Saturday, May 30, 2009

In Treatment

So I finally wrapped up the current season of HBO's In Treatment. I will try to be brief.

It is easy to take potshots at the show's ludicrous inaccuracies: the melodrama, the boundary violations, the additional boundary violations. In this show, therapy is aerobic exercise--patients and therapists jump up and pace, hurl objects, and/or run out of the office. Is this how they do things in New York? Where I come from, passive aggression works just fine--why work yourself into a tizzy when you can just lapse into sullen silence or fail to show up for your next appointment? But that sort of thing takes precious time on screen, and doesn't get the blood pumping.

Perhaps the most unrealistic aspect of the show is the fact that Dr. Weston ("Paul" of course to his patients) is a remarkably astute therapist, except for his Texas-sized blind spot as regards therapeutic boundaries. His formulations and his interpretations seem suspiciously on-target, considering how at sea he seems to be in his own therapy with Gina. And yet all his patients vociferously challenge his therapeutic authority--again, this comes across as somewhat contrived.

Considering that this is television, I suppose one can fault the cases for seeming too pat and tidy. I haven't seen the first season of the show, but in this second season the unifying theme seemed to be reversals of family responsibility, that is, children having to compensate for parents incapacitated by mental illness, grief, or a sheer inability to cope. This happens, to be sure, but does it happen this often?

For me, the single most piercing exchange of the series occurred in Paul's tumultuous penultimate meeting with Gina, in which he questions his entire mission as a therapist, and (jokingly?) expresses his intention to become a "life coach." He notes, as every occasionally despairing therapist must, that his patients seem to want love and/or pills more than they want what he offers, which is understanding. Gina's crucial comment is that even if he could, as their therapist, provide love to his patients, they would be unable to receive it, for that is why they are in therapy. If the offering of advice or "therapeutic love" amounts to feeding people fish, then true therapy is teaching people how to fish, as the saying goes.

Thursday, May 28, 2009

The Consolations of Lucy Snowe

I came across this utterly representative Romantic credo, a mighty riff by Charlotte Bronte, once again from the striking but strange Villette. It brought to mind David Hume's claim that 'tis not contrary to reason to prefer the destruction of the world to the scratching of his little finger:

I groaned under her bitter sternness. Never--never--oh, hard word! This hag, this Reason, would not let me look up, or smile, or hope: she could not rest unless I were altogether crushed, cowed, broken-in, and broken-down. According to her, I was born only to work for a piece of bread to await the pains of death, and steadily through all life to despond. Reason might be right; yet no wonder we are glad at times to defy her, to rush from under her rod and give a truant hour to Imagination--her soft, bright foe, our sweet Help, our divine Hope. We shall and must break bonds at intervals, despite the terrible revenge that awaits our return. Reason is vindictive as a devil: for me, she was always envenomed as a step-mother. If I have obeyed her it has chiefly been with the obedience of fear, not of love. Long ago I should have died of her ill-usage: her stint, her chill, her barren board, her icy bed, her savage, ceaseless blows; but for that kinder Power who holds my secret and sworn allegiance. Often has Reason turned me out by night, in mid-winter, on cold snow, flinging for sustenance the gnawed bone dogs had forsaken: sternly has she vowed her stores held nothing more for me--harshly denied my right to ask better things...Then, looking up, have I seen in the sky a head amidst circling stars, of which the midmost and the brightest lent a ray sympathetic and attent. A spirit, softer and better than Human Reason, has descended with quiet flight to the waste--bringing all round her a sphere of air borrowed of eternal summer; bringing perfume of flowers which cannot fade--fragrance of trees whose fruit is life, bringing breezes pure from a world whose day needs no sun to lighten it. My hunger has this good angel appeased with food, sweet and strange, gathered amongst gleaning angels, garnering their dew-white harvest in the first fresh hour of a heavenly day; tenderly has she assuaged the insufferable tears which weep away life itself--kindly given rest to deadly weariness--generously lent hope and impulse to paralyzed despair. Divine, compassionate, succourable influence! When I bend the knee to other than God, it shall be at they white and winged feet, beautiful on mountain or on plain. Temples have been reared to the Sun--altars dedicated to the Moon. Oh, greater glory! To thee neither hands build, nor lips consecrate; but hearts, through ages, are faithful to thy worship. A dwelling thou hast, too wide for walls, too high for dome--a temple whose floors are space--rites whose mysteries transpire in presence, to the kindling, the harmony of worlds!

All my old English teachers told me not to write paragraphs this long, and this unruly. But as the wag said, "Less is a bore."

Wednesday, May 27, 2009

The Summer Slowdown

You start a conversation you can't even finish it
You're talking a lot, but you're not saying anything
When I have nothing to say, my lips are sealed
Say something once, why say it again?

