walkitout: (Default)
I'm just going to preface this by saying: I'm completely serious in thinking this diagnosis belongs in DSM-V. If you're looking to see if this was posted on April 1 or other indications that I'm kidding, I'm thinking bad thoughts about you as a person because you aren't paying attention.

The current manual for coding diagnoses in the mental health field is the DSM-IV-TR (4th edition of the DSM, text revision which means some words were changed but structure wasn't and new sections weren't added or sections deleted, more or less). The fifth edition (DSM-V) has been in process for a while. As of the end of April, this is the entry for "Caffeine Withdrawal":

"A. Prolonged daily use of caffeine.
B. Abrupt cessation of caffeine use, or reduction in the amount of caffeine used, followed within 24 hours by three or more of the following symptoms:
1. headache
2. marked fatigue or drowsiness
3. dysphoric mood, depressed mood, or irritability
4. difficulty concentrating
5. flu-like symptoms, nausea, vomiting, or muscle pain/stiffness
C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not associated with the direct physiological effects of another medical condition (e.g., migraine, viral illness) and are not better accounted for by another mental disorder."

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=553

You can go there and read the Rationale Tab; I'm not reproducing it here but I will provide an unprofessional and likely inaccurate in some important way that is not obvious to me summary. People who drink coffee or otherwise consume caffeine regularly who stop get the worst headache of their life and it lasts for days and it makes them less able to perform at work or school and cranky to the people around them. People who consume caffeine have to arrange their lives for regular supply or risk having this occur and it can be highly disruptive if their usual routine for getting it is interrupted. When these people stop drinking coffee without realizing this can occur (or for reasons not under their control such as hospitalization or institutionalization), the resulting symptoms can trigger a testing cascade that is expensive, pointless and potentially dangerous.

I will include one paragraph from the Rationale:

Benefits of Inclusion of Caffeine Withdrawal

"As reviewed above, many caffeine users may have caffeine withdrawal and misattribute it to other causes or ailments. If patients and their health care providers were more aware of caffeine withdrawal symptomatology, unnecessary health care utilization and costs could potentially be avoided. For example, caffeine withdrawal should be ruled out when patients present with headache and other typical caffeine withdrawal symptoms before administering expensive diagnostic tests or medications. For example, a simple 2 day caffeine abstinence test could assess for caffeine withdrawal headache and might eliminate the need for more expensive diagnostic procedures. In addition our anecdotal experience is that often psychiatrists ignore the possibility of caffeine withdrawal as a cause of headaches, fatigue, depression, etc. This may occur often when patients are admitted to caffeine-free inpatient units. The inclusion of caffeine withdrawal as a diagnosis in the DSM-5 will engender an awareness of this potentially clinically significant syndrome."

So the next time you're thinking that no way could so-and-so have such-and-such a problem because of a criterion like "C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.", bring caffeine withdrawal to mind. We all know about it. We tend to be dismissive about it. We tend to forget that the consequences of it going _undiagnosed_ can be substantial. By "diagnosed", I don't mean, "going to a neurologist every time you decide to cold turkey off coffee so it starts working for you again when you go back on". I mean "know that this can happen". The writers of DSM-V have an expectation that patients can and will self-diagnose for this and intend by including this in the manual to help them do that self-diagnosis better.

Interested in an example of how inclusion in the diagnostic manual works its way out to ordinary people like you or me?

Sample news coverage:

http://health.msn.com/healthy-living/signs-of-caffeine-addiction
walkitout: (Default)
Reading Ronson's _The Psychopath Test_ immediately after James' _Popular Crime_ made me think about how I've developed related ideas.

I have a deep suspicion of charming people (yes, you read that correctly). I've believed since I was a teenager that mutual respect was the appropriate basis for human relationships, whether friendship, business, etc. Built into that idea of mutual respect was an assumption of trust. Trust is a feeling that tends to accumulate over time as a result of feeling good about social and other interactions, whether with a person or a business. However, that feeling can be engendered much more quickly by proxies (a good handshake, appropriate eye contact, certain vocal characteristics, grooming, etc.). If everyone who has certain characteristics turns out to be trustworthy, then someone who has those characteristics gets to benefit from that generalization.

