A Guided Tour of Madness

 Disclaimer: This essay is probably kind of a drag, just because my condition is kind of a drag, so skip it if you don't want to read Debbie Downer. This isn't a vent post. It's intended to give the sane a little insight into the mad.

 

I have schizoaffective disorder, bipolar type. The condition includes schizophrenia symptoms and symptoms of bipolar mood disorder. In my case, my psychosis and mood swings are handled pretty well with medication, but the other symptoms - particularly of the schizo side of the disease still seriously affect me day to day.

Being medicated is not a lot of fun. At least unmedicated I could find some amount of pleasure in my manic states, but on the meds everything is blunted. I become impossible to live with and care for when I am unmedicated, so I take my meds for the sake of my spouse, but not so much for me. I could write far better when I was unmedicated, so you'll have to bear with me.

I aim to take you through some of the symptoms as I experience or have experienced them. Hopefully it will give you an inside glimpse at madness. Maybe those of you already familiar with madness can find some common thread herein.

Adventures in Diagnosing

Diagnostic paths for mental illnesses are often bumpy roads that may require several different opinions from different doctors. In fact, due to the nature of psychiatry, I recommend getting second and sometimes third opinions in any case.

I was initially "diagnosed" with bipolar one (which is "manic-depressive" with psychosis) in the emergency room of a hospital by a nurse. I was in that emergency room because I was manic and psychotic for well over a week and my partner finally convinced me to go with to the ER. They offered to commit me to the mental hospital (which here is inside the regular hospital) and my spouse declined and told the doctor he'd care for me after I told him they wouldn't let me smoke and I'd lose my shit.

So for about three months or more I thought I was simply bipolar. The mental health professionals I was seeing were running with that bipolar label even though it wasn't an official diagnosis - since it had been given by a nurse. Getting in front of an experienced and competent mental health professional is not so easy, especially in my country, and especially if you don't have ridiculously good insurance. If you're on Medicare/Medicaid you can forget it. Pay out of pocket. The first one I went to refused to even evaluate me to update the diagnosis even though I was showing symptoms other than bipolar.

It was my spouse pouring over the DSM that informed us of schizoaffective disorder. My symptoms are pretty textbook for that illness so it was an easy connection to make. Armed with this information/possibility we set out looking for a good psychiatrist, and finally found one in private practice about a 30 minute drive from us. That's what it took in the end. Letting the therapist know my symptoms, and asking about schizoaffective disorder I think helped - then they knew what to look for at least. I secured that diagnosis and then also got a second opinion as well. I still go to that psychiatrist today despite the drive.

Living With This Mess

I was sick for a long time before I knew it. It should have been obvious the way my adult life had been going, but it wasn't to me. I knew I wasn't normal, but I didn't know how sick I was. I thought I was just different. My parents didn't know, so the early symptoms I exhibited such as the extreme mood swings, were attributable to me being an asshole teenager. My mother called the cops on me repeatedly because of my behavior. She should have had me sectioned instead.

I didn't have psychosis until a few years ago, so I went through my childhood and most of adulthood without any idea I was sick. I had a career in software, which people with my condition simply don't have. We can't hold down jobs. We can't manage things like deadlines. Nobody informed me of that however, so there I was. It helps that I wasn't as sick as I am today. Looking back, my career was rocky. I was good at coding, but not any of the soft skills necessary for a job. I was really difficult to work with but people worked with me because I was a damned good developer. I'm sure I was expensive to manage - I was even told that by an employer once.

My career was there, but my home was a wreck whenever I lived by myself, and generally my personal life was a rolling disaster. My partner who has known me since I was 17 and he 15 always told me I needed to be in a group home. He wasn't wrong, but I thought he was just messing with me. I refused to believe I needed help.

Even when I'd get arrested from time to time (most recently in 2006 because i drank way too much, blacked out and apparently broke a door to a clinic), police would mention at my arraignment that mental health might be an issue. I balked, and got myself a lawyer. Every time. That's the problem with being sick and having cash. I had options, and I didn't choose the right ones.