Talking Heads

I see that as compared to 31 posts in January, I have eked out only 11 so far in May. This shouldn't surprise me--the light and life of impending summer always suppress the urge to write, just as they suppress melatonin. If I were to move to the tropics, a transition devoutly to be wished, the inclination to write might wither away altogether. Summer for me is for movement, love, and music, not so much for the logos.

So to my three (or is it four?) consistent readers, thank you for following. The blog is not ending, just entering a period of languor, to be furthered only when what passes for inspiration in my case strikes. As the pessimist says to himself when passing through a period of prosperity, this too shall pass.

Sunday, May 24, 2009


"Everywhere I go I'm asked if the university stifles writers. My opinion is that they don't stifle enough of them."

Flannery O'Connor

Brad Gooch's economical biography of Flannery O'Connor (reviewed here by Christopher Benfey) suits its subject's concise literary style and externally uneventful life. It was a life dominated by her writing, her Catholic faith, and by the devastating lupus erythematosus that killed her at age 39 in 1964. By sheer temperament, she was a great original: contrary, self-contained, and highly creative from early childhood.

As Benfey suggests, with respect to her literary legacy, O'Connor's death may have been perfectly timed, perpetuating the tradition of genius tragically cut short. However, by her late 30's her short stories already weren't coming to her as quickly or as naturally, and she had become very much the literary sage, besieged constantly by curious well-wishers and by academic lecture series. Given that O'Connor's stories were variations on a theme to begin with, one wonder if she hadn't already conveyed the heart of her vision--what would thirty or forty more years have brought, really?

I went back and reread "A Good Man is Hard to Find," partly because it may be the single most famous of her stories, and also because it is available online. All of the O'Connor essentials are here in potent form: the tacky white-trash "protagonists" (if one can call them that); the heady brew of heat, squalor, and nostalgia that is the South; the mordant wit that makes reading her such a deceptively effortless experience; the preoccupation with evil and faith; and the eruption of death into the quaintly quotidian family adventure. Only the open brutality of the story's violence, usually more veiled in O'Connor's work, prevents it from being exemplary. The story is worth reading for the hilarious southern caricature of Red Sammy Butts alone (before reading the biography I didn't realize O'Connor had been a cartoonist in college, although it makes sense to me now).

One danger in reading O'Connor is that one so easily feels superior to her characters, who are typically an odious combination of gross ignorance, smug complacency, and breathtaking entitlement. The endlessly chattering and infinitely annoying grandmother of this story fits the profile. It is hard to avoid a certain schadenfreude when fools like these get their crushing comeuppance, as they usually do, and yet it may be that in provoking this wicked feeling, O'Connor is in effect making the reader complicit in the (original) evil that is inseparable from human nature.

The Misfit is as good a depiction of the psychopath as one can find--he seems genuinely perplexed by the moral categories that he seems unable or unwilling to fathom or to conform to: "I found out the crime don't matter. You can do one thing or you can do another, kill a man or take a tire off his car, because sooner or later you're going to forget what it was you done and just be punished for it." And yet his predicament is also the universal human one: "I call myself The Misfit," he said, "because I can't make what all I done wrong fit what all I gone through in punishment." Indeed, the basic problem of the moral life--the problem of theodicy too--is that it ultimately isn't fair. And yet the Misfit makes the error of the fundamentalist, the purist, and the fanatic--if morality is not absolute, then it must be meaningless.

In her essay "Some Aspect of the Grotesque in Southern Fiction," O'Connor allied herself with Nathaniel Hawthorne as a writer more of "romances" than of conventional fiction. She wrote, "All novelists are fundamentally seekers and describers of the real, but the realism of each novelist will depend on his view of the ultimate reaches of reality." This seems crucial, as it is the nature of reality--physical, emotional, moral, spiritual--that is at issue in the arts. In an amusing anecdote, O'Connor objects to the notion of the writer as a supporter of social agendas or as an uplifter of public morale--she likens the writer to a porter who, "when he is given the function of domestic, he is going to set the public's luggage down in puddle after puddle."

The following seems a pretty complete statement of O'Connor's mission, and it explains to me why I find her work so compelling even though our theologies differ so completely:

On the other hand, if the writer believes that our life is and will remain essentially mysterious, if he looks upon us as beings existing in a created order to whose laws we freely respond, then what he sees on the surface will be of interest to him only as he can go through it into an experience of mystery itself. His kind of fiction will always be pushing its own limits outward toward the limits of mystery, because for this kind of writer, the meaning of a story does not begin except at a depth where the adequate motivation and the adequate psychology and the various determinations have been exhausted. Such a writer will be interested in what we don't understand rather than in what we do. He will be interested in possibility rather than in probability. He will be interested in characters who are forced out to meet evil and grace and who act on a trust beyond themselves--whether they know very clearly what it is they act upon or not. To the modern mind, this kind of character, and his creator, are typical Don Quixotes, tilting at what is not there.

