Funny listicle

I’m on a roll today.

Funny listicle about 25 things only someone with bipolar would understand:

Checking in

I’d like to check it since it has been a while.

The only news to report is my depression has been continuing. I’m in a transition in my therapy, which may have something to do with it. I left my old therapist months ago. She was capable and well-meaning, but did not have any expertise in bipolar. I felt our sessions were going nowhere.

I recently began working with another therapist, but due to work commitments, have not had a consistent schedule with her. I’m trying to settle into a regular routine with her. So far, my therapy has been ineffective due to this inconsistency. But she is a good therapist with experience with bipolar. So I am trying to be hopeful.

Another source of instability is the fact that I am still in between psychiatrists. My psychiatrist was excellent. But he left private practice. And I’ve been looking for a new one for months.

I tried a well-respected psychiatrist for a while. But it took ages to get an appointment with him. I had to see his RN first. Then I was told I could see him at a later date. But just before that later date, I received a call informing me that I would once again have to meet with an RN. So rescheduled for a month out.

Finally, I met with the his eminence in the flesh. And what a disappointment. The epitome of the disengaged, aloof psychiatrist that one finds sometimes in the field. The entire session last for no more than 5 minutes, which is remarkable giving that I was seeing him for the first time. (Short sessions are sometimes appropriate for follow-ups if there’s not much to discuss.)

He stared at his computer for the first few minutes. Then told me he was upping my medication. Almost no consultation. He asked me one or two questions. That’s it.

It was an enormous letdown.

So now I’ve located another shrink. I will see him in a month. He wasn’t available sooner, unfortunately. I need a change in my meds now though. So I will have to suffer for another month unfortunately. Not sure what I can do at this point.

I’ll update later.

The Fallacies of Stigma: A Primer

Stigma is often masked as reasonable, but a closer examination shows that the arguments supporting it are flawed. We who live with mental illness have good reason to object to it: Prejudice costs us jobs, friendships, and self-dignity. The isolation which we live in worsens our state of mind. Stigma is not only evoked by people who do not suffer as we do, but also by anti-psychiatrists who oppose treatment and who deny mental illness. Both are often clever in hiding tactics, but I have written this article so that you might recognize and confront them successfully.

Herein I shall describe many logical fallacies that are used by people who invest in stigma either to promote an agenda or directly attack those of us with mental illness, giving examples for each. Remember these the next time someone uses them, identify them for what they are and let them know that they are standing on shaky ground.

Argument by assertion describes the belief that the more you say something is true, the more true it is. No matter how many times what you have said has been refuted by psychological studies, you continue to say that it is true. This you believe overwhelms any real evidence. The idea that the mentally ill are violent or the notion that medications are dangerous or that vitamins have no side effects are examples of this kind of logical fallacy.

One of the reasons why I count antipsychiatrists among the purveyors of stigma is that when they argue that the medications cause violence, they are implying that everyone who takes the medication will be violent. This means that those who take an SSRI are violent (as well as corporate shills — see below). I have often pointed this out to them. The best argument they can muster is that they really didn’t mean it — which is moving the goalposts, a type of argumentum ex culo or, simply, lying.

Related to this is the tactic known informally as bullshit. The evidence can’t be right, so you keep asserting without proof that it is wrong. Your arguments amount to little more than ill-formed, unsubstantiated opinions.

When someone cites a popular movie or television series or novel as evidence that the mentally ill are dangerous or incapable, they are employing a generalization from fictional evidence. Those who deploy this kind of reasoning believe that Jason from Halloween is typical of people like us. Of course, this does not constitute as valid information because the source is fictional and a product of some writer’s imagination.

Those who attack advocates for the mentally ill often depict them using straw men. One particularly vicious proponent of Murphy’s Law used to claim that anyone who didn’t support that dubious measure didn’t care about the mentally ill. Of course, that was just plain wrong: it was our concern that the mentally ill would be forced to undergo harsh treatments such as ECT that they did not want and lose their HIPAA protections that motivated us to oppose the law. It’s a cheap trick and nothing more.

Argumentum ad hominem is something that we all have experienced. Because we suffer from mental illness, our criticisms and opinions are by default invalid. Stigma causes us to lose authority in the eyes of some. The use of this logical fallacy defines the center of stigma, namely the idea that we are crazy and incapable of logical thought. I, however, have noticed that even people in the throes of mania and schizophrenia can make rational arguments. Many people hide their mental illness because they want to be taken seriously.