Going Psychotic and Other Hobbies

Psychosis can be fun. It can be enlightening because it is like looking at the world with the brain's filters turned off. Imagine our brains cut out a lot of what we see and hear, because it isn't real (i think this is actually how it works anyway but don't quote me) - what we're left with is roughly reflective of reality, but it had to be pruned by the subconscious mind for us to make sense of those sensory inputs. If any of you have ever taken hallucinogens you'll have at least a vague idea of what I mean above I think. You see it all.

I really enjoy mania induced psychosis because it feels like I have access to the world that exists underneath what we perceive as the world. I've seen the whole of creation unfold before me and it was breathtaking. If I lived 6 lifetimes I'd never see anything so beautiful again. I felt intensely spiritual. Magic was everywhere, and I could understand it and it work with it. I found amazing patterns everywhere I looked, including in scripture. Some of what that "taught" me I still hang on to today, because despite coming to me whilst psychotic, it wasn't all garbage. Some of what I discovered about scripture for example, was legitimate.

Some of what happened to me changed me for good. Even the way I write software is different now, more fluid because I don't have to think about it anymore. I learned to background it reliably so I don't have to devote conscious thought to it a lot of times. That's a trick I learned while psychotic, and it has proved useful to me since. I can now hold a conversation whilst coding. Unfortunately, since my last major psychosis of this nature, some of my other symptoms got much worse, and I think they're related.

I also experienced another form of psychosis, this coming from the schizo end of my illness, and it was terrifying. "Bad magic", bits of the universe I could see that would harm me if I got too close, and the "night people" who wanted to turn me into one of them ruled this experience. The "night people" are particularly terrifying because they're constructed from my deeply seated core fears - pure nightmare fuel. These experiences are not fun at all. Sometimes they can be interspersed with the good ones, leading to a confusing rollercoaster of fear and elation.

Negative Symptoms

A positive symptom is a symptom that's present in a patient that's not found in healthy people - like psychosis
A negative symptom is a symptom of something that's not present in the patient, but is present in healthy people, like the ability to feel pleasure.

The negative symptoms of my condition are debilitating and not very treatable. They include but are not limited to social isolation, a diminished capacity to feel pleasure, disorganized thinking, diminished motivation, and depression that's not responsive to medication.

They're the worst simply because they resist treatment, and the meds don't help, so they're what I have to live with.

The social isolation may be the worst for me. I can't really form and maintain social relationships like I could before I got really sick. I avoid people, in part because of my fear of the night people - even though I no longer believe in them the fear is still there - but mostly I think because that part of me just doesn't work anymore. I don't call people, nor will I keep a phone. I barely leave the house (I also have a panic disorder, which gives me panic attacks while I'm out) and when I do it's with my spouse, not alone. My friends either bailed when I got sick, or we fell out of touch when I became a hermit over the past few years. It doesn't stop you from missing having people in your life. It doesn't stop you from getting cabin fever. It just means there's often no way to be content or comfortable. The only way to be my friend anymore is through concerted effort, because I don't reach out to people anymore. I just don't have it in me.

What I think scares me the most however, is losing interest in my hobbies. Without those I'd just be waiting around to die. Anhedonia (the inability to feel pleasure) and avolition (being unable to be motivated) are terrible symptoms of schizoaffective and schizophrenia disorders. Talk about being zombified. What is someone that is interested in nothing and has no motivation? I fear that.

The disorganized thinking and behavior affects others more than it does me. I talk to myself, I can't foster and keep routines which affects everything from eating regularly to personal hygiene. I have a partner who is home frequently and is good about taking care of me, without which I'd be a mess. These issues don't cause me direct personal grief but they do affect other people, because I'm not so hot at taking care of myself without help these days. I don't like the loss of independence but it's something I can at least see myself being able to live with in the long term.

Prognosis

The prognosis for my illness isn't great, because it's not entirely treatable, and it's pretty debilitating, but schizophrenia, which is like a sister condition to this is worse, prognosis-wise, so at least I didn't end up with that. Schizophrenia runs in my family, however. When I was young - about 18 or 19 I feared I was going to end up with schizophrenia. Turns out, I wasn't far off.