That pretty much sums it up for me: the artist does not reflect reality--she furthers, deepens, and recasts reality, and this makes sense only in the context of Mystery. And O'Connor, along with Kafka, was one of the great moral and metaphysical comedians of the last century.

Thursday, May 21, 2009

Love on the Brain

Last post provoked reflection on love, for a person, for the universe. Anything else I would have to say about this at the moment would be an embarrassment, but I was struck yesterday by this passage from Charlotte Bronte's Villette (the reminiscences of Miss Marchmont).

I haven't finished the book, so don't send any spoilers, Villette fans (you know who you are).

"I love Memory to-night," she said: "I prize her as my best friend. She is just now giving me a deep delight; she is bringing back to my heart, in warm and beautiful life, realities--not mere empty ideas--but what were once realities, and that I long have thought decayed, dissolved, mixed in with grave-mould. I possess just now the hours, the thoughts, the hopes of my youth. I renew the love of my life--its only love--almost its only affection; for I am not a particularly good woman: I am not amiable. Yet I have had my feelings, strong and concentrated; and these feelings had their object; which in its single self, was dear to me, as, to the majority of men and women, are all the unnumbered points on which they dissipate their regard. While I loved, and while I was loved, what an existence I enjoyed! What a glorious year I can recall--how bright it comes back to me! What a living spring--what a warm, glad summer--what soft moonlight, silvering the autumn evenings--what strength of hope under the ice-bound waters and frost-hoar fields of that year's winter! Through that year my heart lived with Frank's heart. O my noble Frank--my faithful Frank--my good Frank! so much better than myself--his standard in all things so much higher! This I can now see and say--if few women have suffered as I did in his loss, few have enjoyed what I did in his love. It was a far better kind of love than common; I had no doubts about it or him: it was such a love as honoured, protected, and elevated, no less than it gladdened her to whom it was given. Let me now ask, just at this moment, when my mind is so strangely clear,--let me reflect why it was taken from me? For what crime was I condemned, after twelve months of bliss, to undergo thirty years of sorrow?"

Is there anything more sad than this? As Samuel Johnson said of friendship, one must keep love--of someone, or something--in constant repair.

Tuesday, May 19, 2009

All in Your Head?

To be in a Passion you Good may do,
But no Good if a Passion is in you.

William Blake

In a fascinating article on NPR, Barbara Bradley Hagerty considers evidence that neuroscientists are closing in on a physiological basis for spiritual experience. As always it is immensely complicated, but it seems to involve serotonin (which is influenced by LSD and other hallucinogenic drugs) and the temporal lobe (affected by some types of epilepsy). But in a sense the neurological details are irrelevant as compared to the ultimate question of whether spiritual experience is subjective or objective, whether it says more about us or about the world outside.

This relates to the primeval roots of philosophy. As I perceive my coffee cup, how can I be sure that it actually exists outside of me in the universe, rather than just as a physiological pattern in my brain? Sure, I can see it, touch it, drink coffee out of it, or break it, but all of these experiences are mediated by my brain--there is no way to know the coffee cup directly. This is related to the problem of philosophical (not political) idealism, or the dorm-room question, "How do I know I am not actually dreaming when I am not awake?"

Arguably and practically we settle this as a matter of consensus. We are irreducibly social beings, and so long as those around me, for instance, agree that there is a coffee cup on the table, I have no legitimate reason to question it. To be sure, these other people could also be mere phantoms of my brain (back to "life as a dream"), but so long as these people exist and behave according to consensually decided physical and psychological laws, this isn't really a problem.

As Hagerty's article mentions, it is agreed by most who actually reflect on the matter that all kinds of experiences near and dear to us exist as brain events. So, what about an experience such as love? Does the fact that love is biochemical in the beholding subject detract in any way from its attachment to the beheld object? Not at all. Love is as precious in the brain as it would be if it were off floating in the ether somewhere (much more so in fact). What matters is that the "love reaction" in the brain be reliably and meaningfully correlated with another person out in the world. If this reaction is set off by the sight of virtually any potentially available partner (the Don Giovanni phenomenon), then this is surely a problem, but it is psychological and relational, not biochemical or philosophical.

Love is an evaluative experience, and one that, significantly, we need not seek consensus for, so its subjectivity is not a difficulty. I do not need my fellows to confirm my experience by falling in love themselves with my beloved (indeed, this is the last thing I want). As such it is totally different from the matter-of-factly epistemological task of recognizing objective states of affairs in the world. Ethical and aesthetic phenomena partake of both aspects--consensually subjective attitudes are sought on the basis of consensually objective artifacts or moral outcomes.

