Wednesday Round Up #3

Wednesday Round Up #3

“Decolonize Maiz” is art work by Ernesto Yerena. You can purchase it from the Saguaro Gallery.

Black Lives Matter: How the movement that’s changing America was built and where it goes next

And according to Muhammad, we can make these big asks now in large part not merely because of Garza, Cullors, and Tometi, but because of the framework they established. Black Lives Matter was born as an organization with a queer, feminist framework that grasped the importance of intersectionality. “Both Patrisse and I have this experience being queer black women in a movement for black freedom that really isn’t shaped in our image. One of the things that actually connected Patrisse and I very early on is what it meant to try to navigate that space,” Garza says.

That was especially important at a time when the media focused on black death centered on straight black men and boys. Since people are oppressed because of race, gender, and all of the various ways they are identified, if black lives are to truly matter, they all had to matter. It is to the movement’s credit that the deaths of trans people like Tony McDade and Nina Pop haven’t been lost in the shuffle of recent tragedies. But visibility hasn’t been the sole accomplishment.

“This moment crystallizes how important organizing is to movement work and movement building,” Muhammad says. “It’s clear that what they did helped to prepare, city by city, what is emerging as a national network of organizers who have been ready, willing, and able to step into a crisis. We have to see what’s happening here in terms of the nucleus of these massive protests being the outcome of all of that work.”

Explainer: what is decolonisation?

Decolonisation is now used to talk about restorative justice through cultural, psychological and economic freedom.

In most countries where colonisers remain, Indigenous people still don’t hold significant positions of power or self-determination. These nations are termed “settler-colonial” countries – a term made popular in the 1990s by academic Patrick Wolfe, who said “invasion is a structure not an event”.

We Can Protect the Economy From Pandemics. Why Didn’t We?

Now 49, Wolfe had traded the Cameroonian jungle for the conference rooms of Silicon Valley. When I saw him on Zoom, his shoulder-length locks were gone, and his quarantine beard was shot through with gray. But he had the same glow of enthusiasm I remembered. His new preoccupation, he told me, was pandemic insurance.

I’ll confess this didn’t immediately pique my interest. The word insurance evokes in me feelings of tedium and loathing. Like many Americans, my personal interface with the industry has, let’s just say, been less than positive. But then Wolfe began to explain the unexpected direction his career had taken. After years of thinking about epidemics in terms of the symptomatic and the dead, he’d begun considering their economic ramifications. A global pandemic, and the steps we would take to stop it, would mean business closings, layoffs, and mass unemployment. Preparing to face an outbreak, he’d come to believe, required anticipating those impacts.

Tanya Luhrman reflects on writing, books, and the difference between anthropology and ethnography. All built around her own trajectory as a scholar.

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Wednesday Roundup #2

Tyrone B. Hayes on how racism works in the academy. Hayes also was featured in the New Yorker for his groundbreaking work on how manufactured chemicals negatively impact our environment, in particular the herbicide atrazine’s impact on sexual development among amphibians

“Why are you always here?” She asked as we walked up the hill from LSA to Morgan Hall where Immunology was taught. I had walked alongside the professor from LSA to class all semester.

Concerned, I answered, “I’m taking the class, is that ok? I’ve never had a course in immunology.” I assumed the Professor was confused because I was an IB graduate student taking an undergraduate course in MCB.

“I didn’t know they let you guys take classes” she responded.

“What do you mean?” I asked.

“Aren’t you the custodian who takes care of the crickets?” she queried.

“No… I’m a graduate student in IB” I answered.

“Oh.” She said unapologetically. “I always see you on the elevator…I just assumed you were the custodian who takes care of the crickets.”

And that was my introduction to Berkeley as a new graduate student (fall of 1989). It was one thing for campus police to block my car twice during my first week of graduate school and interrogate me because someone called and reported me in the building…but it was a completely different one for one of my professors to treat me this way. I dropped the class.

