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Dr Shyam K Bhat MD is a
Psychiatrist and Integrative
Medicine specialist.

He is board certified in
Psychiatry, Internal
Medicine, and
Psychosomatic Medicine,
with additional certification
in clinical hypnosis

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Our Brain is Wired


A post from my Medscape blog for psychiatrists:

I just read a story on MSNBC about grammar vigilantes. The story says that those who are sticklers about grammar, spelling, and punctuation, have become even more fastidious because of all the stress in their lives. ( Hope they are not reading this blog.)

The article is trying to be interesting and cool. I get that. After all how many stories of “the worsening economy is causing stress and depression” can one read?

But I was still irritated by the obligatory quote from a psychologist, a Paula Wallin: “Our brains are wired to notice what s different and when you re sure of the right way and the wrong way, you notice mistakes more, says Wallin. The article goes on to say, “(Wallin) admits to dropping out of an exercise class because the instructor kept misusing the word lay.”

Ms (Dr?) Wallin also adds, “Attribution theory comes into this as well.” (comes into this?)

Now, we all know that her statement about “our brains are wired” is just, how does one put it delicately, BS.

“Our brain is wired” misleadingly implies that the psychologist, or at least, her profession, or science as a whole, has a thorough understanding of the exact pathway that is responsible for the phenomenon in question. In addition, the statement, “Our brain is wired to ___” implies a false cause and effect relationship between neuroanatomy and behavior.

Her statement about “attribution theory” may be peripherally relevant, but it strikes me that this psychologist is struggling to come up with something germane and insightful to say.

This genre of story must be familiar to you. It is what I call “says a psychiatrist” ( I am open to new suggestions for the name).

The formula is straightforward.

1. Start with a novel, sensational premise. Accuracy is not as important as the novelty factor. Examples include, “The Economic recession causes increased baldness,” or “Why Some Men Find Older Women Attractive ( A story that I perused while at the local haberdashery earlier this afternoon.).

2. Interview a Psychiatrist or Psychologist.

3. Throw in a few stories of sufferers of that phenomenon.

4. Write a clever headline.

5. Voila! You ‘ave ze story, monseiur/madame.

Ms Wallin, by the way, is particularly skilled – she helps the journalist fulfil both steps 2 and 3 of the genre.

So how does the psychologist end up sounding like a lay subscriber to Psychology Today?

Here’s how it probably plays out. The interviewer calls up the psychologist who is flattered to be asked. Then they ask her something like “So what are the psychological factors that could be causing this to happen?”

She finds that she can’t bring herself to say, “We don’t really know, I mean I could speculate, but that’s all it is, just speculations and theory.”

So she says, “Our brain is wired to …”

Now you may think I am an exemplary fellow who could never make ill considered remarks like Wallin’s. But I have to confess that a year or so ago, I was interviewed on the radio. And the interviewer said, “Is the election making life more difficult for married couples?”

“Sure, I said. “When a couple does not agree on the candidate, they might have issues in their relationship, because they are disagreeing on something that might be as fundamentally important to them as religion.”

The interviewer didn’t look impressed, and, I, thinking that thousands might be listening, attempted to say something more insightful and informative.” People are always passionate about some things. It s the way human beings are” And then I added, “Our brains are wired to do that.”


The Patient is Unresponsible


“This patient has no responsibility,” the resident said.

Interesting, I thought. Responsibility. Not a word I heard often anymore, at least not since high school, when I was occasionally accused of lacking it.

So what did this young psychiatrist mean exactly – no “responsibility”? Depending on cultural norms, I suppose there could be 2 broad definitions of the word.

Definition 1. Responsibility: To “take ownership of your actions,” a phrase that has become tainted with its use by television psychologists and talk show hosts, and Britney Spears.

Definition 2. Responsibility: To fulfill one’s obligations and duties.