And there are plenty of people out there who exploit that. When I see someone who has a certain kind of smile, that smile that makes me feel special right away, I _do_ feel special. For about a half second, and then every single alarm bell and alert system in my head starts wailing and I run the usual analysis (how are they dressed, how are they speaking, what's their hair style, blah, blah, bleeping blah, and of course, what are they saying and who are they focusing on) with deep suspicion. Lots of charmers are people who are networking because that works well for them and they really don't have any particular harm in mind -- their agenda is one that when I figure it out I'll have an opinion on it and I'll just be careful around them because I know that I'll always tend to find them more convincing than our actual relationship justifies.

But charm is a powerful thing, and people who figure out how to do it really, really well often also figure out that they don't actually need to do much of anything else they are "supposed" to do because charm gets them everything they want. That sounds evil, and it tilts in the direction of the psychopathy test, or at least narcissism. But if someone isn't particularly ambitious and is not particularly cruel, it might not be evil at all: it might just be unambitious, perhaps edging into lazy if you're married to them or you've hired them or you were hoping they'd help out at your barn raising or whatever.

Charm gets worse when it's connected to ambition and lacking in a strong moral core: this can become freeloading and worse. But it's still not evil if the person isn't _trying_ to hurt people. Person with a hammer, everything's a nail. I'm thinking John Edwards kind of thing. You don't want to be married to this person (or working for their campaign), by psychopathy seems ridiculous and really, narcissism might be a little too harsh as well.

Charm plus an attachment problem -- a big hole inside that nothing can fill because the lid is screwed down tight -- is dangerous. And I think at that point, you're looking at narcissism or worse. But attachment problems can be mitigated even in an adult, if the adult wants to work on the problem and is given access to information that can get them to open up and really connect. But it's really hard for a charmer, because that feels like going backwards to go forwards.

Charm plus cruelty (which may or may not be an attachment problem) is where it starts getting ugly. This is a person who can do awful things and get away with them, because it's hard to remember that they did the bad thing and easy to believe their (usually transparently ridiculous) excuses. Old French guy (hey, I'm not naming names. I'm _stereotyping_.) probably falls into this category, as does the Pillar of the Community who beats the spouse and kids to the point where they wind up in the hospital. Repeatedly. While holding elective office.

We cross the line into evil when all of this gets hitched to poor executive function. Then you have someone wandering around that we all trust instantly, who doesn't really care about anyone, who has a capacity for cruelty and the opportunity to exercise it. But even that isn't what really scares us about psychopaths. What scares us about psychopaths is that they are charming people who don't care about anyone, actively LOOKING for an opportunity to exercise their capacity for cruelty. There's a name for that which I've forgotten, but boredom/low response to stimulus of all kinds is a recognize problem that shows up really early in development. And it is _not_ always evil.

Now this _looks_ very similar to Hare's list. But the way I think about it leads in a very different direction when it comes to Things to Try to Fix These Problem People. If you take away the cruelty, the attachment disorder and the poor executive function, a person who is under responsive to stimulus/bored easily, who is charming, who is ambitious -- that could be any number of wonderful people, but I wouldn't be particularly surprised to discover some extreme sports athletes in that group, say, or an entrepreneur.

The cruelty and the attachment disorder are very reminiscent of James' remark about serial murderers being the children of prostitutes. He notes that it turns up so many times in so many serial murderer stories (true ones) that after a while you just start to expect it, even tho there doesn't seem to have been much analysis of this. There are a number of conceivable interventions to interrupt the creation of serial murderers and/or psychopaths, then: readily available birth control, parenting support, economic support, access to protection from law enforcement (I'm not saying decriminalize, but that's certainly one strategy). Once someone is on The Bad Road, however, there are ways to alter their course if we can see that the issue is an inability to attach.

The executive function problem is also serious, and goes a long way to explain the criminals who do horrible things and _literally_ ask to be caught so they can be stopped. But _lots_ of people have executive function problems that are resistant to solution. That by itself is, if not manageable at least it can be mitigated.

It's the whole freaking package that is incurable.

Like Ronson, I think you can use psychopathy as a lens to think about mental illness in general, altho in this case, it's a bit in reverse. I have a lens for thinking about mental health and what modules, skills, etc. go into being mentally healthy. I think it can be applied to psychopathy, and I would be interested to know if anyone has tried to dis-assemble the complex of failures that produces a psychopath with a view to helping that person get to a point where they won't re-offend (or, if they feel like they might, maybe turn themselves in until they feel better, a la rehab). I tend to think this way about a _lot_ of mental illness (viz. the "illness" is a collection of things, each of which is manageable, but trying to treat the collection as a unitary entity, perhaps with pills, does not work well); this could be my hammer making my world look full of nails.