I thought Berkeley would be better. It reminded me of my first day at Harvard…

The Biggest Psychological Experiment in History Is Running Now

Individual resilience is further complicated by the fact that this pandemic has not affected each person in the same way. For all that is shared–the coronavirus has struck every level of society and left few lives unchanged–there has been tremendous variation in the disruption and devastation experienced. Consider Brooklyn, just one borough in hard-hit New York City. Residents who started the year living or working within a few miles of one another have very different stories of illness, loss and navigating the challenges of social distancing. How quickly and how well individuals, businesses and organizations recover will depend on the jobs, insurance and health they had when this started, on whether they have endured hassle or heartbreak, and on whether they can tap financial resources and social support.

The pandemic has laid bare the inequities in the American health care system and economic safety net. Black and Latino Americans are dying at much higher rates than white Americans. “When we talk about preexisting conditions, it isn’t just if I’m obese, it’s our society’s preexisting condition,” says medical anthropologist Carol Worthman of Emory University, an expert in global mental health.

Fortunately, the unprecedented pandemic is leading to unprecedented science not just in virology but on mental health and resilience. Behavioral scientists are measuring the psychological toll in real time and striving to identify what helps people cope.

This Is What I Want To Tell My White Professors When They Ask, ‘How Are You Today?’

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Wednesday Round Up #1

I’m starting the Wednesday round up back up. I didn’t post yesterday because of #shutdownstem. For more information on that, see shutdownstem.com.

In the wake of the most recent murders of Black people in the US, it is clear that white and other non-Black people have to step up and do the work to eradicate anti-Black racism. As members of the global academic and STEM communities, we have an enormous ethical obligation to stop doing “business as usual.” No matter where we physically live, we impact and are impacted by this moment in history.

Our responsibility starts with our role in society. In academia, our thoughts and words turn into new ways of knowing. Our research papers turn into media releases, books and legislation that reinforce anti-Black narratives. In STEM, we create technologies that affect every part of our society and are routinely weaponized against Black people.

Black academic and Black STEM professionals are hurting because they exist in and are attacked by institutional and systemic racism. Black people have been tirelessly working for change, alongside their Indigenous and People of Color allies. For Black academics and STEM professionals, #ShutDownAcademia and #ShutDownSTEM is a time to prioritize their needs— whether that is to rest, reflect, or to act— without incurring additional cumulative disadvantage.

I encourage people to watch this short video with Ibram X. Kendi. “I’m not racist” is not good enough. We have to strive to actively become anti-racist.

Kendi’s longer talk here is well worth it. He provides more context and depth to his basic framing, and explains the history with keen insight.

I was also struck by this piece from footballer Liam Rosenior: This is just the beginning, I promise you: an open letter to Donald Trump.

Thank you for shining a spotlight to people around the world who have been sadly unaware of your country and the state it has been in for hundreds of years, and for outing the racist, hateful, bigoted and violent people who not only voted for you but have held the cultural key to an unjust, corrupt and fundamentally prejudiced society and system from the conception of the USA, built on the genocide of Native Americans and the slavery and incarceration of millions of black people.

Thank you for giving us a tangible, symbolic enemy (yourself and your Make America Great Again minions) against which people now have fuel to organise, strategise and mobilise a long-lasting movement and process to change our planet for good.

Ezra Klein interviewed Ta-Nehisi Coates.

“I can’t believe I’m gonna say this,” he replied, “but I see hope. I see progress right now” …
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Flattening the Mental Health Curve: Answers Already in Hand

Covid has impacted mental health. So too has police violence. And we still operate from a model where we have to go someplace to access individual care. Many of us fear going out, and our very institutions attack us. Somehow we think that expert care by institutions is what can solve the problem.

In this piece, I want to bring together two different views on this problem. The first comes from clinical psychologists addressing specific concerns about how to promote mental health during covid. The second comes from a cultural psychiatrist who fought for decolonizing psychiatry and recognizing how institutions have long been complicit in creating mental health problems, not just solving them.

June Gruber and Jonathan Rottenberg argue in Flattening the mental health curve is the next big coronavirus challenge:

Our field has accumulated long lists of evidence-based approaches to treat and prevent anxiety, depression and suicide. But these existing tools are inadequate for the task at hand. Our shining examples of successful in-person psychotherapies – such as cognitive behavioral therapy for depression, or dialectical behavioral therapy for suicidal patients – were already underserving the population before the pandemic.