In any case, there are very few jobs I can work at, so I hang on to the one I have, despite it being something that would otherwise be well beneath me due to my skill set. I went from coding for Microsoft at 18 to cleaning toilets at 40 because of this condition. Fortunately, I work alone - am not out of the house for more than an hour and a half at a time, I set my hours, and I don't speak to my supervisors for months on end. That's the sort of job I can do these days. Anything more than that and at best I get panic attacks, at worst I have another breakdown and sink further into my illness, which has already happened a couple of times.

I've accepted that I'll probably never have anything resembling a normal social life anymore. My outlet is online because it's what I can do. At least I'm married so I'm not totally alone.

Conclusion

I don't have some sort of happy ending for you. The condition sucks. Medication ostensibly helps keep it from getting worse, but it doesn't make people any better. It just fixes some of the symptoms. Cognitive Behavioral Therapy with emphasis on patients with psychosis can help with some of the negative symptoms, but how much is questionable. I've got my spouse, and I've still got my physical health. Fuck the rest of it.

Chapter Review: The Cognitive Neuroscience of Moral Judgment and Decision-Making

The Cognitive Neuroscience of Moral Judgment and Decision-Making is chapter 88 of the 2020 book The Cognitive Neurosciences (sixth edition). This chapter was written by Joshua Greene and Liane Young. The book is academic, 1113 pages long and expensive ($233). It is not written for a general audience. It is a fairly detailed review of the state of cognitive neurosciences for academics and researchers.

Moral thinking is whole-brain thinking

Greene is the pioneer of one of the major models of the neuroscience of morality, the dual process model (mentioned in this book review):

Unconscious emotion-intuition and conscious reasoning lead to moral judgment (dual inputs): Reasoning + emotion → moral judgment

According to this hypothesis, both unconscious emotions and intuitions and conscious reason play a role in moral thinking and decision-making. The evidence to support that general thesis strikes me as overwhelming. What isn't known is the details of how the brain does what it does.

One concern about the neuroscience of morality that Greene and Young (G&Y) discuss is the possibility that morality as a separate scientific research field could be in danger of becoming meaningless. Accumulating evidence shows that morality appears to have few or no neural mechanisms that are unique to  moral thinking. In other words, moral thinking appears to rely mostly or completely on the same pathways and brain structures that mediate various kinds of non-moral thinking. G&Y comment: “It’s now clear, however, that the ‘moral brain’ is, more or less, the whole brain .... Understanding this is, itself, a kind of progress .... if this unified [whole brain] theory of morality is correct, it doesn't bode well for a unified theory for moral neuroscience.”

Apparently, there is no specific brain structure(s) that uniquely do the mental data processing involved in making moral judgments.

Morality and moral neuroscience defined; The specter of warring tribalism

If one wants to do research on something, it helps to have a definition or description of it. The description has troubling implications for long-term human survival and well-being. G&Y write:

“... we regard morality as a suite of cognitive mechanisms to enable otherwise selfish individuals to reap the benefits of cooperation. Humans have psychological features that are straightforwardly moral (such as empathy) and others that are not (such as in-group favoritism) because they enable us to achieve goals that we can’t achieve through pure selfishness. .... Morality evolved, not as a device for universal cooperation but as a competitive weapon -- as a system for turning Me into Us, which in turn enables Us to outcompete Them. It does not follow from this, however, that are are doomed to be warring tribalists. Drawing on our ingenuity and flexibility, it’s possible to put human values ahead of evolutionary imperatives, as we do when we use birth control.”

Morality and pragmatic rationalism

Based on my limited understanding of history, humans have always been warring tribalists and arguably still are today to some extent. Although it usually doesn’t seem that way, here is less warring between armies and nations going on in modern times than in past centuries.

Other than birth control, G&Y do not give evidence for their belief that ingenuity and flexibility can allow the species to put moral values ahead of evolutionary imperatives. The sentiment seems to be mostly aspirational, not empirical. In view of the major expansion of power that modern communications technologies give to demagogues, tyrants, liars and other bad people, one can argue that democratic, rule of law-driven societies are falling to evolutionary imperatives, including authoritarianism. The rapid rise of modern communications technology has blown right past slow human evolution. Societies have to evolve because biological evolution cannot keep up.