ETA: I thought about making this a separate post, but I'd really just as soon not draw that much attention to it. Better to bury it in a postscript.

Ronson quotes a number of people who say, essentially, that if you read over Hare's diagnostic criteria and become concerned that you might yourself be psychopathic, that means you are not. Ronson took the list and had a really great conversation with Al "Chainsaw" Dunlap of Sunbeam and other infamy. This conversation was really okay with Dunlap (if Ronson is to be believed, and I do) and fits well within the general understanding of Dunlap's personality. Ronson's conclusion is that it's hard to know where the boundary is between some of these traits as "leadership" vs. pathology.

I think a better way to think about it is, if you're worried about whether you are a psychopath in the "worried" sense, you aren't. But if the criteria might make you think you are a psychopath and that is interesting but not exciting, you may be a psychopath -- but there's not a lot we can do to you and you're a low priority compared to the more chaotic ones anyway.
walkitout: (Default)
Subtitled: A Journey Through the Madness Industry

Publisher is Riverhead, which is a division of Penguin (a division of Pearson -- Penguin/Pearson is one of the Big 6 publishers).

I have read two previous books by this author, and will look forward to his next effort. (It looks like there is at least one book by him I have not read, which is a collection of his newspaper work.)

Ronson likes to write books about people who are crazy. _Them_ was about religious extremists. _The Men Who Stare at Goats_ is about certain US military programs that sound like stupid conspiracy theories but turn out to have actually occurred. _The Psychopath Test_ is about mental illness, its definition, people who might or might not have it, and the people who work on it either academically, therapeutically or in the criminal justice system. He's mostly focused on psychopathy/psychopaths as defined by Bob Hare's PCL-R.

Wikipedia has a really great article about it:

http://en.wikipedia.org/wiki/Hare_Psychopathy_Checklist

However, Ronson is also prepared to explore other aspects of mental health, changing diagnoses, etc. and how those interact with society in general.

Ronson has a couple of really strong attributes as a person and a writer. He feels things strongly, notices those feelings, and can describe them effectively in writing. Also, he is conscious of his fascination with things that are somewhat nutty: too nutty, and it's sort of sad. Not very nutty, and it's a little boring. His books, therefore, are _really fascinating_, because we're all interested in things that are the right amount nutty, and a lot of us like to connect emotionally with an author when we're reading.

If you want to learn about psychopathy per se, you're probably better off with the wikipedia entry. Ronson's approach tends to be a little bit scattered. He does a lot of really interesting interviews (obviously, given that he's looking for The Crazy) and he's very compassionate. His presentation is partly chronological, and partly thematic and unfortunately that is sometimes extremely confusing. Also, I'm still uncertain what all that stuff was about the weird book getting send 'round at the beginning of the book and towards the end. (I was deeply skeptical whether this was even true, and was starting to be suspicious of whether I should trust Ronson, but then I found this: http://muriloq.com/blog/2008/09/being-or-nothingness-marketing-viral-bizarro/). If you want an entertaining book that contemplates what it means to be mentally ill in a way that is dangerous to self and others, and very carefully avoids taking any kind of ideological or doctrinaire stance on the question, this is definitely for you.

Or, if you're just looking for some funny non-fiction.

I think the big take-away for me is that the internet is everyone's playground -- and that some of the participants really are very crazy, as in, not really entertaining any more, just destructive and/or sad.
walkitout: (Default)
I got up this morning and thought I was going to fall over. :(

ETA: I called the doctor's office asking to talk to a nurse, figuring they'd tell me it was probably an ear thing and to wait and see what happened. But no, if I think it's worth calling the doctor, they always think it's worth getting me into urgent care.

Hopefully this one won't then lead to the ER.

ETAYA: Labyrinthitis. A prescription for corticosteroids and a recommendation to try motion sickness meds. I figured out that chewing gum helped on my own. Doc says 3-5 days is likely, and to call if it lasts longer or gets worse or changes.

January 2026

S M T W T F S
     1 2 3
45678910
11121314151617
18192021222324
25262728293031

Syndicate

RSS Atom

Most Popular Tags

Style Credit

Expand Cut Tags

No cut tags
Page generated Jan. 4th, 2026 05:12 pm
Powered by Dreamwidth Studios