Now, these therapies are largely not available to patients in person, due to physical distancing mandates and continuing anxieties about virus exposure in public places. A further complication: Physical distancing interferes with support networks of friends and family. These networks ordinarily allow people to cope with major shocks. Now they are, if not completely severed, surely diminished.

They argue for four inter-related factors: (1) just as with a switch to online teaching and learning, they see tele-health as one important way to bridge the gap; (2) democratizing mental health care and drawing on peer programs and social support more explicitly (rather than just delivering expert care); (3) promote populational mental health, which includes promoting better sleep, more exercise, and the ability to spend time outdoors; and (4) tracking populational mental health.

#4 will likely require new approaches and measures, as so much of psychology operates with a focus on the individual, rather than having scales and theories to address problems such as deaths of despair. Nancy Krieger’s ecosocial approach offers one place to start.

The second piece comes from the Foundation for Psychocultural Research: Owning Our Madness: Honoring Cultural Psychiatrist Frederick Hickling.

Hickling argues that we must own our madness. Own our mental health. And for Hickling this approach requires decolonization:

The mental health challenge for descendants of African people enslaved in Jamaica is to reverse the psychological impact of 500 years of European racism and colonial oppression and create a blueprint for the decolonization of Global Mental Health. The core innovations were the gradual downsizing and dismantling of the colonial mental hospital and the establishment of a novel community mental health initiative. The successful management of acute psychosis in open medical wards of general hospitals and a Diversion at the Point of Arrest Programme (DAPA) resulted in the reduction of stigma and the assimilation of mental health care into medicine in Jamaica. Successful decentralization has led to unmasking underlying social psychopathology and the subsequent development of primary prevention therapeutic programs based on psychohistoriographic cultural therapy and the Dream-A-World Cultural Therapy interventions.

In the video, Hickling tells us, “First we must understand colonialism and what I call the European-American psychosis… A primary delusion that has shaped contemporary psychological experience. Imagine, this small group of white people arriving in a boat after 10 or 12 weeks across the Atlantic, not having enough food and enough water and starving and hungry. And they arrive in this place of paradise, wonderful paradise, and they look at it and they say, This all belongs to me. And you all in here belong to me. And your wife and your husband and your children, you all belong to me. That must be the primary grandiose delusion of Europe.”

Hickling details his specific approach to cultural therapy in his Owning the Madness article in Transcultural Psychiatry.

The unique psychohistoriographic cultural therapy program pioneered in Bellevue Mental Hospital, Jamaica, in 1978 was a novel large group psychotherapy technique aimed at stimulating group insight and catalyzing change (Hickling, 1989, 2007). Created by combining the concept of historiography (Becker, 1938; Goveia,1958) with the oral tradition (Brodber, 1982),psychohistoriography is a method of dialectic analysis of reflective anecdotes to determine a group’s outlook, ideology, and beliefs and to identify dynamics and social forces that compel change.

The article then details (1) the development of community-wide mental health services, (2) short-stay treatement, (3) diversion at point of arrest, (4) reduction of stigma, (5) assimilation of mental health into medical care, (6) unmasking underlying social psychopathology, (7) the development of primary prevention programs, and (8) the development of specific cultural therapies to promote cultural resilience.

Decades of work in Jamaica offers the paths for how we might flatten the curve of mental health.

Maps, Figurative Symbols, and Songlines

When I think of symbols, I default to a rather literal sense of them. In my Introduction to Anthropology class, I put up the symbol for radiation, say there is nothing inherent in that symbol to tell us what it is, rather we put meaning on it – the symbol then tells us, beware of radiation. And thinking about early symbolism is often presented in a similar way. Pigments from Bombos caves, those must have been used to indicate group and individual identity. Radcliffe-Brown’s structural-functional jokes meets Geertz’s system of symbols…

But when I write, I am often trying to feel my way, to find a way to express and configure and connect. Not always – good science writing requires trying to express complicated ideas in a literal way, but that is often helped along by metaphors and comparisons. And when I take a photo, it is not the meaning of the photo that captures me, but the composition and trying to catch a moment that works within larger constellations of happenings in my life and the lives of others.

