear, except fear of being in a similarly helpless situation and not receiving help.

That isn't Breivik. It's not a "delusional madman" either, because that is a TV trope. Dr Rygnestad is right when he points out that careful, lengthy planning and complex execution are evidence against, not for, the possibility of an NGRI verdict, but he is wrong to call the severely ill people that NGRI verdicts are supposed to help "madmen" ("delusional" is a technical term, but that doesn't mean it's the right term to use outside of medical papers, or even in them): sympathy for the lawbreaker might not be the emotion actually elicited by specific incidents that result in NGRI verdicts—the legal border between the verdicts might not always match precisely the emotional limit—but, in aggregate, that's what they're about: there is a class of lawbreakers, sometimes violent but more often negligent or untruthful, that it would be wrong to seek revenge from, because the overwhelming reaction should be one of sympathy.

And that's simply not compatible with ever calling any of them a madman.

(It's not quite true that NGRI verdicts are supposed to help the mentally ill: it's cynical, but they're more about helping judges and lawyers sleep at night. I don't know how wrong it is that Norway apparently considers NGRI verdict incidents a strict subset of situations in which a person is psychotic, but Rygnestad's statement is a missed opportunity to remind people that the operative syllable in that is sub. Most likely missed by the journalist, of course.)

Biology is still naming random things the something-ome, and still putting tremendous effort into eperiments that a computer could do automatically if we could predict protein folding:

The researchers tested all pairwise combinations of the 8,000 proteins, one couple at a time

That's 32 million tests. One year of non-stop work if each test takes a second, which is a lot of time to spend even if it's grad students who do it. You know what else takes a few seconds?

In the second study, Jeffrey Dangl of the University of North Carlolina at Chapel Hill...

Spell-check.

I'm double-quoting that because it's a headline that is itself a quote, and what really gets me about that is that "sick" made it through two stages of review (the whole thing has probably been translated back-and-forth, too). The article in question makes two points about how the public Norway broadcaster NRK reacted to the Utøya thing, one pertaining to interviews with relatives of victims on Utøya, the other relating to what Breivik himself said and says:

- some of the relatives were "so disturbed mentally" that the TV channel decided not to put out their interviews, even though the relatives were requesting it, and had gone to the huge effort of doing the interview in the first place because they figured it would get broadcast
- they don't want to be a platform for Breivik's "sick" views, so they're not quoting him or using information provided by him.

In other words:

- the Utøya relatives are mentally ill, and we don't want that on TV
- Breivik is mentally ill, and we don't want that on TV

Note that only one part of the syllogism is invalid in each case: Breivik's views should indeed not be taken seriously because of Utøya, and someone in the early stages of extreme grief is indeed mentally ill—they can't work, for example, and most employers know and accept that. But Breivik does not automatically get the sympathy and support that should be offered the mentally ill.

Similarly, it's a valid journalistic decision that an interview that has been recorded should have been aborted or never begun, that the initial decision to record the interview had been a mistake: but to suggest that it is okay to mislead a grieving person about what's happening and to go through the motions of recording an interview, to have them go through the stress of addressing an audience even after it has been decided they'll never actually get whatever help to their grieving process might result from the broadcast, is dishonest and abusive. These interviews were recorded, and the journalists are now saying that everything went the way it should have, and that's simply not true if there's a simplistic "crazy filter" in the editorial process.

Again, it's true to say that a bereaved person is mentally ill: it sounds odd because one of those terms applies to nearly everyone at some stage of their life and the other one carries life-long stigma, so it sounds like an insult. It's not: a sudden loss can entitle you, to the same extent, to sympathy, support, and even legal amnesty as mental illness, a stroke, or a case of rabies would. It's usually time-limited, but then that is true of most classical forms of mental illness, particularly depression. But that doesn't mean you can't ever broadcast anything a mentally ill person said. The decision will be more difficult, because the mentally ill at large should be more visible, but making a specific mentally ill person more visible is likely to expose them to more stigma, but that's no excuse for not making the decision at all, and congratulating yourself for providing no platform for the mentally ill.

