Time for the long overdue post on clinomorphism. A couple of people who know me will appreciate that this is literally years in the making and is sort of a running joke at this point.

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Psychiatry is a branch of medicine, and rightly so, but it’s in a unique position within medical science. Medicine is traditionally a very “hard” or rigorous science, dating all the way back to Hippocrates of Cos, whose suggestions that medicine be evidence-based, and physicians be accountable, revolutionized Ancient Greek thought. The technology and knowledge base we now have in the medical establishment, particularly in North America, is astounding. The speed, accuracy, and rigor of modern diagnostics is absolutely staggering when we consider how far we’ve come in 50 years, or 100 years, or 200 years. Every area of medicine—pathology, oncology, neurology—is in itself a triumph of scientific progress. That’s not to say we don’t have a lot to learn and a long way to go in each of those areas, because we do, but it’s amazing to think how far we’ve come in understanding how our own bodies work, and how to fix them when they stop working in one way or another.

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Psychiatry, though, has always been seen as lagging slightly behind. In my life, I’ve had the experience of knowing lots of doctors, in lots of different settings, and while they all seemed to appreciate the general need for doctors who fix brain problems, there was a tendency to view psychiatry and psychiatrists as a little whimsical, a little self-indulgent, a little less rigorous. I heard many of them describe their psychiatric colleagues as people who just talked. No science, just talking. From a few others, including a lot of psychiatrists, I heard a deep appreciation for pharmaceutical medicine. “The only part of psychiatry I can stand is the drugs,” one actual psychiatrist told me. “The rest of that bullshit, I can’t deal with it. I deal in neurochemical problems.” Then I’d talk to patients, or prospective patients. They all unilaterally hated drugs, hated the idea that someone would give them a pill that would take away their problems. There are issues in pharmaceutical medicine, for sure, but I thought that if a large number of people were actively foregoing treatment because of real or imagined issues with psychiatrists and the way they practiced their trade, then something deeper was wrong.

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On some level, it’s very obvious. Of course something deeper is wrong. Bones are complex, sure, but when they break it’s not that hard, intellectually or mechanically, to put them back together, most of the time. Cells are complex, sure, but we already know a whole bunch of stuff about cells, enough that we can predict the gradient of chemical cascades during cellular chemical signalling. But the brain is several orders of magnitude more complex. It’s the most complex thing in the known universe. Approach it from any angle, in any field, and it’s absolutely daunting. Treating a cracked rib or a tropical disease is tricky, and demanding, and not always successful, but it’s a problem that you can state in clear scientific language. And language, if you’ve been reading my tumblr, is an essential component to problem solving. If we can phrase a problem, we can look at how we might solve it. But what the hell does depression even mean?

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Brain functions depend on a phenomenon called emergence. Emergence is the aggregate behavior of smaller entities within a complex, chaotic system—mathematicians call this chaos theory or complexity theory and it’s kind of a sexy thing to study, but the point is this: the brain is made of neurons. Neurons are complex from a literal standpoint but biologically they are fairly simple and fairly well understood. Neurons don’t think, don’t feel, don’t develop specialized anxiety disorders or start smoking marijuana in the garage to piss off their parents. But sometimes, huge numbers of neurons working together do those things, and we don’t know how or why. 

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I took a research seminar course on the emergence of conscious thought last semester, with a South African guy who runs a lab studying correlations between hand movements and brain activity. His lab employs a quantum physicist to do the path integrals that they use to model the movement. I was pleased to learn about this use of interdisciplinary thought—if there are just two things I got from years of education, it’s that interdisciplinary thought and precise language are the best problem solving tools we have—and so I told him about my background in math, and my speculations about the intersection of chaos theory, Turing-completeness, and consciousness. He considered all of this and told me I had good ideas and that I should consider graduate work, but that many geniuses had spent their careers on this particular question and if I’d been paying attention in the seminar, I would remember that we didn’t have any clear answers just yet. Stay humble. Stay motivated. I didn’t want to do graduate work in neuroscience, even though I’d sort of planned on that for a while, but it sort of confirmed what I already knew from talking to lots of psychiatrists. Nobody, in any field, really knows what consciousness is or what it does or how the brain, composed of lots of simple neurons, can produce complex behaviors that we all take for granted.