A graduate student of mine sent me this article, Thinking in maps: from the Lascaux caves to modern knowledge graphs by Anne-Laure Le Cunff over at Ness Labs. It opens:

“What do hieroglyphs, flowcharts, road signs, and knowledge graphs have in common? They’re all thinking maps. Humans have been thinking in maps since the very first symbolic communication systems.

While thinking in maps may first bring to mind the idea of cartography, a map does not need to be geographic—it can be any symbolic depiction of the relationship between elements of some physical or mental space, such as themes, objects, or areas.

In the December 2007 edition of Philosophy of Mind, Professor Elisabeth Camp, whose research has focused on forms of thoughts that do not fit standard models, wrote: “Thinking in maps is substantively different from thinking in sentences.””

And immediately I am struck by how my approach to symbols is one based in “thinking in sentences” – symbols tell me things. Figurative renderings, not so much. But any symbolic relationship between elements could count… That opens a much wider field for how to think about symbols and cognition in the past and the present.

The songlines of indigenous Australians operate more in this figurative realm, as stories and maps and music all together. Nganyinytja, a Pitjantjatjara woman, tells us:

“We have no books, our history was not written by people with pen and paper. It is in the land, the footprints of our Creation Ancestors are on the rocks. The hills and creek beds they created as they dwelled in this land surround us. We learned from our grandmothers and grandfathers as they showed us these sacred sites, told us the stories, sang and danced with us the Tjukurpa (the Dreaming Law). We remember it all; in our minds, our bodies and feet as we dance the stories. We continually recreate the Tjukurpa … ”

These ways of knowing help inform novel ways of thinking about how education can and should work, cultivating this long-existing and robust civilization, and even game design.

This figurative relationship is illustrated so well in this video with Elwyn Henaway demonstrating how the patterning works.

Now back to the original article:
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Neuronal Systems as Networks

I want to cover two different open-access papers here, both of which represent advances in how we can study and understand how the brain achieves complex outcomes using different levels of interaction, from neurotransmitter systems, to connections among brain areas, to how networks work as systems. The first is a neuroscience-heavy paper, the second more on philosophy of science and complexity. So a good pairing!

Dynamic coupling of whole-brain neuronal and neurotransmitter systems by Morten L. Kringelbach et al.
Abstract:

Remarkable progress has come from whole-brain models linking anatomy and function. Paradoxically, it is not clear how a neuronal dynamical system running in the fixed human anatomical connectome can give rise to the rich changes in the functional repertoire associated with human brain function, which is impossible to explain through long-term plasticity. Neuromodulation evolved to allow for such flexibility by dynamically updating the effectivity of the fixed anatomical connectivity. Here, we introduce a theoretical framework modeling the dynamical mutual coupling between the neuronal and neurotransmitter systems. We demonstrate that this framework is crucial to advance our understanding of whole-brain dynamics by bidirectional coupling of the two systems through combining multimodal neuroimaging data (diffusion magnetic resonance imaging [dMRI], functional magnetic resonance imaging [fMRI], and positron electron tomography [PET]) to explain the functional effects of specific serotoninergic receptor (5-HT2AR) stimulation with psilocybin in healthy humans. This advance provides an understanding of why psilocybin is showing considerable promise as a therapeutic intervention for neuropsychiatric disorders including depression, anxiety, and addiction. Overall, these insights demonstrate that the whole-brain mutual coupling between the neuronal and the neurotransmission systems is essential for understanding the remarkable flexibility of human brain function despite having to rely on fixed anatomical connectivity.

A key section explaining their basic modeling:

Specifically, the bidirectional coupling of the neuronal and neurotransmitter systems was modeled in the following way: For the placebo condition, we used a standard whole-brain model to simulate the neuronal system, i.e., modeling spontaneous brain activity at the whole-brain level (measured with blood oxygen level-dependent [BOLD] fMRI), where each node represents a brain area and the links between them are represented by white matter connections (measured with dMRI). For the psilocybin condition, we mutually coupled the whole-brain neuronal and neurotransmitter systems by including an explicit description of the neurotransmitter dynamical system and the mutual coupling with the neuronal system. This was done by modeling the dynamics of the neurotransmitter system through simulating the release-and-reuptake dynamics, where the serotonin receptor density of each brain area is measured with PET. The neurotransmitter dynamics are then in turn coupled with the neuronal activity through the firing rate activity of the raphe nucleus, source of the serotonin neurotransmitter.