No Platform for the Mentally Ill isn't new: it's medieval stigma, an excuse to avoid difficult decisions by introducing a rigid censor who only checks the rules. It's as offensive and pointless as banning all children from appearing on TV, or from watching it: childhood isn't a mental illness, but it is a state of reduced (or altered) mental capacity (like all mental illnesses) and a state of reduced capacity to consent (unlike most mental illnesses all of the time, and all mental illnesses at least some of the time). We have sympathy for children, even children who break the law or resort to violence, and the depiction of real children in real journalism helps us retain some of that sympathy even when dealing with the worst-behaved of children, and that's something to aim for for the mentally ill, too. (I'm less clear on the positive effects of child actors, particularly young children. Watching TV, I already suspend disbelief for two-dimensional images, unrealistic lighting, stutter-free dialogue, L-shaped blankets, and the absence of bathroom breaks and wrong-number calls, so adding age to that wouldn't be that much of an issue. We no more need child actors to portray children than we need actors with an actual legal degree to portray all lawyers.)

It's possible Per Edgar Kokkvold said, before it was translated to German, "sickening views", rather than "sick views", which would be less stigmatizing but wrong in a different way: I don't think what Breivik said, as opposed to what he did, was sickening.

And, yes, there's the very small probability that Breivik will be diagnosed with a mental illness severe and treatable enough he will enter rehabilitation soon, and the (still small, but more realistic) possibility that he has, or appears to have, a severe and treatable mental illness that doesn't exculpate him, that he is simultaneously mentally ill and a criminal, that psychiatrists think treatment can help him, even if only help him to be a healthier prisoner.

Time will tell, and that's also true of Jared Loughner: he has, apparently, been diagnosed with schizophrenia, but that doesn't make him innocent, and a diagnosis isn't final. (Indeed, as long as the death penalty is an option, there's at least the theoretical possibility any given doctor would subscribe to the view that they are morally required to protect a guilty patient from execution, even if they were to perjure themselves. Going to jail in order to do the right thing for a patient isn't something a few eccentric doctors think about: it's discussed in ethics classes in medical school, and I hope that most of them will make it clear to medical students that receiving a medical license comes with that responsibility.)

You shouldn't call him a madman. It's not fair to those with genuine mental illness, and it's suggesting he didn't have a choice. Like, you know, mentally ill people don't have the choice not to be mentally ill.

I can't diagnose a mental illness over the internet (but everyone else can, apparently), but I won't accept the dangerous tautology that no mind that can make a horribly wrong decision is sane.

And, hey, someone agrees with me:

Labels like "madman", "monster", or "maniac" won't do

Except, of course, that's not all he said:

Presumably he wanted to make a name for himself, which is why I won't identify him. His name deserves to be forgotten. Discarded. Deleted. Labels like "madman", "monster", or "maniac" won't do, either. There's a perverse glorification in terms like that. If the media's going to call him anything, it should call him pathetic; a nothing.

Oh, right. We shouldn't insult people as mentally ill because being declared mentally ill is the worst thing that can happen to a person, worse than being tortured to death, and it will only make that person a martyr.

That's the logic, as far as I can see, behind "perverse glorification", and it's also clearly reflected in many comments: being mentally ill is worse than being a murderer, there's no cure (there is, of course), and, anyway, wouldn't it be an apposite time to bring up how expensive mental illness is for health insurers? That's what one health insurer just did.

More people are seeking help for mental illness, and there are people whose job it is to insinuate that that means mental illness is more of a problem than it used to be, and that we need to go back to the good old days when suicide was the first indication of mental illness.

In their defense, they didn't know about Utøya when they set the date for releasing their corporate-sponsored pseudoscience, but they did know the first institution housing the recently-created new caste of "mentally disturbed" criminals (that's the term, psychisch gestört—if anyone cared about mental illness, they would presumably try to keep this term separate from psychisch krank, mentally ill, but, hey, it turns out no-one does care about us) would be opening in Germany: the caste is meant to cover insane-axe-murderer types who have served their sentence and are still dangerous; since those don't exist (they do, but not enough of them to require a huge building), it actually covers men with little formal education who don't communicate well with the psychologists who evaluate them.

No name should be discarded or deleted. A murderer is still a human being, and so is a mentally ill person, but it is only the mentally ill that, regularly, don't even count as people.

But even then, glorification? Yes, I'll go enjoy my glorious mental illness now.

I have a great idea! Let's redefine cancer to include, in its new definition, heart disease. And then we'll have fixed one of the top 3 causes of death!