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Whereas, we know all about bones and how they break. 

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If you don’t know much about how something works, and nobody else in the world really knows either, how good are you going to be at fixing it? Psychiatry is necessary, because brain problems are real and serious, but it’s important to stay humble about psychiatry, because it has a far more ambitious task than any other medical field, and far fewer resources with which to approach that task. The problem, as I saw it at 18 when I started thinking about this stuff, is that psychiatry is using the same methodology as other medical fields. Find a set of related problems, name it, and find a treatment pattern that generally works. That’s an effective methodology in, say, internal medicine, because when I say “heart attack” I mean a specific thing, with a specific set of causes (actually, that’s another post for another time) and a specific set of treatments, but when I say “depression” I usually just mean feeling sad, and that’s not a clear medical phrasing of a clear medical phenomenon.

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On the other hand, read the DSM, a catalog of psychiatric disorders. I have, cover to cover, because I was an odd 17 year old. The DSM is published every few years, with a panel of professionals voting on which disorders to officially recognize. A long time ago, the DSM mentioned homosexuality as a disorder. Now, of course, that seems ludicrous, but there was a time. Not that long ago, psychopathy was a disorder, and now it’s called antisocial and dissocial personality disorder. The set of disorders included in the DSM evolves with our understanding of psychiatry, and the optimistic and I guess mainstream way to look at this is to say that we are getting better at naming and understanding specific disorders. The other way to look at this is to say that some disorders happen to be trendy, and others happen to be politically incorrect, and the end result is a product that is very much a reflection of its social and historical context rather than a paragon of diagnostic accuracy. I’m on the fence. 

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Setting aside the problems of complexity, lack of precision, and questionable definitions, we also have the problem of communication to the public. Because the average person doesn’t know that the presence of ascites implies cirrhosis, and because the average person accepts this, there’s generally an understanding between patient and physician wherein the patient accepts that the physician’s diagnostic training and scientific knowledge is both specialized and exclusive, and that, all other things being equal, you should probably do what the doctor says. Not so in psychiatry. There’s a trend among psychiatric patients I’ve met and talked to, and even among the general public, of self-diagnosis, or active diagnosis of other people. So-and-so is a sociopath. So-and-so is clearly autistic. That damn doctor can’t see that I’m depressed.

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This is called clinomorphism.

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Nobody would falsely say “I’m having a heart attack right now,” because a heart attack is a specific thing, and nobody would say “Sarah in accounting is being a jerk, probably because she has cirrhosis” but somehow it’s okay for us to say “I’m feeling depressed today” or “I’m so socially awkward, I basically have Asperger Syndrome.” Psychiatry isn’t a powerful science. It’s affected, more than any other field of medicine, by trends and whims, and two psychiatrists will differ more in their perspectives than two cardiologists or two pediatricians, which is in itself a pretty good test of rigor. But self-diagnosis, or diagnosis of other people when you don’t have a lifetime of medical training behind you, does a disservice to real sufferers of real disorders, because those people have big, big problems that they are dealing with. Nothing is helped by malingering. 

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I’m only being this aggressively critical because I’m guilty of clinomorphism too. As a teenager, I did it all the time. My mom really does have anxiety, really does have severe obsessive compulsive disorder at times, and when I felt nervous, I would say that I have anxiety. Test anxiety. Social anxiety. In high school, I wrote most of my exams in my own little room because the teachers all believed me when I said I had a generalized anxiety disorder. Nobody talked to a doctor. Nobody asked what a generalized anxiety disorder was. I very obviously don’t have one. I very obviously have no anxiety problems whatsoever. But I got my own rooms to write exams, all the way up to second year university, because nobody bothered to double check. At the time, I thought I really did fit into one or more of those diagnostic categories; now, I’m certain that I don’t and didn’t.