One core goal of pragmatic rationalism’s moral structure is to somehow form a gigantic Us in-group for the human species. As I learn more, e.g., by reading chapter 88 of this book, that seems increasingly unlikely. The next best thing seems to try to unite all people in a single country based on the four core moral values that pragmatic rationalism is based on. Inherent in the third moral value, service to the public interest, is an anti-war bias that is intended to reduce violence generally, including between nations.

The problem with the nation-size In group formation hypothesis is that, as we are witnessing in real time, demagogues, liars and other bad people who rely on dark free speech, can tear the people of a nation to pieces. It is odd because the conservative and GOP side is explicitly appealing to American nationalism, but it nonetheless is tearing us apart. A major reason the modern conservative appeal is tearing us apart appears to be that it is significantly grounded in irrational bigotry, racism, distrust, hate, misogyny and intolerance of Out groups. Dark free speech has created all of that poison in the minds of millions of people.

At present, circumstances and evolutionary imperatives do not bode well for the rise of pragmatic rationalism. In my opinion, that is unfortunate to say the least.

Marge Simpson has something to say to the Trump campaign

 Marge Simpson is feeling a little disrespected.

On Friday, the official “The Simpsons” Twitter account posted a video of the blue-haired matriarch responding to a Trump campaign advisor who appeared to try to insult California senator and vice presidential candidate Kamala Harris by comparing her voice to the character’s.

“I usually don’t get into politics, but the president’s senior advisor, Jenna Ellis, just said Kamala Harris sounds like me,” said Marge, who has been voiced by Julie Kavner on the animated Fox series for 31 seasons. “Lisa says she doesn’t mean it as a compliment.”

“If that’s so, as an ordinary suburban housewife, I’m starting to feel a little disrespected,” she continued. “I teach my children not to name-call, Jenna. I was going to say I’m pissed off, but I’m afraid they’d bleep it.”

https://twitter.com/TheSimpsons/status/1294287342144872449

https://www.latimes.com/entertainment-arts/tv/story/2020-08-14/marge-simpson-responds-kamala-harris-trump

Lies Gush Forth Upon the Land

The president is ramping up his lies and using them against his political opposition. The New York Times reports:

"President Trump on Thursday encouraged a racist conspiracy theory that is rampant among some of his followers: that Senator Kamala Harris, the presumptive Democratic vice-presidential nominee born in California, was not eligible for the vice presidency or presidency because her parents were immigrants. 

That assertion is false. Ms. Harris is eligible to serve. 

Mr. Trump, speaking to reporters on Thursday, nevertheless pushed forward with the attack, reminiscent of the lie he perpetrated for years that President Barack Obama was born in Kenya."

The transparency of his lie is obvious. It is also discouraging because millions of his followers will come to believe it. The president lamely commented: "I heard it today that she doesn’t meet the requirements. I have no idea if that’s right. I would have thought, I would have assumed, that the Democrats would have checked that out before she gets chosen to run for vice president."

This lie appears to be based on an August 12, 2020 article in Newsweek that asserted that children born in the US of immigrant residents are not US citizens. That false idea was asserted by a conservative lawyer who has been arguing that for years. Once again, crackpot lies become mainstream conservative politics and their sacred alt-reality. Trump himself has been arguing the same thing for a while.

Regarding COVID-19: It's Worse Than What is Reported

A New York Times analysis of excess deaths data from the CDC indicates that about 60,000 more people have probably died from the pandemic than official statistics are reporting. If that analysis is correct, the number of coronavirus deaths is now well over 200,000. Some of the extra deaths is probably from unintentional under counting of deaths. Some is from intentional reducing the death count for political purposes, especially since the president took the counting away from the CDC and gave it Peter Thiel's company. The NYT writes:

Across the United States, at least 200,000 more people have died than usual since March, according to a New York Times analysis of estimates from the Centers for Disease Control and Prevention. This is about 60,000 higher than the number of deaths that have been directly linked to the coronavirus. 