That is, at least, the best argument I can come up with for the idea that we should just redefine mental illness so all criminal behavior is included. Sometimes the idea is to send the mentally ill to jail, sometimes it's to treat all criminals in hospital: the effect, of course, would be the same in both cases: the creation of a doubly-stigmatized caste of undesirables.

It's not a new idea—many US states replaced the "not guilty by reason of insanity" verdict by "guilty but mentally ill" after the man who shot Reagan was found NGRI), and the liberal use of pedophilia as an example is telling: let's lump together the mentally ill and criminals into a single pervert caste, removed from the streets as a form of pest control because of the danger they pose and confined to dungeons where they can kill each other and provide entertainment, just like people who are sexually attracted to children and those who actually rape children are already lumped together in the handily-ambiguous "pedophile" category!

When I say that the idea is to send all psychiatric patients to jail, such proposals actually attempt to make a distinction between the good psychiatric patients of the depressed-sister type and the bad ones of the psychotic/involuntarily committed/suicidal/violent/manipulative type. Let them talk for a while and the second set will grow to include everyone: self-harmers who might need restraints (because what better place to do that than a jail?), the unemployed and economically unproductive, those who spit out their drugs when the nurse isn't looking, those who refuse to apologize for actions they don't remember or don't pray hard enough or insist on a controlled-consumption approach to addiction rather than teetotalling (indeed, AA will gladly throw out patients who do any of the last three).

In reality, there is little overlap between violent criminals and the mentally ill—violence is emotionally difficult, and we mentally ill people do badly on difficult tasks: psychiatry for common mental illness and psychological approaches to rehabilitating violent criminals are totally different, even more so than cardiology and oncology: even if you're simultaneously mentally ill and violent, you need both kinds of specialists, not someone who was redesignated by legislation to be a specialist for two different things.

There is a lot of overlap, on the other hand, between the US jail population, the desperately poor, and the mentally ill, but that overlap is overwhelmingly because of victimless or petty crime, and it can be fixed without dismantling the idea that there should be a criminal justice system at all, or the idea that it should be separate from mental health care. If you don't know the answer, you can copy from other industrialized countries.

But the big issue that the article is missing, the huge issue, is that everyone who's released from psychiatric hospital (at least in theory) takes responsibility for their own behavior: if you notice your brain isn't working, fail to seek help even though you could, and something happens, you're as responsible as the driver who noticed the brakes aren't working but never did anything about it. Sure, it's possible in theory that brake failure is sudden and unpreventable, but usually there were warning signs—sometimes the driver ignored them, sometimes they notice but couldn't afford to have anyone look at them, and sometimes it's simply not clear which one happened and the driver gets off without a criminal sentence in dubio pro reo.

If this sounds like biofeedback from the 1970s, it is—but this time with vastly more sophistication, monitoring specific networks inside the head rather than a single electrode on the skin. This research is just beginning, so the method’s efficacy is not yet known—but if it works well, it will be a game changer. We will be able to take it to the incarcerated population, especially those approaching release, to try to help them avoid coming back through the revolving prison doors.

That's just funny, now. Mental health care has been known to be cost-effective for decades, but scientific proof of cost-effectiveness does not translate into funding: US mental health care is massively underfunded, and the situation is deteriorating.

C S Lewis's "Madman" Argument goes like this:

1. the Bible is an accurate record of things Jesus said, and doesn't omit anything important Jesus said.
2. some of the things Jesus said, if sincere, would be enough to diagnose a mental illness.
3. Since a person who is at one time mentally ill cannot possibly be of any value of society, all atheists must denounce everything Jesus ever said.

All of these are wrong, of course: the Bible cannot be an accurate record because it contradicts itself; diagnosing a mental illness is not something you can do based on hearsay (in fact, it's not something you can do unless you've been trained); but the big one, of course, is that it's perfectly possible to be mentally ill, evil, or both, and contribute to society. There are mathematical theorems proved by ardent Nazis, literature written by child rapists, and schizophrenics are now basically expected to be great painters based on that fact alone.

