The Person’s error wasn’t about my sexual preferences; it was that they thought I go to nightclubs!†
What impression do you have of The Person?
Would your impression change if The Person is:
a man?
a woman?
the teenage child of a friend?
a stranger over the age of 70?
a white person? a non-white person?
a straight person? a queer person?
my boss?
As much as we try, we can never really get away from ourselves. We all think we view the world through relatively impartial lenses. Then we encounter people and situations that trigger our mental habits.
Like viewing the world and the people in it through the lens of sexual preferences.
Or believing that blog posts are only worthwhile if they resemble articles.
† Long-time readers know my opinions about dancing.
Although “mental endurance” is more wordy than “grit”, I prefer the extra syllables. “Grit” sounds difficult and uncomfortable: Jaws clenched, the jagged surfaces of molars grinding together, or granules of sand scratching the surface of your eyeball.
“Grit” also suggests firmness and unyielding. It doesn’t matter what the conditions are: I will not change my strategy or tactics. I will not bend, even if I might break.
“Mental endurance” offers more flexibility. There is room to breathe. Maybe you can keep more enamel on your teeth.
When Things Are Hard, how can we unclench our jaws? When we run psychological marathons we did not sign up for, how can we keep moving without falling down from exhaustion or heartache? How can we practice and manifest mental endurance?
Build and commit to routines. If the word “ritual” is more pleasing to your ear, build and commit to rituals. This includes the essentials of eating, sleeping, and other healthful activities. (Without a basic foundation, any type of endurance is hard to achieve.) Creating and sticking to routines brings comfort when most things seem out of control. Rituals help us feel like we have agency over something. To start, the less profound the ritual, the better:
Make the bed every morning.
Always say “thank you” to the bus driver, even if they don’t make eye contact with you and look like they’re grinding the enamel off of their teeth.
After you put your kids in the car and shut their door, make a point of taking three full breaths before you get in to drive.
No one has to know what your routines are or the reasons behind them. Maybe you run because you actually want to run away from your problems. Maybe you watch the same video on YouTube before bed because it increases the chances that you will fall asleep. Maybe you behold the cereal in your bowl and say thanks to all the nameless people who transformed and transported the cereal to you.
What matters is that you created a ritual. You’re choosing to do it. Within is freedom and power.
Pace yourself. Or, it’s okay to take a break. When Things Are Hard, we often want to get through All Of It as soon as possible. Who wants to feel psychologically uncomfortable?
However, the logical conclusion of this approach doesn’t make sense: Life is hard. If we want to get through the Hard Stuff as fast as possible, that means we should try to get through life as fast as possible. This is impossible. (Puberty over in 24 hours! bone fracture healing in five minutes! grief resolved in two seconds!)
Yes, there are often external pressures: The boss wants us to do something. The kids have a need that only you can fulfill. There isn’t enough money to deal with The Thing the way you’d like to deal with The Thing.
It’s okay to take a break. If you were able to think your way out of this problem, you would have already thought of the solution. Spending 30 minutes thinking about something else is nothing when you spend hours dwelling on The Thing. Your mind will welcome the break, too, because it needs it. (Epiphanies seem to arrive when we give our mind a break: showering, doing our laundry, etc.)
Talk with people you trust. Many burdens are not meant to be carried alone. If someone is able and willing to help lift the burden from your mind, or at least shift it so you can adjust your psychological grip, not only are you blessed, but you are also letting someone help you. Sometimes our grip is so tight on The Thing because we insist on bearing it ourselves. (What would it mean if we let someone help us? Does it mean that we’re weak? unreliable? a failure?) Olympians and chess grandmasters all have coaches and esteemed colleagues. Amateur chefs share their dishes with tasters and amateur writers share their words on blogs. While it may be true that no one in your social circle has been through what you’re going through, that doesn’t mean that they are useless. Support, attention, and care from others has value. It’s okay to unclench.
Remember that everything changes. Things may not change as fast as we want them to, but everything changes. What feels intolerable now will one day be a memory. We ourselves change because of The Thing; our values will shift and we will make different choices. With heartbreak, we might ultimately discover more love flowing through our lives. Instead of the friction associated with grit, there can be a softening, a light, gentle expansion of our hearts. There is room to breathe. Our bigger hearts will buoy us forward for whatever changes await us next.
Hi. I feel some obligation to apologize for my lack of posting here over the past three months (!).
Challenging Events happened in the last two months of 2023. Things settled down. (Let us not forget, though, that stability is an illusion.)