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Asperger Syndrome is even more trendy. The diagnostic incidence has increased enormously over the last couple decades, even posthumously; we hear, occasionally, that Einstein or Newton were clearly “on the autism spectrum” although anybody who is making that claim should realize that diagnosis simply doesn’t work that way. Never has, never will. Diagnosis requires facetime with a professional. I have two cousins with Asperger Syndrome, genuine, diagnosed, treatment-in-progress Asperger Syndrome. As a kid, because I was awkward and shy, I wondered if I had it, too. As a teenager, I worked consciously and deliberately on awkwardness and shyness and now I think I’m the opposite of those things, but there was a time. And my wondering, and occasional claims, did nothing to help those unfortunate people and families who are really dealing with it. The fact is, if a couple years of concentrated workaholic effort could make me socially confident and comfortable, then it wasn’t enough of a problem to merit a diagnosis. I feel kind of ashamed, now, looking back at how easily and casually I labelled myself and others. 

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Because I’d worked through that myself, I began to be a little less tolerant of people who engaged in haphazard psychiatric diagnosis. I’d seen enough depressed people who wanted or tried to die, enough anxious people who couldn’t live normal lives, enough psychotic people who had to take their meds lest they strip naked and play chicken with a train. Everyone is fighting their own battle. Everyone you see has some problem in their life, something that requires every bit of their energy to solve. And psychiatric problems are real, even if you don’t necessarily believe that the diagnostic categories are. Those people whose battles are psychiatric, who really do irrationally want to die or who cut themselves just to feel something, who nearly pass out when asked to leave their houses, who hear voices, who only eat even numbers of french fries that haven’t touched anything green or to whom human behavior is not merely confusing and bizarre, but actively alien and sadistic, those people deserve better than to be put in the same category as Sarah from accounting who is simply having a bad day. After all, Sarah from accounting has her own battles to fight. 

Languages are Awesome, Part 5: The Hockey Sweater

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“Pas de panic,” the French teacher said on the first day, and I took it to heart. “Don’t panic. This is the golden rule.” Where other students wrote FRAN 100 or the date at the top of the page, I started every day with Pas de Panic.

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The French teacher was a tiny, very expressive woman from Quebec who believed that the best way to teach somebody to swim is to try and drown them, so she spoke only French to us unless she was absolutely forced to use English. Since the majority of us spoke barely three words of French, she resorted to a series of gestures and chirps to communicate. “Ecoutez!” she would say excitedly, pointing to her ear. “J’aime le lapin!” Literally hopping up and down and holding her hands above her head. Four days a week, it was a three hour lecture in applied charades. We all got very good at charades, very fast.

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In introductory French, there are only two genders and the definite and indefinite articles don’t change with the grammatical case. Fresh from German and Russian and the more recent horrors of Arabic, I was delighted to discover this. In German there are at least 16 possible forms of the word “the”. In French there are only three; in English, just one. In Russian there are yet more, and we’re not even going to discuss Arabic. French has its exceptions and complexities, but as far as languages go, it’s not so bad.

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As a kid, I read a short story called The Hockey Sweater by Roch Carrier. It’s about a kid growing up in Quebec, as a fan of the Montreal Canadiens, whose Montreal jersey eventually decomposes through overuse. His mother buys him a new jersey, but, not being a hockey fan and not speaking English, she gets him a Toronto Maple Leafs jersey instead. The kid is horrified; his friends are ashamed; the coach refuses to let him play. He smashes his stick on the ice and goes to the local church to pray that God will send moths to eat his new jersey.

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I suppose there’s some allegorical value there but as I kid I was focused on the moths. I wondered if I could do the same thing, and summon moths whenever I wanted something eaten. Turns out I couldn’t, but that was not really the point of the poem; there’s a line, which now appears on the $5 bill, that appealed to me a lot more as a teenager and an adult. Carrier wrote “We lived three places—the church, the school, and the hockey rink. But our real life was on the hockey rink.”

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The way I took that line, your real life is what you’re thinking about when you are doing other stuff. When I was a kid, that was the hockey rink. I’d sit in school daydreaming about the next game or tournament. That evolved over time, obviously, but I always thought of that as a good way to look at things. Maybe your real life is knitting or playing rugby or hanging out with your girlfriend or programming neural nets in Python. But whatever it is, it’s what you’re thinking about. It’s always in the back of your mind. It’s when you feel most like yourself.

