But is it really ‘wiring problems’ which underlie such disorders?

Related? Misreading the Mind

Jonah Lehrer, author of Proust Was a Neuroscientist, argues against neuroreductionism. How can we get beyond the fact that modern neuroscience is in the process of throwing out the only reality that we know, the ghost in the machine of the self? (Los Angeles Times op-ed)

[Warning: this piece strays, by the end, quite far from mystery…]

There is new case law that says so. A novelist living in Devon has just won a large settlement award for a claim that, brain-damaged by toxic fumes, she became unable to finish a ‘serious’ novel and instead turned to writing crime fiction. This happens just as the barriers between ‘literary’ and ‘populist’ fiction appear to be breaking down. I came upon this Guardian article because I have a standing Google alert set up for new references to Ian Rankin, Scottish writer of police procedurals who is mentioned in the lede of the essay and whose work I enjoy as much as any ‘serious’ fiction I read. If the major distinction is the relatively greater emphasis on plot, then perhaps I do not read any serious literature at all any more, as I look for a thumpin’ good story in most of the literature I read.

Many psychiatrists and therapists are aficionados of mysteries. I have considered several explanations for that. For one thing, mystery writers are in the habit of looking unflinchingly iinto the dark recesses of the soul, as do mental health professionals. When I was in training, one of my supervisors, Les Havens, a brilliant and iconoclastic psychiatrist on whose every word I hung as if it was the gospel, once told me that John Le Carré was one of the most insightful analysts of character who had ever written, and I’ve devoured Le Carré ever since.

But, for another thing, after a day at the office many a therapist tires of thinking only about character and thirsts for something with a storyline. This is especially true of stories that have a satisfying outcome, which I sometimes feel we do not see that often in my line of work. Patients with major mental illnesses often remain static, the things that do not work about their lives unchanging, with few resolutions and only minor improvements despite considerable and repetitive struggle. When one works with the severely mentally ill, it seems to me on many days that it is about helping them and their loved ones in bearing what cannot change rather than changing what cannot be borne. But, ah, a story with tension, a climax, and resolution….

For most psychiatrists, science fiction does not have an appeal comparable to mysteries, but I have been an aficionado of that genre as well. (Few psychiatrist are as geeky as I have become, I suspect…) I have a Google alert set for Neal Stephenson as well as Rankin. Stephenson, incidentally, might consider himself as much a genre-bender as Rankin. Can one really say, with his Baroque Cycle, that he is still writing science fiction? For that matter, can one say that of William Gibson’s recent work? I have always paid attention to the ways in which social context causes, or contributes to, my patients’ psychiatric distress. Speculative fiction often turns on the extrapolation of social trends to extreme and/or surprising conclusions. That, more than ‘hard’ science fiction revolving merely around scientific or technological extrapolation, has always appealed to me, although it is a truism to say that technological trends are major shapers of social trends.

As for my geekiness, my involvement with computing, I find the appeal to a mental health professional clear and I have been surprised it is not more broadly shared by my colleagues. When I sit down at my computer desk, I can make a machine do whatever I want it to do in a manner that never happens in interacting with other human beings during my workday. And, if things don’t turn out as I expect with the machine, it is entirely my fault and my approach can be corrected or perfected to gain the expected outcome, my mistake immediately clear. There are alot of “aha!” moments; the sense of mastery is immediate and very satisfying. This is very unlike psychotherapeutic work, which depends on the complex dance of interacting with the subjectivity of another (the I-Thou relationship, as distinct from the I-It relationship, to use Martin Buber’s terminology) and where, I might argue, mastery is never a word one would use except in a cocky sense.

This appeal of mechanistic success, which I get out of ordering a computer around, may be what drives some psychiatrists to psychopharmacology, in the illusion that it is more definitive and that results come more rapidly than any of the other more murky facets of mental health work. But, I would argue, the satisfaction from mechanistic psychopharmacology in isolation is usually ill-founded and transient, and people are mistaken if they think pushing pills is treating people with mental illnesses. One of the best, least mechanistic, psychopharmacologists I knew fulfilled himself in his off-hours with sculptural metal welding, and another with wooden boat building. Hmmm. Maybe more mental health folks ought to take up a technological pursuit, so that they do not have to be so mechanistic with their psychiatric patients.

What we know and what we remember are both clearly part of the memory system but a new study demonstrates they are mediated differently neuropsychologically. (Cognitive Daily)