Now that my adrenal glands aren’t squirting out large volumes of adrenaline, I’m starting again. Getting started is often the hardest part. (What should I write about? Do I have anything to say that hasn’t already been said? Am I sending signals or simply generating noise? Am I making useful contributions? etc.)
My goal today is simply to post something. (Prior to the onset of Challenging Events, I was crafting a post brimming with self-righteous outrage about my patient’s inability to get a prescription for generic nicotine gum filled. That post is forthcoming.) Hang in there with me as I crack my knuckles to reacclimate myself to writing posts again:
I’ve moved to a different newsletter service. If you’re reading this in your e-mail, that means you’re already subscribed to my newsletter. (I hope you don’t mind that I migrated your e-mail address over to Buttondown without telling you.) If you’re reading this on RSS or on my website and would prefer to receive posts in your e-mail, please feel free to sign up here. (If you do use RSS, I use and recommend CommaFeed.)
I don’t use any social media platforms anymore. One of the unintended benefits of Challenging Events is that I stopped using Twitter/X because I didn’t have the will or energy to. Twitter/X may have stopped using me, too: As of this writing, I am not able to log in to Twitter/X. Oh well (and good riddance).
The Omnivore app has helped me read more. Instapaper was letting me down and Pocket had too many bells and whistles for my taste. The Omnivore web and mobile apps are visually appealing, easy to navigate, and a pleasure to use. (The ability of Omnivore to sync with Logseq is also wonderful.)
The Friends of Big Bear Valley live eagle cam is worth your time.Big Bear Bald Eagle Live Nest – Cam 1 is the live webcam; the channel has video summaries of the eagle pair.
I am still trying to learn how to play Go (well). I first learned how to play Go literally decades ago and remain a perpetual student. The Way to Go tutorial (…) is pretty good.
Lunar New Year is nearly upon us. The Year of the Dragon starts on the new moon on February 10th. I wish you, fine reader, good health, safety, and prosperity.
ruling by a third criminal court in Tehran defining not wearing the veil as “a contagious mental illness that causes sexual promiscuity.” The defendant was sentenced to two months in prison and ordered to pay for six months of psychological treatment.”
(It’s unclear what “psychotherapy / psychological treatment” means. This is likely intentional.)
Do women in Iran who refuse to wear a head covering truly have antisocial personality disorder?
Here are the primary DSM-5 criteria, which are similar to the criteria in ICD-10:
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
Impulsivity or failure to plan ahead.
Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
Reckless disregard for safety of self or others.
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
The key here is disregard for and violation of the rights of others. I am unfamiliar with Iranian religious law, though it is hard to understand how a woman who is not wearing a head covering is disregarding and violating the rights of others. Is the argument that the hair of women impinges on the rights of men? What freedoms are taken from men when they see women’s hair? What freedoms are returned to them when women’s heads are covered?
However, it’s also not hard to see how one can twist the criteria for women to receive a diagnosis of antisocial personality disorder:
Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. Women are required to wear a hijab by law. Women who don’t cover their heads are breaking social norms and the law.
Impulsivity or failure to plan ahead. Wearing a hijab requires planning. Only someone who is impulsive or short-sighted would forget to wear a hijab when going out.
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. A responsible woman would consistently wear hijab.
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. Women who refuse to wear a hijab are unapologetic about their behavior. They clearly don’t care about the disrespect they are showing to religious law.
That’s four criteria when only three are required. Though it’s still unclear whose rights are being violated, the twisting of criteria is easy to do to distract from the intentional distortion of context.
The Lancet article correctly notes that the “diagnosis” of women who refuse to wear hijabs and their subsequent “treatment” is political abuse of psychiatry. One of the authors, Robert van Voren, has written other articles on this topic, including Political Abuse of Psychiatry—An [sic] Historical Overview, where he teaches us that the Soviet Union was a major culprit:
Socialist ideology is focused on the establishment of the ideal society, where all are equal and all will be happy, and thus, those who are against must be mad. … The political abuse of psychiatry in the Soviet Union originated from the concept that persons who opposed the Soviet regime were mentally ill because there was no other logical explanation why one would oppose the best sociopolitical system in the world.
Sending people to a psychiatric institution is particularly practical because hospitalisation has no end and thus, if need be, people can be locked away forever, or as long as they continue to have views that are considered politically or socially dangerous, or remain inconvenient to the authorities. … At the same time, declaring a person mentally ill provides a perfect opportunity not to have to respond to their political or religious convictions, as they are the product of an ill mind and do not have to be taken seriously.