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The cultural or allegorical value of Roch Carrier’s story was something about the English-French divide in Canada, which has been written about extensively and which I won’t get into very much here. I have a lot of respect for Quebecois culture but the closest I’ve come to that was flirting with a girl from Montreal during a dull lecture on the future of, well, I have no idea what the lecture was about. 

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Countries like ours, with more than one ethnic group encapsulated under a single political entity, are always going to have some fairly complex politics. Somalia is an example I’ve written about once or twice; Bosnia and Russia come to mind as other good examples. In Canada, we have English and French, and we have a bewildering variety of First Nations cultures, and we have a vast, welcoming border that invites an enormous collection of international diaspora. We’ve handled it well, and it’s not a bad thing, but it’s something to be aware of; there is no typical Canadian. There are very few social or cultural or linguistic markers of being Canadian. 

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“Comme ci, comme ca,” said a kid in the back of the class, when the teacher asked him. She looked up from her attendance list, because everybody else said “Bien, merci” and inquired “Por quoi?” Without missing a beat he responded “Il y a un teste demain.” We have a test today. We’re not even supposed to know how to say that yet. My lab partner in this course is a girl who claims to speak no French but is apparently completely fluent, which is a mixed blessing—she does all the lab work, but I’m playing catch up. We therefore always finish lab work early, and turn to small talk. She’s a masters student in early modern history, studied Latin as an undergraduate and is taking this course to get her second language requirement dealt with. From Nova Scotia. The guy who spoke up earlier is a pilot, like me, and is joining the air force once he finishes his degree. There’s a girl from the Phillipines and a girl from Nigeria and there’s a guy from Winnipeg who speaks Mandarin but might be the whitest person I’ve ever met. 

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All this because there is no typical Canadian. 

Have you read Faust, I am thinking. Have you read any Goethe at all. Are you familiar with the story of Mephistopheles. 

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I am sitting at a table. Eating bacon. It’s a beautiful day outside. It’s warm and sunny and there is a light breeze coming in from the ocean. Sailboats and seagulls. Beautiful. I love the coast. And bacon. Bacon is delicious, and I am hungry. It’s going to be a perfect day.

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Addy hands me a bottle of Nos and says, just one little sip. Every slippery slope begins with one little sip. Nos is an energy drink. Taurine and caffeine and L-carnitine. Addy is grinning the grin Addy sometimes gets that makes me think of Mephistopheles. 

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In the Faust legend, Faust is this guy who reads a whole bunch of stuff and eventually concludes that, despite all his book learning, he is really not very close to knowing what life is about. Faust is an allegory for every academic, every human quest for knowledge. I identify with Faust occasionally and I think most people do. Most really good stories are retellings of things Plato or Socrates alluded to and Faust is no different. In the Faust legend, Faust is occasionally visited by Mephistopheles, a demon who tempts him repeatedly with various promises and pleasures. Mephistopheles is a cultural icon now, a symbol of temptation and corruption.

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Just one little sip, Addy says. She is pouring it into my glass. I never agreed to this. Addy is telling me how when she first drank Nos, she stayed awake for three days. I think this is a terrible idea but here we are. It’s yellow and fizzy. Addy is getting her Mephistopheles Grin. Usually when Addy gets that grin it is because we are doing something awesome, but today I am just a little bit, maybe, slightly, mildly, vaguely, worried. Because I have a lightning quick metabolism, and coffee, even just a couple of cups, makes me bounce off walls. And here Addy is pouring me a glass of taurine.

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A literary interpretation of Mephistopheles that I have skimmed suggested that Mephistopheles isn’t really the devil’s tempter. That Mephistopheles only appears to souls that are already damned and people who are already corrupt, to push them over the edge. That Mephistopheles was only brought into poor Faust’s reality because Faust, deep down, wanted it. Faust was on the dark side before ever Mephistopheles appeared to him. 

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One sip, Addy says. You are not good, I say to her. You are a bad, bad, person. Mephistopheles grins. One sip. Alright Addy. One sip. 