And how they made that model statistically tractable:

We fitted the mutually coupled whole-brain model using our framework of describing a brain state as an ensemble or probabilistic “cloud” in a given state space (29). This cloud is of course not clustered into discrete states (30), but it has been shown that clustering can nevertheless be useful in providing so-called “metastable substates” that can significantly distinguish between brain states (31, 32). A brain state is determined by a collection of metastable substates, i.e., of time-varying pseudo-states resulting from the clustering process (33⇓–35).

And their conclusion:
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A Re-Opening: Some Reflections on the US

So I am coming back to the blog that started it all. Here are two related pieces on the US and higher education, but with a broader framing.

First in the New York Review of Books, What Kind of Country Do We Want? by Marilynne Robinson

When schools and hospitals close, the value of everything that is dependent on them falls. Austerity toward some is a tax cut for others, a privatization of social wealth. The economics of opportunism is obvious at every stage in this great shift. And yet Americans have reacted to the drove of presumptive, quasi, and faux billionaires as if preternatural wealth were a credential of some kind.

All the talk of national wealth, which is presented as the meaning and vindication of America, has been simultaneous with a coercive atmosphere of scarcity. America is the most powerful economy in history and at the same time so threatened by global competition that it must dismantle its own institutions, the educational system, the post office. The national parks are increasingly abandoned to neglect in service to fiscal restraint. We cannot maintain our infrastructure. And, of course, we cannot raise the minimum wage. The belief has been general and urgent that the mass of people and their children can look forward to a future in which they must scramble for employment, a life-engrossing struggle in which success will depend on their making themselves useful to whatever industries emerge, contingent on their being competitive in the global labor market. Polarization is the inevitable consequence of all this.

The great error of any conspiracy theory is the assumption that blame can be placed on particular persons and interests. A chord is struck, a predisposition is awakened. America as a whole has embraced, under the name of conservatism and also patriotism, a radical departure from its own history. This richest country has been overtaken with a deep and general conviction of scarcity, a conviction that has become an expectation, then a kind of discipline, even an ethic. The sense of scarcity instantiates itself. It reinforces an anxiety that makes scarcity feel real and encroaching, and generosity, even investment, an imprudent risk.

And then Bashing Administrators While the University Burns by Gabriel Paquette in The Chronicle of Higher Ed.

At my university as at many others, public and private, we are, out of necessity, in a market for students. And that market is shrinking because of demographic trends and accelerated by Covid-19. To sustain our institutions, we must adapt. Otherwise, we are doomed.

Denunciation, recrimination, and grandstanding are pit stops on the road to oblivion. This is not to say that faculty criticisms of university leadership are unfounded or invalid. But they are a dead end unless accompanied by the constructive aim of collective betterment. The allure of mounting the barricades is almost irresistible, but what’s the point if we all end up guillotined? What use is rehearsing old grievances if students balk at further indebtedness, and our revenue models collapse?

I anticipate one of two scenarios in the coming years. In the first, the familiar feuds persist, and the university edifice crumbles, with old enmities slight consolation for those who remain amid the ruins. In the second, instinctive self-preservation and mutual interest incite faculty-administrative cooperation, institutional moribundity is reversed, and a new university is erected on the foundations of the old.

Delusions, odd and common: Living in the prodrome, part 2 (originally 10 January 2011)

(We are republishing ‘legacy content’ from our PLOS Neuroanthropology weblog, which has been taken down, along with many of the other founding PLOS Blogs. Some of these, I am putting up because I teach with them. If you have any requests, don’t hesitate to email me at: greg.downey @ mq (dot) edu (dot) au. I suspect many of the links in this piece will be broken, but I will endeavour to try to slowly rebuild this content. I originally published this on 1 January, 2011. Comments have been pasted in at the end of the post from the original.) 