It's not a great philosophical argument. It is a good rant, about how annoyed Lewis was by "moderate" atheists who considered British culture not a monolith to be accepted in full, but a smorgasbord to pick and choose and criticize bits of. (I put "moderate" in quotes because I've been told that holding some positions of a given ideology and some of mainstream beliefs doesn't make you a "moderate", it makes you a hypocrite, and I'm actually trying to approve of Lewis here.) It's a legitimate pattern, though I don't think it was legitimate with respect to British culture: but this was 1952, Stalin and Hitler and Ford (okay, now it's a Godwin, I might as well add Mao and Gandhi and Franco and Quisling) were essentially still warm; those alternatives to the British Empire were, or seemed, much worse. All of those people argued that theirs would be a third way, keeping what was good and doing away with what was bad, and if you, again, assume total sincerity (that seems to be a recurring theme), it must have seemed an easy conclusion that it couldn't be done: whatever the recipe was that made life in the United Kingdom, or at least Oxford, nice for rich, white, English men, it shouldn't be changed. There's a story that after the British discovered how to use lime juice to prevent scurvy, they changed the recipe, and what they actually handed out to their sailors had no vitamin C in it, and that's what things might have seemed like: you change anything, anything at all, and everything goes horribly wrong. Abolish the monarchy and you get rampant antisemitism, prohibit alcohol and Al Capone takes over, obligatory Sunday mass at the public schools might be the only thing standing between you and a police state.

That's wrong, but an understandable sentiment, and an argument that's worth going through in other contexts (the US is a phenomenally successful state, and it also has a constitution that, in large part, cannot be amended. Is one because of the other?), but an awful lot of history has happened since it was expressed: the "lost century" (maybe more like 80 years) between the industrialisation of Japan and that of South Korea, when not a single capitalist country managed to make that transition, ended. The Soviet Union saw periods of unbelievable economic growth, but so did Turkey, Ethiopia, and both Chinese states. People turned out to be tougher than was predicted in dystopian books, in Prague, in 1989, and in Egypt. The Civil Rights movement began, but never really ended: it just spread to more and more countries. And, hopefully, attitudes to mental illness changed. Not enough, and certainly not as much as language for mental illness changed, but, maybe, at least enough that when I point out step 3 in the argument above, that makes some sense.

It's 2011. We can attack, with 60 years of hindsight, all three of the steps of Lewis's argument. Or, of course, we can accept it and repeat "madman" over and over again like an unsupervised child who's learned a new dirty word. I assume the movie's more of the same, but haven't watched it, because, hey, look at what happened even without doing that. A lot of words happened. Someone needs to clean them up now.

Yes, I understand the State of California isn't awash in cash. I understand that letting random strangers watch video lectures is not that high on their priority list. Still:

404, File Not Found, Where did the old content go?

Thank you for your interest in webcast.berkeley. Please note that we launched a new site on June 30, 2011. As part of the launch, much of our back catalog of courses that we were unable to migrate out of a proprietary format which we no longer support are now unavailable.

You couldn't figure out how to re-encode video, so you deleted. perfectly. good. content?! This isn't a lecture or two, it's not just Real Media, it's most of the content that was ever there, as mp4s, on HTTP links. A lot of which admittedly did need a noise filter and volume normalization to be watchable, but the point is that I could do those things. It was data, it was useful, it had already been produced and licensed and put online, I could download it and run it through a filter and OCR the still frames and capture interesting slides, but someone decided that what Berkeley lectures really needed was "first" comments on YouTube.

The last archive.org crawl was on November 27, but it didn't capture any of the media anyway, as far as I can tell.

Preventing suicides is a good thing, but it's not some sort of technological break-through that has yet to be achieved for the first time. We know how to do it: to prevent suicide, talk about suicide. To prevent suicide, acknowledge that there is an underlying mental health issue—it doesn't matter whether it's endogenous or not, whether you were born with it or whether someone else caused it or anything in between—and that you can't just snap out of it. Acknowledge that it's not a lack of hope that can be cured by stories, in church or on youtube, of how wonderful things will be if only you swallow back your tears and keep up appearances for a while longer: often, it is precisely the inability to derive hope from those stories, or pleasure from activities you once enjoyed, that's the problem.

Seeking help is okay. Not believing in a wonderful future is okay. Believing in a wonderful future and still wanting to kill yourself, and seeking help for it, is okay, just like there are people who love their spouses and are still suicidal: that's not because they don't love them enough, but because there is an illness, something that can be in control of you as strongly as gravity is.