When you proceed from the assumption that the other person’s opinion is wrong and then go on to explain why they held it, that is known as Bulverism. Bulverism is almost always associated with some kind of psychological condition. Such arguments are cheap shots and an end run around the burden of proving that the idea is wrong. Sometimes there is an actual diagnosis, sometimes the attacker just makes one up. I have known anti-psychiatrists to employ a version of this wherein because my thought process is distorted by medication, my views aren’t worth considering. Of course, there are also legions of armchair psychiatrists who think they can recognize a mental disorder in anyone. Consider those who try to come up with insanities for prominent politicians. I often tell them that when they use my diagnosis they are associating me with people with whom I do not agree with. Their views are not the product of insanity, but of ideology. And it is the ideology which logic demands that we focus our efforts. You argue with the argument,not the person. (If a person is in episode, you may decline to argue with them. But this has nothing to do with the validity of their argument.)

The Shill Gambit is a particular favorite of anti-psychiatrists. Defend the use of psychotropics? You are obviously a thrall of pharmaceutical companies. Once again, you are avoiding making a case by capitalizing on prejudices and conspiracy theories.

Sometimes people try to accuse us of distorting the numbers because we are mentally ill and we just don’t want to take our meds or we want special treatment for ourselves. This is appeal to motive. The idea is that you imply that the person making the argument has ulterior reasons for making the argument like they want to cover up the fact that really are the way that stigma claims they are. It can have its place, however, as in when the NRA suddenly becomes interested in promoting Murphy’s Law so that the whole gun question isn’t being discussed, but you have to prove this connection. Most of the time, you know where to stick this one.

Many of those who want to take the discussion away from the ownership of guns point to the head of the NRA as an authority. He claims that mental illness is what is behind the mass killings, not gun ownership. So his followers lick up the talking point and spit it out again. When you point to a famous person and say something is right because they said it, it is argumentum ad verecundiam. (What kind of authority is the head of the NRA on mental illness? Not one we can count on.) Needless to say, famous people cannot be cited as authorities just because they are famous. (This applies to politicians, too.) If they don’t cite evidence for their arguments, there is a good chance that they made it up. There’s a difference between mentioning studies that show that people with mental illness aren’t dangerous and flat out just saying that they are. The former uses empirical evidence and the latter just makes a statement without the backing of such studies.

“C’mon,” someone might say to you, “everyone knows that the mentally ill are dangerous. Look at all the newspapers, the media, politicians, etc. who say that it is.” Just because an idea is popular, it does mean that the idea is right. People can be wrong in scores. The insistence that this proves the correctness of the feeling is Argumentum ad populum or bandwagon. It is the usual short-cutting of proof using a flimsy pretext. I think many climate-change proponents make this mistake when they talk about the scientific consensus for the idea. What matters is not the number of scientists who have been convinced by the evidence, but by the evidence itself (and there is plenty of it). Likewise, the evidence shows that we who live with mental illness are not any more violent than those who don’t. Many years ago, most geologists laughed off the Wegener Hypothesis which showed that the continents have been moving. As the evidence came in, geologists started to look at landscapes anew, not because it was a popular idea but because strong findings came in from the field showed that Wegener was right! Likewise, we don’t just assert that the mentally ill aren’t more prone to harming others: we have information that shows so. Always concentrate on what the evidence says.

The composition fallacy and the related division fallacy are the particular favorites of those who use stigma to advance their agendas against the mentally ill. I have seen it used by both advocates of forced medication and anti-psychiatrists. They are defined like this:

The logical fallacies of composition and division are a pair of fallacies which are based on a confusion between what is true of the part and what is true of the whole. The fallacy of composition is an incorrect inference from what is known of the parts to asserting the same of the whole; and the fallacy of division is the reverse, from the whole to the part. Comparing the fallacy to the figures of speech called synecdoche (as when one says “wheels” to refer to an auto), one might say that the fallacy consists of taking the figure of speech literally.

So, the forced medication advocates reason, if we can show that one person committing a well publicized shooting is mentally ill, they all must be mentally ill. Or, if we can show that one psychotropic medication can be shown to cause people to be violent, then all such drugs cause people to be violent.