The philosophical problem of most religious phenomena is that they combine both of these aspects, epistemological and evaluative, in a more questionable fashion. They postulate often quite specific states of affairs in the universe (e. g. it was created in such and such way, God has such and such attributes, did such and such) and also enjoin particular attitudes and evaluations that ought to follow from this (e. g. you must embrace this deity, you must avoid such and such actions). The problem, of course, is that while I can in practice get essentially 100% of my fellows to agree that there is a coffee cup on the table, I cannot arrive at anywhere near that degree of unanimity when it comes to cosmic states of affairs, at least beyond artificially organized subgroups.

This embarrassing situation prompts many liberal apologists to minimize theological speculations and focus on the emotional heart of spiritual experience. It is interesting that after one strips away theology and church doctrine, what is left is what Aldous Huxley called "The Perennial Philosophy," which is also what often accompanies hallucinogenic drugs and temporal lobe phenomena. That is, one arrives at a generally transcendent sense of plenitude, of the unity of beings and the universe, of a white light, and of ecstatic peace and acceptance. In other words, one arrives at the primal sense of love, but confusingly, without a clear love object.

Perhaps the history of conventional religion is the communal attempt to soothe this cognitive dissonance, to find--to create if necessary--a cosmic object worthy of this cosmic feeling. Needless to say, the project has had mixed results, but as for many that feeling (or perhaps more accurately, the need to have what Freud called the "oceanic" feeling, which I too have had) won't go away, the effort proceeds.

So the heart of religion, at its most barebones and austere, may be love of the universe. But if the universe is in fact the love object, then the project of knowing and specifying the beloved is science, and the act of praising the universe is poetry (by which I mean all the arts). Is there anything else?

Monday, May 18, 2009

A Fry Cook Comes of Age

"The Child is father of the Man."


I indulge in a good deal of fluff here on the blog, but every now and then I tackle weightier subjects, such as this month's tenth anniversary of the indomitable, indefatigable, and inimitable SpongeBob Squarepants. James Parker profiles the cadmium yellow phenomenon in this month's Atlantic Monthly.

As Parker argues, no cartoon character has been more characteristically American than Spongebob--both buoyant and irrepressible, his greatest passion is serving up the Krabby Patty, a variant of that most quintessential American product. Spongebob is either stupidly naive or uncorruptibly optimistic, depending on how one views him; inherently blind to limits, he somehow winds up being pardonable owing to his basic good will. Like our preferred conception of children, he is deeply but innocently egotistical and a boundless generator of entropy, yet he is ultimately incapable of vindictiveness.

If Spongebob embodies the can-do, entrepreneurial spirit, the absurdly acquisitive Mr. Krabs correspondingly reflects the reckless greed than which he, unlike his fry cook, ought to know better. Yet Krabs is fallible, not vicious, and as such serves as a father figure for his young charge. He forgives Spongebob his frequent trespasses, and is forgiven in turn. Their nemesis, the menacing but miniscule and maladroit Plankton, is more bad uncle than real villain--as his chief aim is not destruction but theft of the Krabby Patty's secret formula, the greatest danger he poses is perversion of the business ethos.

The ludicrously stupid starfish Patrick, Spongebob's faithful companion, is a useful foil to the latter's misadventures; while Spongebob makes many mistakes in a large and complicated world, Patrick reminds the young viewer that he has, at least, come a long way from primal idiocy. The curmudgeonly Squidward embodies that most scary and puzzling quantity to the child, that adult world that is immune to his charms (and he is a figure to which the viewing parent may well relate). Yet even he, of course, is more long-suffering than threatening.

As Parker notes, the series borrows some of the hallucinatory dynamism of the 1990's Ren and Stimpy Show, but domesticated for a mainstream audience. Absurdity and breakneck speed constitute the pulse, but the show avoids decadence inasmuch as hard work, ingenuity, and allegiance to friends and colleagues will finally prevail. Over the top, dripping with excess, yet unapologetic and deeply moral, Spongebob Squarepants is a snapshot of contemporary American culture. And I don't think I can stand another episode.

Saturday, May 16, 2009

Means and Ends

"Faith" is a fine invention
When Gentlemen can see --
But Microscopes are prudent
In an Emergency.

Emily Dickinson

Psychology Today had an interesting post by Norman N. Holland, Ph. D., who specializes in psychology and the arts, suggesting that psychology belongs more to the humanities than to the sciences. I find the suggestion at least somewhat persuasive, but not necessarily for the reasons he advances.

Holland points out that knowledge cumulates in the sciences, but not in the humanities. Postmodern quibbles aside, we can say that contemporary physics involves an objectively more true understanding of reality than, say, 17th century physics. But contemporary literature or philosophy represents no objective advance over the work of Milton or Spinoza (indeed, some might say quite the opposite). Science progresses, while the humanities are a neverending conversation about meaning and value.