He argues that the way to combat political abuse of psychiatry is similar to combating misinformation:
stimulating communication and access, providing training in issues of medical ethics and human rights, and translating key documents and manuals into local languages may make it impossible for the public to remain uninformed.
Why am I writing about abuses of psychiatry in Iran? With increasing overt conflict between and within nations, psychiatrists and other mental health professionals should know the history (some of it recent!) of the political abuse of psychiatry. None of us are immune to persuasion and coercion. Though I hope that governments and other authorities will never ask us to use our skills to harm people, hope is not a strategy. People in power can exhibit antisocial behaviors, too. Democracy may decrease the likelihood that psychiatrists will succumb to political pressure, though psychiatrists are still people. Most people avoid conflict, respond to incentives, and do not want their status to drop. Psychiatrists are not morally invincible.
The public also needs to know this history. (I recognize I am but a tiny fish in the ocean that is the internet. I appreciate that anyone is willing to give the gift of attention to my writing here.) If psychiatrists and other mental health professionals start “treating” people whose only symptom is having an opinion that diverges from the government’s perspective and propaganda, we need the public to call this out.
Hospitals have better food, softer linens, and more space than jail, but both places can restrict your movements and prevent you from leaving. Psychotherapy can be harmful and punishing. The stigma of mental illness and treatment, while decreased over the past few years due to the pandemic, persists and can be used to reject and dismiss people.
Civil disobedience doesn’t disregard and violate the rights of others.
Though over three years have passed since the start of the pandemic, we on Earth have yet to escape the specters of death and destruction. With murderous tragedies large and small happening around the globe, one might wonder, “All these people who are killing other people: There must be something wrong with them. Do they have a mental disorder?”
The Diagnostic and Statistical Manual, now in its fifth, text-revised edition, provides this definition for “mental disorder” (emphases mine):
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
Let’s consider some examples:
The man who shot 18 people in Maine. There are accounts that he has heard voices in the recent past. It is unclear if these voices were related to his threats to carry out a shooting at a military base. Reporting suggests that these two events resulted in a psychiatric hospitalization.
If we assume that he is still experiencing now the symptoms he had over the summer, he has a disturbance in his cognition (hearing voices) and behavior (use of a firearm to kill other people). We don’t know if the voices have caused him distress. He is certainly experiencing major disability at this time, as it seems that he has no social connections at this moment and he isn’t able to engage in activities such as work and leisure. He has demonstrated socially deviant behavior that, at least the way it is reported, is related to a dysfunction inherent to him.
Thus, it seems likely that this man who has killed 18 people in Maine has a mental disorder.
The Long Island Sex Killer. This is the man who allegedly killed 11 women between 1996 and 2011 and put their remains on Gilgo Beach. This man worked as an architect in New York City, was married, and had children.
It is debatable if he had a clinically significant disturbance in his thoughts, emotions, and behaviors: No one in his life seemed to notice any disturbances. For 15 years he presumably didn’t exhibit concerning distress or disability, as he was able to maintain multiple roles in his life with success. No one knew of his socially deviant behavior until he was caught.
Under this framework and given what has been shared, the Long Island Sex Killer does not appear to have a mental disorder.
People fighting in wars. This can include a military attacking an opposing nation-state, an organization attacking a nation-state, or a nation-state attacking an exclave.
We’ve already encountered a barrier: Mental disorders, by definition, only occur in individuals, not populations.
So let’s broadly consider the leadership of these populations, such as elected officials and others with high rank and authority. Propaganda obscures whether any of them are exhibiting disturbances. Note that their followers would not interpret their leaders’ thoughts, emotions, and behaviors as disturbed. Any distress the leaders express is related to their rage towards the enemy. Anyone showing disability would likely be removed, as this would be construed as a vulnerability. Attacking the enemy is not socially deviant behavior. (Resisting such efforts is.)
Leaders who order the killing of other people, in this framework, do not have mental disorders.
(As you already know, those fighting and harmed in wars are at higher risk of developing mental disorders. It is unjust that once someone demonstrates disturbances, distress, and disability due to war, the consequences of a state action land solely on individuals who must bear the psychological burdens and stigma.)
So, if mental disorders are not the underlying reason why people kill other people, then what is?
(Evil?)
(If it is evil, that is not something psychiatrists can treat.)
Maria Yang, MD 