To fulfill one’s duties. Is that a sign of psychological health? After all, the existentialists would argue that duty and obligations are ultimately decided by family, community, and society; therefore to fulfill your duty is to give up your intrinsic freedom, to bow to external social forces and expectations.

By this logic, an irresponsible person would be considered more psychologically evolved than the responsible person.
Put another way: If duties are dictated by social structures, and responsibility means fulfilling your duties, then to be irresponsible is actually a sign of psychological health.

But that’s clearly not true: The irresponsible person – someone who endangers other people by his actions – is not completely healthy. And the responsible person – someone who fulfills his or her duty, who does only what society and culture and subculture expect – is not at the highest level of psychological functioning either.

So, what is healthy responsibility then? And how to define it so different psychiatrists can agree upon its absence or presence in a person?

Well, what if the definition of “duty” was expanded to include not just obligations to a few people, but to all people?

In other words, a responsible person looks out for his own, but also for those who are not, he knows that although he is an individual, he has a responsibility to the world, he thinks about immediate as well as long-term consequences of his actions. To paraphrase some great man, the responsible person acts locally and thinks globally.

“In what way does the patient have no responsibility?” I asked the resident, ready to launch into a lengthy discourse.

“She is not responsible to time, place, or person, not even responsible to painful stimuli,” the resident replied, with characteristic confidence. “The patient is unresponsible.”

“Oh, ” I said. “You mean, the patient is unresponsive.”

Disclaimer: A work of fiction. Any resemblance to anyone alive, or deceased is purely coincidental.


Solzhenitsyn


“If only there were evil people somewhere insidiously committing evil deeds and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?”

Aleksandr Solzhenitsyn


The Nietzsche Syndrome


“Do what you like, it’s not going to make a difference. I will kill myself.”

“You sound determined.”

“Life’s not for me.”

“How do you mean?”

“I just don’t want it.”

“What’s a typical day like for you?”

“I wake up in the morning, then I walk 4 miles. That’s crazy, right, that I want to die but I want to stay healthy? Anyway, I watch some TV, get something to eat, maybe take a nap.”

“You watch a lot of TV?”

“The TV’s my friend. I come back home and the house is all empty, there’s nothing going on, then I turn it on and the whole room fills up.”

“How do you feel, most of the time?”

“You mean my mood? I feel alright.”

“Sad?”

“Not really.”

“Happy?”

“No. Just numb.”

“For how long?”

“Ever since I can remember. Look, I know you’re trying to figure out how to help me, but you’re wasting your time. Nothing you can do.”

“You just don’t want to live.”

“Right.”

“Why are you still alive?”

“You mean, why haven’t I succeeded in killing myself? Well, I thought about jumping out of a building but I’m scared of going that way. I want to take pills, but only barbiturates or sleeping pills and you can’t get that at the store and my doctor won’t give them to me. Thought about hanging myself, but I’ve read stuff about how it’s easy to screw that up.”

“How about a gun?”

“No, I knew someone who tried that and he’s a vegetable, living in a nursing home. Tried cutting my wrists, but I didn’t go deep enough, and that didn’t work either.”

“So what did you do last night?”

“You mean with my throat? I cut here and -”

“Did you use a knife?”

“No, a blade. I -”

“Were you in front of a mirror?”

“Yeah, I set it on my bed – my bed’s in the living room so I can watch TV lying down – and I sat down, got a towel on my lap…”

“What did you do then?”

“I made some cuts, slowly, just scratches, then I said I got to do it now, so I push the blade in. I get a lot of blood so I lay down and wait and the blood’s coming out and the towel’s soaked but I’m still awake and I start to think, ‘What if the blood to my brain stops and I wind up brain dead like that guy I know?’, so I called 911.”

“How long do you think before you try again?”

“Oh, I don’t know, it could be tomorrow, could be next year. You want to keep me in the hospital, you go ahead. But I’m telling you, it’s not going to help. I will kill myself someday.”

“It is always consoling to think of suicide: in that way one gets through many a bad night”
Nietzsche