Overgeneralisation is a subset of this attack. I see it happen in support groups sometimes when people hear that some people experience a certain side effect, they assume that the drug is going to cause the same side effect for them. You’re taking a few experiences and insisting that they are true for everyone. It is a fact that many people get fat and diabetic on olanzapine (Zyprexa), but it is also true that not everyone does. To point to one or the other end of this continuum — to focus on the negative or positive personal experiences of some of the population of those who take Zyprexa only and then insisting that this is what happens to everyone is to overgeneralize. To say that because some people instigating highly publicized shootings are mentally ill means that all these shooters are mentally ill is another example.

Stigma users like to spotlight. They will focus on one example — e.g. the Aurora shooter — and use this as their proof that the mentally ill are dangerous. You can also perform this trick by focusing on one patient who has a bad reaction, say your sister-in-law or yourself. If they got sick with disastrous side effects, the reasoning goes, so will you. The burden of proof requires double-blind studies and empirical rather than anecdotal evidence. Much of the time you will find that the people who use this tactic don’t have the evidence to back themselves up.

There is a rise in violence, goes another argument, and a rise in the number of people being medicated. The logical conclusion is that medication causes people to be violent. Right? Wrong. False cause means that you draw an assumption based on a perceived relationship. There was a man named Francis Galton who pointed out that when you see a correlation between A and B, it can mean a few things: A might cause B. B might cause A. C might cause both A and B. Or there is no relationship between A and B: it’s just a coincidence. Anti-vaxxers see a rise in the cancer rate that correlates with the rise in vaccinations. Based on this, they say that vaccinations cause cancer. But when we apply Occam’s Razor, we find a better explantion: because of vaccines, people are living longer — long enough to get cancer! As for the argument that I mentioned at the start of this section, I have not seen evidence showing that the people committing the violence are taking medications. It is only an assertion (see above) and a composition fallacy at work here.

The genetic fallacy holds that you trust or don’t trust an idea based on where it comes from. But the reality is that sometimes E. Fuller Torrey and D.J. Jaffe have a good idea, sometimes the antipsychiatrists make a reasonable point. As stigma, it holds that because a mentally ill person or one on medication offers the idea, you can’t trust it. Logical discussion is about the arguments and whether they are valid and truthful, not who made them in the first place.

A recent alliance between the likes of E. Fuller Torrey, D.J. Jaffe, and the NRA is founded upon the “my enemy’s enemy” fallacy. Given that the NRA is promoting the idea that we have to do something about the mentally ill, we can draw the conclusion that they have the best interests of the mentally ill at heart because the people who oppose its solution are antipsychiatrists goes this illogic. People all along the spectrum of opinion can be drawn into this, so it is always important to return to the heart of any discussion.

The Nirvana Fallacy is currently being used by the proponents of Murphy’s Law. It is refusing reasonable solutions such as more commmunity mental health clinics and demanding that we impose forced treatment and bring back mental hospitals because the community mental health solutions don’t help 100% of the mentally ill. Of course, they ignore the expense of their proposals and the fact that many people with mental illness will likely go undiagnosed because they don’t have clinics. But the main problem is that their proposal is fantasy and that there are more realistic solutions out there.

Colorblindness or rather something similar to it affects discussions about mental illness. This is used by people who deny mental illness from many fronts, beginning with antipsychiatrists and extending to those who tell us just to get over our depressions. It is a false equality that states that all people have emotional problems, but some people are big whiners. This type of stigma colors us as fakers of our illness who should be ignored.

The same people are often guilty of the fallacy of relative privation which is also called “whataboutery” or the “not as bad as” fallacy. You who live with mental illness know the song: “What do you have to be depressed about? Your cousin Leonard broke both his legs and had to have twenty nine stitches. He’s not depressed, so why are you?” It is little more than a guilt trip, one of the cruelest forms that stigma takes.

Emotional appeal is often what is left when you have identified and refuted all the tactics above. Fear is a powerful emotion. We do not like the unknown and we don’t like being bothered to take the time to understand it. If any fallacy is central to stigma, I think this is it.