So far so good, but Holland then claims that scientific research in psychology is not in fact amassing real knowledge, because empirical studies now necessarily involve such minute areas of focus, with such tightly controlled variables, that they do not contribute to a meaningful overall theory of mind (he doesn't use this example, but he might have alluded to the fact that despite thousands of studies carried out over decades, we seem no closer to a scientific understanding of consciousness than we ever were). That is, we have oceans of data, but they do not cohere into real understanding, and psychologists can carry out thousands more experiments, focused on increasingly miniscule areas of brain function, without changing this fact.

I don't find this argument convincing for a couple of reasons. In all the sciences, whether particle physics or marine biology, researchers must focus on narrow areas of interest with rigid variables; the second-order task of science is to combine these over time into a broader understanding. It just takes a long time. And when it comes to the brain, which arguably is the single most complex phenomenon in the known universe, it could be expected to take a much longer time. The fact that many trivial tenure-supporting studies are done, and no grand unified theory of the mind has yet emerged, does not mean that progress is not being made.

I would maintain that, beyond the cumulation of knowledge or the lack thereof, there is a more crucial distinction between the sciences and the humanities, and that is the difference between means and ends. Science is the domain of how things are, and the humanities is the domain of how things ought to be, that is, what and how we ought to value. Via technology, science also concerns itself with how things may be materially modified, but neither science nor technology can ultimately contribute much to the question of how things should best be appreciated, and whether in fact they ought to be modified.

The humanities obviously don't "decide" such questions conclusively or universally; they entail a fluid, continually changing dialogue in the form of historical, philosophical, and aesthetic inquiries. Every science and technology has its corresponding humanistic dimensions involving the proper places of fact and engineering within human experience. The difference with biology, and particularly psychology, is that the focus of study is human identity itself, not an object out in the world.

So the point is not that real factual understanding of the brain is not occurring, or that we will not eventually have massive potential to modify the brain even in subtle ways. The point is that consciousness is inherently a dynamic entity, and one engaged in essential value discrimination, on its own and in relation to other minds. The latter is the humanistic endeavor, and when it comes to the mind regarding itself, the stakes are highest of all. One can imagine a future neuroscientist describing and cataloguing an individual mind in all of its exhaustive attributes and propensities; but the subject may always respond, "Okay, that's what I am today, but I want to be...something else tomorrow, yet I'm not sure what." That is where the humanities, as opposed to science, come into play.

Tuesday, May 12, 2009

Dylan at 68

"The world of research has gone berzerk,
Too much paperwork."

"Nettie Moore"

"She's sixty-eight but she says she's fifty-four."

"Maggie's Farm"

Every now and then I like to prune my readership here (an undertaking that might seem superfluous) by offering a comment on popular music. My last foray in this direction was insufficiently appreciated, but I was not deterred.

I obtained my Dylan tickets for July, as the grand master of blasted bluesy Americana does another summer tour of minor league ball parks. I have also enjoyed a few listens to his new, 33rd studio album, Together Through Life, which I found to be a refreshingly light-hearted effort. Particularly over his last few records, he has alternated between the grimly resigned (Time Out of Mind and Modern Times, whose last track, "Ain't Talkin'," was a virtual dirge) and the wittily whimsical (Love and Theft and now Together Through Life).

Dylan turns 68 this month, but he sings like he's 168. I wish some throat specialist could explain to me how his voice now and his voice from forty years ago could belong to the same human being. He croaks along like a veteran not of lysergic acid diethylamide, but of sulfuric acid, steadily sipped over the years. If a corpse could sing, this is what it would sound like--but this is precisely what makes the late Dylan so wondrous. To paraphrase Samuel Johnson when he spoke of a dog walking on its hind legs, one is less inclined to criticize the performance than to marvel that it is done at all. By all rights Dylan should be dead, with Presley, Morrison, and Cobain, but instead he persists in his globe-roaming neverending tour.

Doesn't Dylan belong to a quartet of titans bestriding the past century of American popular music, with Bing Crosby, Sinatra, and Elvis? Going back to listen to his 60's records, from The Freewheelin' Bob Dylan to John Wesley Harding, plus a few prodigious 70's aftershocks like Blood on the Tracks and Desire, is to hear a genius at white heat, a supernova of words, images, and sounds. Back then he sang thinly and nasally, to be sure, but with boundless conviction and joyous plenitude. Over the decades he has proven transcendent also in his recurrent self-creation and dour inscrutability. By now he has generated so many personae and so many grotesque and surrealistic scenarios that there is no definitive Dylan for the public to pin to the wall, just a whirl of virtually compulsive invention. "He not busy being born is busy dying."

Together Through Life is generally propulsive and insouciant, the buoyancy of songs like "If You Ever Go to Houston" contrasting as always with Dylan's ancient articulation. "If you see her sister Judy/Tell her I'm sorry I'm not there" echoes the Dylan ethos pretty well: not there, or now you see me, now you don't. But there is, as ever, darkness, the ravaged "Forgetful Heart" opening with the discouraging (and redundant) reminder of human fallibility "Forgetful heart/ Lost your power of recall."

