Maggie's Farm

Conscious guilt causes agony while unconscious guilt can shape a person.

I tend to see more people wracked with conscious guilt. Sometimes it's neurotic (ie, irrational in proportion), and sometimes it is good old ordinary guilt for rotten behavior and/or evil thoughts.

There are many causes of self-defeating or self-sabotaging behavior besides unconscious guilt (for examples, avoidance of difficult things or avoidance of risky challenges), but guilt is always on the list of considerations.

Dr. X discusses the topic here and here.

People love to make fun of Psychiatry, but here's a sample of what life could be like in a world without us.

Remember that Dr. Benjamin Rush, the founder of American Psychiatry, was a signer of the Declaration of Independence. He was vehemently opposed to the chaining of the mentally ill, and proposed treating them with compassion and understanding. He also opposed slavery.

Image is Benjamin Rush, MD. Charles Wilson Peale, 1818.

Medicine has always abounded with quackery, and placebo effect is real. Hope springs eternal...

However, when tax dollars are expected to pay for it, it's another matter: Europeans Cast Critical Eye on Homeopathy.

In a free country, folks are welcome to buy their own quackery if they want, on their own nickel. Most docs privately think of Chiropractic as quackery, but the Chiropractors have a lobby in DC, and I believe there is a legal injunction against MDs terming chiropractors "quacks" in public. They sometimes do help people with sore backs. I am just imagining the debates about whether federal guidelines will include crystal therapy and massage therapy.

American medicine itself has little intentional quackery, but many treatments which are of dubious value. For examples, futile treatments for terminal cancer, or those $15,000 treatments for "Chronic Lyme". Thus far, in America you can pretty much get whatever medical treatment you want regardless of its usefulness for you. Problem is, others are usually paying for it.

My prediction is that government-controlled medical care will be determined by politics and, to some extent, politically- or bureaucratically-oriented docs. That is not good medicine.

Good medicine is individualized, not based on statistics.

All the docs are passing around this article from the CSM. "In a landmark Idaho case, the Justice Department forced a group of doctors to accept government price controls."

Is it illegal collusion for docs to pass it around? 

Sex-appeal still counts for something: Dating Market Value Test For Women. h/t, Dr. Helen

I will not tell you my score.

Our Editor asked me to comment on McArdle's post of the above title. Happiness is, as I have discussed here in the past, undefineable.

Joy is defineable, peace of mind is, contentment is, delight is. Pursuit of happiness is a fool's errand. (Is it true that Jefferson's first draft was "pursuit of property", but that was edited out?)

Key quote from her post:

Instead of asking parents and non-parents whether they are happy right now, we might ask whether they are becoming more like the people they want to be. And then we might see children not as factors that may or may not be contributing to our happiness, but as opportunities to practice what most of us -- perhaps me most of all -- need to do more often, which is to put someone else before ourselves.

Shrinkwrapped's post on sociopathy is a good update, and raises intriguing, age-old questions about free will and responsibility which go far beyond the topic of sociopathy. The Greeks understood these things better than we do. Fate, personality temperaments, and all that.

Everybody's brain seeks excuses for their body's wrong or irresponsible behavior: My Brain Made Me Do it.

I might revise the title to "My brain made me blame my brain." That's the one I use when I screw up.

I have no answers to these conundrums (conundra?).

Erik Erikson said "Psychotherapy begins where common sense ends."

Well, common sense isn't all that common. In fact, it is as rare and precious a thing as honesty.

The shrink proprietor of F*ck Feelings is darn good with common sense. As they say in The Program, "Feelings aren't Facts." I always like to apply common sense first, then other things if that doesn't help.

Sociopathy seems to be, to some extent, bred in the bone. As I have discussed here in the past, it's about a cool indifference to others, often while presenting a mask of warm caring and self-sacrifice (the so-called Mask of Sanity). It's about an easy ability to lie to your face, and it's usually not about violence and murder.

High IQ sociopaths fool shrinks all the time and we kick ourselves every time we finally realize it. Often, they confess things as red herrings for us. They tend to have ulterior motives, but do not mention them to us at all. People who repeatedly lie to shrinks generally have sociopathic traits, at the least. They tend to have an assortment of other symptoms and problem behaviors also, such as substance abuse, shame, narcissism, blaming, exploitative relationships, and anxiety. They always have an excuse at the ready, tend to be impulsive, and always have their self-interest in mind.