Videos won't cure that. Drugs might.

Isn't "It Gets Better" worth it if it prevents even a single suicide? As horrible as it sounds, there are thought processes those videos might (and do) spawn that aren't helpful: if "it gets better", but that doesn't make you happy, shouldn't you feel guilty? "It Gets Better" sounds an awful lot, to me, like "snap out of it". That's not how it's meant, but it's still the message it conveys: don't seek help, because I managed without. Don't let on there's something wrong, because you need to make it through high school somehow. Your problems aren't legitimate, because mine were so much worse. All the problems are in your environment, not in your body or brain.

There are, of course, anecdotes of how "It Gets Better" helped or might have helped. Again, it sounds horrible, but that's not sufficient evidence.

I hope "It Gets Better" helps. I hope it helps someone, but I can't share the conviction so many participants have that they are achieving so much and have finally solved the proble of suicide. It's more complicated than that, and the dismal laws of suicide prevention, I think, remain in force: you can't prevent suicide without talking about suicide. Talking about suicide is unpleasant. What you say can, and will, be taken the wrong way.

There's a limited amount of attention for mental health issues, and "It Gets Better" is not, in my opinion, the best message to spend it on. NAMI needs help, and more government money must be spent on mental health—not as a form of pest control to keep dangerous people locked up, but as an investment into the well-being and successful futures for people with diseases that are incapacitating when untreated, but treatable.

I assume. No one uses "cripple" these days, or says "female circumcision", or "spastic", or "mongolism". And that's good, those terms were so offensive they couldn't be reclaimed. But the bouquet of mental-illness terms is just as offensive, and it is, I think, legitimate to insist that they, too, be removed from the vocabulary of acceptable language. Not prefaced by an explanation that you mean "not medically crazy":

And Bachmann is exactly the right kind of completely batshit crazy. Not medically crazy, not talking-to-herself-on-the-subway crazy, but grandiose crazy, late-stage Kim Jong-Il crazy — crazy in the sense that she's living completely inside her own mind, frenetically pacing the hallways of a vast sand castle she's built in there, unable to meaningfully communicate with the human beings on the other side of the moat, who are all presumed to be enemies.

No. Stop using that word entirely. Stop, in particular, the inconsistent argument of simultaneously claiming not to be referring to the medical concept of mental illness (pro tip: the medical term is not, actually, "medically crazy") while you're also hinting at actual psychiatric issues (talking to yourself on the subway, grandiose delusions, being unable to communicate with others, presuming everyone to be an enemy: those can be real symptoms).

"Medically crazy" makes as much sense as "medical female circumcision", or "medically crippled": once you strip the term of its offensive connotations, there's nothing left to use.

and slut shaming: There's not enough stigma. We need more of it, for rich people! ("glut shaming"?)

Before delving too far into this, I'd like to give my general take on money. To me, money is a lot like sex and cupcakes. Meaning that while they're all things that everyone wants to have in one form or another, it's entirely possible to overindulge in all three. The key difference is, we don't stigmatize greedy people the same way we stigmatize people who are cads (i.e., Tiger Woods and Anthony Weiner) or people who are overweight (i.e., Michael Moore).

More stigma! For, you know, those un-Christian greedy people in financial careers. Whose worthless speculation hurts us all and benefits only them. Does that sound familiar?

Yes, this is a Godwin, but those stereotypes match Nazi stereotypes of Jewish capitalists: overweight, sexually deviant, greedy. To seriously argue that we need some of that stigma back is incredibly misguided, but to reuse antisemitic stereotypes, either deliberately or because one is genuinely unaware of them, is incredibly wrong. And, of course, so is providing support arguments for the stigmatization of body mass, sexual behavior.

This isn't antisemitism, but it's a small step removed from it, and it's calling for a fuzzy intangible goodness of intention in finance; historically, that meant religious discrimination.

"Greed is goodstigma is good" is not a good article to write; writing yet another article that states the financial crisis was a bad thing seems a little pointless, but that's all that remains, as far as I can tell.

(Update: it's raining swastikas. I'm not sure whether that poster was supposed to suggest homosexuality in having the naked guardian-angel socialist holding the Jewish capitalist's hand.)