The record ends with Dylan's drily hilarious send-up of the odiously smug phrase "It's All Good." "Big politicians telling lies/Restaurant kitchen full of flies...but it's all good," he rasps, Dr. Pangloss wandering through Sodom and Gomorrah. This album, like all the haggard late Dylan, would be a moderate curiosity if created by John Doe, but authored by him, it is like some deep-space nebula, with an elegaic and crepuscular beauty most noteworthy for the violent creativity it commemorates.

If Dylan were good for nothing else, he inspired this exquisite homage from Cat Power.

Monday, May 11, 2009

What Are The Chances?

(Happy 200th post to me...)

And so it stays just on the edge of vision,
A small unfocused blur, a standing chill
That slows each impulse down to indecision.
Most things may never happen: this one will
And realisation of it rages out
In furnace-fear when we are caught without
People or drink. Courage is no good:
It means not scaring others. Being brave
Lets no one off the grave.
Death is no different whined at than withstood.

From "Aubade," Philip Larkin

Last week saw an evening of violent storms and tornado warnings, greeting by my disaster-enthralled son with hopefulness and by my more knowing daughter with alarm. The tornadoes were many miles away, so there was no real need for concern at that point, but still she pleaded for reassurance: "Daddy, are you sure there won't be a tornado?" Well, no I couldn't be absolutely sure, but I tried to explain that some things in life are so rare that there's no point in worrying about them beyond taking common-sense precautions.

She wanted some examples. Well, having the house get nailed by a tornado may be comparable to a person getting struck by lightning. Really bad stuff, but extremely unlikely. What else, she wanted to know, and a couple of responses came to mind but were discarded. Maybe like getting eaten by a shark (no good--beach season coming up). Maybe like someone invading our home and killing us all ("So when did you start having problems sleeping?" her therapist asks 20 years from now). So I came up with: Like getting hit by a meteorite. This wasn't really accurate, as no human being in recorded history has been struck and killed by a meteorite, but it sounded sufficiently farfetched that she was reassured.

Anxiety disorders are basically the mind's inability to tolerate horrendous but rare outcomes. The daily stream of consciousness continually flows over and around appalling eventualities. This nagging cough could mean cancer. This plane could go down at any moment. My child could be snatched away from the bus stop by a passing pedophile. All of these are non-bizarre possibilities, but the non-anxiety-disordered mind, knowing that there is only so much apprehension to go around, is able to focus on more probable scenarios that can realistically be modified.

One component of cognitive-behavioral therapy for anxiety disorders entails pointing out statistical considerations. The cough is much more likely to be a lingering but benign virus. Air travel is far safer than ground travel. This is a safe neighborhood, and you can't watch your child every second of every day. The reason why anxiety disorders can be tough, and CBT can be limited, is that human beings are rational only to a point. After all, terrible things do happen, every day, even if the sensational media makes them seem far more common than they are.

The flip side of the anxious person's intolerance of uncertainty is a craving for control. The more control we have over our lives, the more we seem to demand. Many have complained of our hypervigilant contemporary culture, obsessed with food additives and helmets and whatnot when objectively most of us live safer and more secure lives than any in the past.

I am fond of biographies, and whenever I read about a life prior to this century I am always struck by how commonplace and open death used to be. Obviously this was particularly true of young children falling prey to infectious diseases, and in the past, once one made it past age 5 or so, one had a decent chance of a full lifespan. But nonetheless, otherwise healthy adults succumbing unexpectedly to various ailments was far more common throughout history than it is now. To be sure, automobile accidents negate some of this gap, as did AIDS before it became a somewhat treatable disease, but the gap remains. In first world countries the default assumption is now a life of eighty years at least, and any remote endangerment of this forecast, whether by swine flu or tainted peanut butter, provokes near-panic.

That stormy night I reflected briefly on what it would be like if, against all odds, an F-5 tornado devastated the neighborhood at 2:00 A.M. A thunderous roar vaguely perceived through the fog of sleep, then the house exploding around, then a split second of feeling thrown violently through the air, then a dreadful impact, then nothing--forever.

"Good night...Everything will be fine...I'll see you in the morning," In life one is walking parallel to an abyss--just don't look down, or at least not for more than a moment. What else is one to do?

Now Mondays are worth worrying about, rolling around as they do with high predictability. I suppose that recurrent Mondays, as the wag said about enduring old age, are preferable to the alternative.

Saturday, May 9, 2009

Mothers of (Literary) Invention

It's definitely time to steer clear of the Hamlet quotations for Mother's Day. As I tried to recall a great poem about mothers or motherhood, I found myself coming up strangely empty--I'm sure I must be overlooking many (Retriever, help me out here--and Happy Mother's Day to you). Yet as I've speculated here before, the annals of great artists and writers who were also mothers are brief, and those few that do come to mind--Sylvia Plath for one--give one pause. It would appear that young 'uns tend to drown out the muse.