At Gene Expression's Bad to the Bone:

Could a psychopath mount a legal defense by saying “my brain made me do it”? Or my “genes made me do it”? Is this any different from saying my rotten childhood made me do it? Psychopaths know right from wrong – they just don’t care. That is what society calls “bad”, not “mad”. But if they are constitutionally incapable of caring, can they really be blamed for it? On the other hand, if violent psychopaths are a continuing danger to society and completely refractory to rehabilitation, what is to be done with them?

Don't ask me. Just keep them out of my office. They are Very Bad News for soft-hearted gullible trusting folks like me.

I have been mulling over the notion of doing a post on ineffectiveness in people, but every time I thought about it, the subject just got too big to tackle. There are so many ways to be ineffective in life, ways of not addressing reality - and oneself - firmly.

Schneiderman is keeping it simple: "The 7 Habits of Highly Ineffective People"

It always amuses me when expensive and time-consuming studies are done to demonstrate something that everybody and his grandmother knew already.

Great example: Personalities Accurately Judged by Physical Appearance Alone

Without that subliminal processing, neither actors nor con men could exist because there would be nothing to imitate.

I do not know how material poverty can be defined. I have an easier time defining poverty of spirit. Man can not live on bread alone, and material appurtenances are no measure of quality of life.

(I have mentioned before two "poor" people I have come to know well: a Maine Guide who lives with his family in an unelectrified log cabin built by his own hands and who home-schools, and a New Hampshire farmer who attends my church whose life is as spartan and spare as that of the Guide, but whose life is full of joy, accomplishment, friends, pride, and serenity - except when his equipment breaks.)

Few people get this as well as my fellow shrink Dr. Ted Dalrymple, a man who has seen it all both in the jails and government housing of England and around the world. Sympathy Deformed: Misguided compassion hurts the poor.

The examples from Africa are heartbreaking.

Given all that, I am grateful to be what I am, an American professional woman married to a Boston finance guy with money to spare. He still plays Rugby and hockey, and I never lacked for life spirit either. We lack neither the Holy sort nor the secular sort of spirit, I think, and Shame On You if you do not jump into the thick of life and grab it by the balls the ball. Our family motto is a Nike ad. I do not need much in material comforts, but I do like and desire other things, including a closer walk with Christ. There is something about having spare money that causes one to want less material stuff, at least for me.

As our Editor says, a new car is a used car after 24 hours. Thoreau would have said the same thing, but it was all hypothetical for him. He had a family business (always a good thing to have).

Dr. Arie Friedman on A Dying Profession

I think it is still appealing (as a second income) for those who find the work interesting and challenging. It will be mostly women in the US, I think, in the future, and on government pay.

No More Identity Politics; Palin Proves Old School Feminism is Dead. A quote from Lori Ziganto's piece (h/t, Linkiest):

The reason I’m happy that Palin and the “mama grizzlies” are in the forefront isn’t because they have girl parts. It is because of what they believe. It is because of the kind of people they are. It is that they are coming forward now, as freedom fighters. It is because, like it or not, it just so happens to be the women of the GOP who have the will and the fighting spirit at this time. That is what we need: leaders with spines, regardless of having breasts or not.

You see, while “Feminists/Femisogynists” were busily pant suiting themselves and trying to become men, other women were out there annihilating the glass ceiling, by raising their families and learning through actual living and perseverance. We didn’t learn by trying to be something we are not, but rather we learned by living. Most often in our wonderful small towns, none of which, in my experience are bitter.

We don’t rely on a victim mentality; we rely on ourselves and the love of our families.

Regular people living in the real world never bought the Leftist narrative that criminals are victims. Neither did shrinks, who know how much character matters. Criminality knows no socio-economic or ethnic boundaries.

This is right on the money: Were Liberals Wrong on Crime? It's a sad day when honest, hard-working people who are willing to work two tough jobs to pay their bills and support their families are made to feel like chumps, or worse.

Such good folks are the salt of the earth and the backbone of America, whatever the Manhattan radical chic set thinks of them.