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Boom. 

I have never done this before and I probably won’t do it again for a very long time. 

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Limited time offer: Make a request. You can comment on this or submit it as an inbox request or contact me in person if you know me in person. 

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I will look over any requests I receive and consider writing a post about them. Call it a literary experiment. The only qualification you need to make a request is being able to see and read this sentence. Request as many times as you like on any subject. 

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Begin. 

Languages are Awesome, Part 4: Diglossia

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There are three big problems you encounter when trying to learn Arabic. The first is that it’s very hard to learn a language if you don’t have anyone to converse with, and where I live, Arabic speakers are hard to come by. In fact, I don’t know any. 

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The second problem is the language itself. Arabic is not anything like English. The alphabet looks funny, and it’s written right-to-left, and it’s only written in cursive, and each letter can be written four different ways depending on its position in a word, and short vowels aren’t written at all, just implied, and the letter which has the same sound as A is also the same letter signifying a glottal stop except for a tiny symbol called Hamza which is usually omitted because no Arabic words start with vowels so if you see the letter signifying A at the start of a word you know it starts with a glottal stop, which is not a sound we make very much in English, and you can’t really start learning the vocabulary or grammar (both of which are daunting) until you’ve mastered the alphabet. I mean, I’ll work at it and I’ll succeed, but if you’re trying to learn a language by yourself, Arabic is not the one to pick. 

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The third problem is called diglossia. I have a little bit of exposure to this with German, but in German, it’s a very minor problem. Diglossia is basically the condition of a group of speakers having two different languages or dialects spoken in different settings. In most cases this refers to formal/old fashioned/businesslike distinctions. The Canadian English equivalent of diglossia would be using words like “cool” in popular speech, but using words like “misappropriated” if you’re in court. We don’t think about it because in English, it doesn’t matter. It’s the same language, but the vocabulary makes a very slight shift in different settings. German has a bit more of a distinction, with Hochdeutsche Sprachen being spoken in formal contexts and various local dialects being spoken around Germany. Everybody learns Hochdeutsche Sprachen in school—if you take a German course, you’re learning formal, high German—and then you go home and speak your local dialect. When I went to Germany for the first time, I was very cocky about my German and in the north, where the dialect is quite similar to High German, I got along fine. In the Black Forest, where Schwebish (Schwebian) is spoken, I was utterly lost unless I was talking to people who had a reason to use High German with me.

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Arabic is much, much worse. Everybody learns what we’ll call Formal Arabic, although there’s an actual name for it which is hard to write in English, and then everybody goes home and learns their dialect. In English, some of the vocabulary changes. In German, some of the pronunciations and a little vocabulary changes. In Arabic, the grammar changes. They are almost literally different languages, and to make it worse, it’s not even a two-language situation with Formal and Informal Arabic being spoken in different settings. Formal Arabic is spoken basically the same way all over the world, and each region has its own Informal Arabic, which has a unique grammar, syntax, and vocabulary. That’s an oversimplification, but not by a lot.

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Formal Arabic is used in formal settings, obviously, but it’s also used as a way for Arabic speakers from different parts of the word to talk on common ground. It’s fairly regulated, and fairly regular, so in theory an Iraqi Arab, a Lebanese Arab, and some kid from Canada who learned Arabic out of a book, could all have a conversation. Then they would go home and literally speak different languages. If you’re going to travel in Arabic countries, which I don’t really plan to, then it’s a big problem. You have to learn Formal Arabic, and then you have to learn the specific Informal Arabic of the country you’re visiting. If you speak Formal Arabic, it’s not necessarily a huge leap, it’s doable, but it’s not quite the same as remembering not to say “bro, these data points are sick” during your thesis defense.

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I had a sort of discussion recently, with a professor, about what language is actually for. It’s for communication, obviously, but it’s also for organizing and manipulating thought, and it’s for defining your world (your world is literally made out of language) and the professor tried to make her point by interpreting Plato’s cave allegory as a language issue. Language isn’t precise, it’s not a perfect description of the things it purports to describe. I hadn’t thought about Plato’s cave that way but it made a sort of sense.