So I came up with this, an excerpt from Wallace Stevens's "Auroras of Autumn:"

Farewell to an idea...The mother's face,
The purpose of the poem, fills the room.
They are together, here, and it is warm,

With none of the prescience of oncoming dreams,
It is evening. The house is evening, half dissolved,
Only the half they can never possess remains,

Still-starred. It is the mother they possess,
Who gives transparence to their present peace.
She makes that gentler that can gentle be.

And yet she too is dissolved, she is destroyed.
She gives transparence. But she has grown old.
The necklace is a carving not a kiss.

The soft hands are a motion not a touch.
The house will crumble and the books will burn.
They are at ease in a shelter of the mind

And the house is of the mind and they and time,
Together, all together. Boreal night
Will look like frost as it approaches them

And to the mother as she falls asleep
And as they say good-night, good-night. Upstairs
The windows will be lighted, not the rooms.

A wind will spread its windy grandeurs round
And knock lilke a rifle-butt against the door.
The wind will command them with invincible sound.

Thursday, May 7, 2009

Yer Blues

I have of late--but wherefore I know not--lost all my mirth, forgone all custom of exercise; and indeed it goes so heavily with my disposition that this goodly frame, the earth, seems to me a sterile promontory. This most excellent canopy the air, look you, this brave o'erhanging, this majestical roof fretted with golden fire--why, it appears no other thing to me than a foul and pestilent congregation of vapours. What a piece of work is a man! How noble in reason, how infinite in faculty, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god--the beauty of the world, the paragon of animals! And yet to me what is this quintessence of dust? Man delights not me--no, nor woman neither, though by your smiling you seem to say so.


I don't know of a more powerful or compact account of depression than these few words from Shakespeare, and William Styron's Darkness Visible sufficiently conveys the essence of a severe melacholic episode and its treatment. But given the perennial shroud of mystery surrounding depression, I suppose additional memoirs couldn't hurt. So Daphne Merkin provides a narrative of her latest depressive episode, in the Times. I recall reading some years ago an article by her in The New Yorker, and this one generates a sense of deja vu. But given that depression tends to be recurrent, that may be fitting.

We speak much of the bottomless nuance of psychiatry, and the infinite individual variations of its maladies, but when it comes to really debilitating depressions, one is struck by their uniformity. The lethargy, the anhedonia, the leaden numbness, the hopelessness, the sense of utter isolation and estrangement from humanity, the inevitable thoughts of self-extinction. Whatever the myriad causes feeding into depression, its symptoms constitute a universal final common pathway.

As Merkin notes, depressives are always encouraged to seek out social contact and support, but they soon encounter the hard truth that most non-depressed people, beyond a few encouraging words, have little understanding of or patience with depression. The depressive essentially must forge a relatively euthymic facade to gain any real foothold in the social world that may eventually help boost his spirits for real. This masquerade of equanimity can feel dishonest.

She describes the peculiarly disheartening quality of the late middle-aged breakdown. The depression of youth may seem more appropriate--life is hard, and one is after all just learning the ropes, right? But several decades in, shouldn't one have gained some mastery? So the kernel of self-doubt germinates.

I relished Merkin's exasperation with her analytically-inclined therapist, who after long questioning the real helpfulness of medications, suddenly switches course and suggests that she have ECT--this is a nice illustration of the throw-up-your-hands-and-throw-in-the-kitchen-sink aspect of treating depression.

Depression, like most mental disorders, is both illness and meta-illness, sickening the body and mind at the same time that it saps the self's capacity to maintain in all respects. It is a bit like AIDS in this formal respect, an assault on the organism's defenses against all kinds of entropy. It wounds and disarms in one stroke.

Merkin's article contains what by now is the stock account of the dismal psychiatric ward experience. The usual players are here: the execrable decor, the mind-numbing routines, the callous and distant staff, and of course the insipid food. Even the antiseptic fluorescent lighting gets a mention. I'm no fan of psychiatric units, but what exactly is expected here, incandescent lighting? As if inpatient wards, in addition to their other crimes against humanity, should generate unnecessary carbon as well?

What is it about ping pong tables and psychiatric units? It is low-maintenance, offers competitive and enjoyable exercise, and unlike billiard balls, its implements cannot cause harm. The perfect pastime for the bored and potentially suicidal (and I mean this quite seriously).

Her episode ends as many, fortunately, do, more with a whimper than with a bang. Just when things seem bleakest and she is considering a return to the hospital for ECT, the gloom lightens subtly, and all of a sudden the notion of writing, of doing anything, no longer seems absurd or insurmountable. She is on Abilify--can we credit the drug, or did the episode simply wind down of its own accord? Neither she nor her psychiatrist can really know. Take what you can get and keep your fingers crossed.