Do DSM psychiatric diagnoses have any validity? Or are they superficial descriptors on the order of "Patient has a fever" or "Patient is dehydrated," but with pseudo-scientific-sounding specificity?

What’s in a name? Genetic overlap between major psychiatric disorders

Readers know that I view a DSM diagnosis as just a little bit more than an insurance form entry item, most of the time. As a highly experienced colleague says, "I've read the DSM, and I have never found a patient of mine in there."

I plan to bore our readers by reposting my series on Psychiatric Diagnosis during vacation this summer.

Broken Heart Syndrome. It's a real thing, believed to be caused by a massive adrenaline surge.

A few basic books on psychotherapy and analytic psychiatry at Dr. X. He can keep the Kohut, because I cannot understand him, or any of the "Self Psychology" stuff.

What I read this weekend (and recommend): Gyorgy Buzsaki's Rhythms of the Brain.

It is about the self-generating powers and activities of the brain. While presented as a popular science book for the layman, some familiarity with modern neuroscience would help.

I have been working on ways of talking about personality traits and relationships which avoid all psychobabble, fancy convoluted theorizing, and obscure terminology and latinate or greekified jargon. That means trying to invent better, more intuitive, metaphors. This is just a first draft to help get me thinking about what it is I really want to say -

For 40 or 50 years, Psychiatry and especially Psychoanalysis has tended to view the formation of a person - their pathology and their normality - as being founded in their relationships during development. I do not agree with that premise.

However, as a shrink I am naturally interested in peoples' relationships. It's one of the main topics I listen to, and it is one of the main arenas in which people live out their personality tendencies, for better or worse.

A patient of mine, 59 years old, was married at 21 to his high school sweetheart on their college graduation. He comes to me because he has let himself fall in love with a younger co-worker in his office, and feels torn up with the conflicts. So torn up that he cannot work or concentrate. He is an entrepreneur and has built a series of multi-million dollar businesses during his life, some successful, some not.

Naturally, I inquire about his marriage. A picture gradually forms in my mind of a relationship which is frozen in the past. Two young folks, mad about each other, created a romantic relationship template - their manner of relating and interacting at the time - which has neither changed or grown much since then except, of course, a marked cooling of the passion. Meanwhile, everything else in life has changed: raising kids, financial ups and downs, deaths of parents, new activities and new friends and relationships, etc.

The relationship model that worked at 20 didn't do much at 59, but they unwittingly clung to the original template they had formed early on.

Everybody has had the experience of seeing an old friend after many years, and thinking "Gee, we picked up just where we left off ten years ago." Or, even more commonly, "I feel a bit like a 14 year-old or a 16 year-old when I spend time with my parents."

It's neither a good nor a bad thing; it's just a fact that we have a limited number of relationship templates on hand to apply to our different sorts of relationships, and we tend to keep using the same ones.

Often, in Psychiatry and Psychoanalysis, this is termed "transference." I just call it recycling of old templates. Mental efficiency, however imperfect.

Sometimes we are forced to form new ones, regardless of our age. Getting a new sibling requires a new one (an evil and unwelcome interloper), becoming a parent requires new ones, as does becoming a grandparent or an in-law. New love relationships sometimes do, but more often tend to draw on past templates, modified a bit, and superimposed on a new relationship. Even a new house dog demands a new template (unless one imposes one of one's human templates on the relationship - as I do. I seem to use my "toddler" template for dogs.).

Sometimes we do things on purpose to create new, more mature or more satisfying templates for our arsenal, or to adjust old ones (relationship templates have wiggle room on the edges). That's one of the purposes of marriage encounter, marital therapy, psychoanalytic psychotherapy, etc. Much of what can feel sterile in relationships is our clinging to old templates - clinging for comfort and familiarity.

People usually form new relationships on their pre-existing templates, and the lack of perfect "fit" of mental template to reality is what makes for all the fun and challenge and mess. (You can generalize that metaphor to lots of things in life...most of what we do and how we do it is from an existing pattern.)

Humans stick to their patterns most of the time - creatures of habit - and usually prefer venturing outside of them (adventure) to a limited extent - just enough to keep it interesting, depending on where one falls on the timidity-recklessness spectrum.

More later about what our templates are made of...