As the pandemic has moved south and west from its epicenter in New York City, so have the unusual patterns in deaths from all causes. That suggests that the official death counts may be substantially underestimating the overall effects of the virus, as people die from the virus as well as by other causes linked to the pandemic.

 

The president's creepy supporter

One source characterized Peter Thiel's involvement like this: "Peter Thiel’s Creepy Tech Firm Is Helping The Government Track Coronavirus." Thiel is a billionaire who made his money by co-founding PayPal. Thiel was a major supporter of the president in 2016, but now fears that he won't be re-elected. Thiel now claims to be backing away from supporting the president's re-election. Given how frequently both the president and the people around him lie, it is reasonable to believe that Thiel is lying about COVID-19 deaths to help his friend get re-elected without donating any cash. Cash donations can be traced back to donors under current law. To hide his support for the president, Thiel's donations are fudged COVID-19 death counts instead of cash. That could be worth more than a pile of gold.

Coronavirus Update 13

Faking the coronavirus pandemic data & lying to the American people: 
“the federal data continue to be unreliable”

A New York Times article reports that experts believe that coronavirus data is being manipulated. In July the president ordered data collection, analysis and reporting to be taken from the experts at the CDC and done by private sector political hacks the HHS hired. Since that time, the infection data veered off the course it was on and infection numbers started to decrease. That was especially true for some red states where the pandemic had spun out of control. The NYT comments:

“Nearly three dozen current and former members of a federal health advisory committee, including nine appointed or reappointed by the health secretary, Alex M. Azar II, are warning that the Trump administration’s new coronavirus database is placing an undue burden on hospitals and will have ‘serious consequences on data integrity.’ 

The advisers, all current or former members of the Healthcare Infection Control Practices Advisory Committee, issued their warning in a previously unpublished letter [shown above] shared with The New York Times. 

The letter was made public as both hospital officials and independent data experts around the country were reporting kinks in the new system, which critics say is undermining the government’s ability to understand the course of the pandemic. The Covid Tracking Project, a respected and widely used resource, identified “major problems” with the new Department of Health and Human Services system in late July, and reported this week that ‘the federal data continue to be unreliable.’”

Once again, an administration with no respect for truth or honesty with the American people is desperately trying to convert real reality into a fake reality. When that happens, as it is right now, reality becomes fake and fake becomes real.

Coronavirus provides weak cover for a major attack on democracy

One possible long-term effect of the pandemic could be a permanent loss of voting rights for democrats and many independents. A Washington Post article, Trump says he’s blocking Postal Service funding because Democrats want to expand mail-in voting during pandemic, comments:

“Trump said Thursday he does not want to fund the U.S. Postal Service because Democrats are seeking to expand mail-in voting during the coronavirus pandemic, making explicit the reason he has declined to approve $25 billion in emergency funding for the cash-strapped agency.

‘Now, they need that money in order to make the Post Office work, so it can take all of these millions and millions of ballots,’ Trump said in an interview on Fox Business Network’s Maria Bartiromo. He added: ‘If they don’t get those two items, that means you can’t have universal mail-in voting, because they’re not equipped.’”

In view of how blatant this move to suppress voting is, the president, the political right and the GOP appear to have given up on even trying to appear to be pro-democracy. To them, single-party rule is the goal. There is no obvious reason to think that after the president leaves office, assuming he ever does, that the radical right will ever go back to actually supporting free and fair elections. To the radicals, the new model of democracy is single party rule. The pandemic appears to have flushed this long-term radical right authoritarian goal into the open.

That the postal service needs additional money is entirely the fault of the GOP. The GOP has been financially crippling the postal service for years because it wants postal service to be privatized. The New Yorker commented in a May 2020 article: “For the past forty years, Republicans have been seeking to starve, strangle, and sabotage the U.S. Postal Service, hoping to privatize one of the oldest and most important public goods in American history.”

An anecdote: We pay some bills by checks in the mail. It is now taking a few days longer for the checks to arrive. Since the president has already specifically targeted mail-in ballots for slower delivery, it appears that all mail is slowing down as part of the authoritarian assault on elections. Time will tell if the anomaly this month constitutes a new normal.