When we have become exhausted refuting these points, we may choose to retreat. We do not have to argue with fools. Yet there is a snare that trolls and stupid people use to attempt to trap us known as the Chewbacca Defense. This tries to declare a win by several fallacious principles:

  • If you can prove the other side wrong (even if they are wrong about something totally irrelevant), it makes you right.
  • If you can word your statements and arguments in a way that is too confusing, intelligent-sounding, or nonsensical for the opponent to respond to, it makes them wrong and it makes you right.
  • If you can shock or confuse your opponent and make them think you are a lost cause and not worth arguing with, you are right.
  • If you can make your opponent give up on arguing with you, because you appear too crazy to understand them and/or don’t seem to be listening, then they must be wrong and you must be right.
  • If you can make an opponent look bad, their logic must be equally bad, and therefore you are right.
  • If you are more popular or have more support than your opponent, it makes them wrong and it makes you right because more people agree with you.
  • If you just keep arguing and shouting, even if everyone else (not just everyone else in the debate — everyone else in the world) thinks you are not just wrong, but insane, until everyone else just gets tired of listening to you spew nonsense, you’re the last man standing, and, by default, you are right.

Realize that they will continue to be wrong no matter when you choose to end the “discussion” and be satisfied that you have mastered them.

We must not only out these when we see our opponents use them, but we must also be aware of them in ourselves. The facts and how they are to be interpreted are what are relevant. Plenty of studies show that the mentally ill are not as dangerous as the promulgators of stigma hold, so we should use these as our principle sources for our defense. It does not help us to use anecdotal evidence and slippery slope reasoning. The truth is our aim.

In all things, be a Credible Hulk.


See also Misleading Vividness

Two great sources for information about logical fallacies:

What could go wrong?

FDA asked to consider adherence sensor on Abilify

Proteus Health, located in Redwood City CA, along with Tokyo based Otsuka Pharmaceutical Co. have a new drug application that is ready for review by regulators determined by the FDA.

The new drug is embedded with an ingestible sensor. When the medication, and sensor, reach the stomach, it sends a signal to a patch the patient wears externally. The information can be sent to physicians or caregivers with consent.

The sensor has previously been approved in a placebo taken along with a medication.

The goal is to help with medication compliance. All well and good up to this point. But, what is the first drug they choose? Abilify, an atypical anti-psychotic. It isn’t always taken for psychosis. It can be used as an add-on for depression and other ways. But, it is also used to treat psychosis.

Some, not uncommon, delusions are that:

you have sensors embedded, that your medicine has been poisoned or tampered with or that people are tracking you. This is to be taken by consent, but personally, I think they chose a bad medication.

I don’t know what is wrong with injectable abilify? That would be my choice.


Keeping away from the future

This post is about focusing on the present as best as one can.

One problem many people with depression and bipolar struggle with is hopelessness about the future.  It can be irrational, but often attaches itself to real world events.  It’s a kind of inflationary problem; it takes real world concerns and balloons them up to an absurd size.

One subject of my recent hopelessness–actually, one that I’ve had for going on 10 years now–is my work.  In short, I hate my job.  I don’t like to whine.  I’m luck to have a job.  Last year I lost my job and didn’t have steady work for almost a year.  As the only income earner for my family, that was a difficult time.

But still, even while I appreciate my job, I still hate it.  I feel that I made some important mistakes years ago by falling into my line of work.  Trouble is that when you get on a particular career path, it is difficult to switch course.  And since I’m still the only bread winner, it’s even more difficult.

So what should I try to remember?  How does a depressed person keep a realistic, and not pessimistic, view of the future?

One important fact is that my wife will hopefully be getting a professional license soon and can go back to work after a long period as a homemaker.  Of course, the job market is terrible and it will likely take her a while.  But I trust her abilities and know she will be persistent.  And we are looking for something for her in the interim.

Another fact that I try to remember is that I am a capable person.  It’s so hard to believe this, though, deep down.  One consequence of my depression and dissatisfaction with my job is that I feel that I’m incompetent.  So I try to remember times when I excelled at my job.  The flip side is that my bipolar affects my ability to do my work.  I get depressed, distracted; I make stupid mistakes.  It will be a challenge.  There’s the “realistic” thinking.  Not overly optimistic, not pessimistic.

So if I am capable, though, I may be able to make the transition to another job.  I just have to be persistent.  When my wife begins working, I can afford to look for something that pays less but that I enjoy.

It’s a struggle.  That’s why I have to try to keep my focus on the present.