Tuesday, May 5, 2009

Look for Me on "60 Minutes"

Well, not exactly (and no thank you). But lacking both time and other pressing concerns today, I belatedly take note of a passing mention of the humble blog in Melissa Healy's health column in the Los Angeles Times last month.

The common mantra now is that if you have depression, seek treatment because it is a treatable illness. By all means seek treatment, but part of psychiatry's soft underbelly (well, okay, psychiatry is really pretty soft all over, a real pussycat) is the weakness of its antidepressant treatments.

Based on both my clinical experience and my understanding of the literature, I don't buy the argument that antidepressants are a vast fraud, no better than placebo. But they're certainly not as robust as many would like to believe.

Often in this blog I have been critical of psychiatry, and the profession has left a lot to be desired in terms of the results it delivers. And I know that the most puerile response to criticism of any field is to say, "Well, do you think you could do better?" As my recently profiled favorite Samuel Johnson put it, one needn't be skilled at making tables in order to offer an informed critique of a particular table.

However, when the antipsychiatry folks shake their heads in disgust when patients end up on multiple medications, often "off label" and carrying significant side effects, I can't help wondering what they would do if faced with the patients psychiatrists see. Tell them to eat healthy food, get fresh air and exercise, find God, get married, get divorced, get a therapist? What if you do all these things and a hundred more, and try all the FDA-indicated treatments for depression, and years go by, and nothing happens? Well, you get creative, in a sometimes desperate attempt to alleviate suffering. It is easy to disdain the endeavor in a blog, with no patient sitting across from you.

Sunday, May 3, 2009

Hippocrates and the Hangman

"Many that live deserve death. And some that die deserve life. Can you give it to them? Then be not too eager to deal out death in the name of justice, fearing for your own safety. Even the wise cannot see all ends."

Gandalf, The Fellowship of the Ring

Granted, when it comes to the question of capital punishment, those on death row tend in their character to be more like Gollum (for whom Frodo desires death in this Tolkien quote) than like Socrates faced with the hemlock in Jacques-Louis David's famous painting. And it is noteworthy as regards the quote that contemporary America endeavors to give (deserved) life to those fated to die every bit as aggressively as it seeks to give (deserved) death to those otherwise fated to live after committing heinous crimes. In this respect capital punishment is a grim mirror image of the out-of-control medical-industrial complex. Even the wise...

This came to mind after a recent local story in which the Supreme Court of North Carolina decided (4-3!) that the state medical board cannot in fact discipline physicians who participate in executions (i.e. by monitoring vital signs to insure that the inmate is "not suffering"). Death sentences, which had been on hold for a couple of years because of this question, can presumably start up again.

It took me years to decide where I came down on the question of the death penalty. I used to be for it, as I've always had a healthy respect for evil as a real force in the world, and as Tolkien wrote, in terms of abstract justice there are people who have done things so awful that they deserve to die. However, in an odd parallel to the question of the possible rationality of suicide, I think that the absoluteness of death precludes, in practice, the ethically justifiable intentional taking of life for any reason but direct and obvious self-defense (any society-wide deterrent effect of capital punishment is debated, and is definitely not direct and obvious).

Capital punishment, like suicide, is a declaration that this particular person's life cannot be considered worth living; in an execution the state effectively commits suicide on another's behalf, conflating vengeance and penance. In this sense it is richly ironic that those on death row are not permitted to commit suicide, and indeed may not be considered "competent" for execution if they are suicidal. Both execution and suicide are acts of dreadful certainty: "By the permanence of this act I affirm that I (or we, the state) cannot possibly be mistaken, that things could never come to be different, whether through additional evidence or altered perception." Playing God, indeed, although to do so with someone else's life is rather different, isn't it, than to do so with one's own?

What physician would want the job of monitoring an execution? I suppose it could be a deeply ethical act, inasmuch as the about-to-be-executed are, by definition, those who have had every human right stripped from them--except for the right to freedom from inflicted physical agony. Another irony, as Atul Gawande's recent New Yorker article painfully described, is the regular use of long-term solitary confinement, which arguably inflicts emotional distress far more horrific than the physical pain someone could undergo during lethal injection. What is the difference? Well, there are media and family representatives observing an execution, but in a solitary cell, not so much. Very discreet.

I always come back to Oliver Cromwell's (paraphrased) admonition, "I beseech you, in the bowels of Christ, consider that you may be mistaken." Suicide means blinding oneself to the possibility of the ultimate error. Execution leaves this possibility open, but removes the option of ever rectifying it. Eventually the civilized world will view capital punishment much in the way it views slavery, as beyond the pale (much of the world does already actually, we just haven't joined it yet).