Author Rachel Aviv talked at length with a number of young people who had been identified as being ‘prodromal’ for schizophrenia, experiencing periodic delusions and at risk of converting to full-blown schizophrenia, following some of the at-risk individuals for a year.  In December’s Harper’s, Aviv offered a sensitive, insightful account of their day-to-day struggles to maintain insight, recognizing which of their experiences are not real: Which way madness lies: Can psychosis be prevented? (Freely accessible pdf available here.)

Psychiatric Research by Ted Watson

Aviv’s piece was really moving and inspired this post and an earlier one. The first part (Slipping into psychosis: living in the prodrome (part 1)) provides some sense of Aviv’s interviews, especially the story of ‘Anna,’ a woman who feared that she, like her mother before her, might be losing her grasp on reality.  In addition, the earlier post covered the controversy surrounding the attempt to formalize a diagnosis in the DSM-V of ‘prodrome’ and the ethical problems created by trying to identify who is at risk of ‘going mad.’

This post is my more speculative offering, contemplating the relation of the content of delusions to the cultural context in which they occur. How do the specific details of delusions arise and how might the particularity of any one person’s delusions affect the way that a delusional individual is treated by others?  Are you mad if everyone around you talks as if they, too, were experiencing the same delusions?

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Florida Governor: Anthropology Not Needed Here (originally 11 October, 2011)

(We are republishing ‘legacy content’ from our PLOS Neuroanthropology weblog, which has been taken down, along with many of the other founding PLOS Blogs. Some of these, I am putting up because I teach with them. If you have any requests, don’t hesitate to email me at: greg.downey @ mq (dot) edu (dot) au. I suspect many of the links in this piece will be broken, but I will endeavour to try to slowly rebuild this content. Daniel originally published this on 11 October, 2011. Comments have been pasted in at the end of the post from the original.) 

Anthropologists have been singled out by Florida Governor Rick Scott as not being needed. On the Marc Benier show, Gov. Scott said:

We don’t need a lot more anthropologists in the state. It’s a great degree if people want to get it, but we don’t need them here. I want to spend our dollars giving people science, technology, engineering, and math degrees. That’s what our kids need to focus all their time and attention on, those types of degrees, so when they get out of school, they can get a job.

The American Anthropological Association issued a swift response to Gov. Scott, and the news that he thinks anthropology majors are not needed.

As an association, we are a group of over 11,000 scholars, scientists, and professionals who are dedicated to studying humankind in all its aspects, including through archaeological, biological, cultural, medical, and linguistic research… Perhaps you are unaware that anthropologists are leaders in our nation’s top science fields, making groundbreaking discoveries in areas as varied as public health, human genetics, legal history, bilingualism, the African American heritage, and infant learning.

As reported by the Orlando Sentinel, anthropology has become Gov. Scott’s primary example of an area where he believes public spending should be cut.

Tax revenues are expected to be lower than expected, forcing the state to prioritize where it spends dollars. Along those lines, Scott repeated a statement earlier this week by saying the state should spend less on education programs that aren’t related to current workforce demands, singling out anthropology.

“We’re spending a lot of money on education, and when you look at the results, it’s not great,” the governor told a luncheon crowd of the Northwest Business Association in Tallahassee. “Do you want to use your tax money to educate more people who can’t get jobs in anthropology? I don’t.”

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Slipping into psychosis: living in the prodrome (part 1, originally 5 January 2011)

(I am republishing ‘legacy content’ from our PLOS Neuroanthropology weblog, which has been taken down, along with many of the other founding PLOS Blogs. Some of these, I am putting up because I teach with them. If you have any requests, don’t hesitate to email me at: greg.downey @ mq (dot) edu (dot) au. I suspect many of the links in this piece will be broken, but I will endeavour to try to slowly rebuild this content. I originally published this on 5 January 2011. Part 2 is here: Delusions, odd and common: Living in the prodrome, part 2 (originally 10 January 2011).

How might it feel to sense your own sanity eroding? Would you realize it? How might you sift the phantoms from physical reality, daydream from delusion, the irrefutable from the implausible? Or, as author Rachel Aviv puts it,

When does a strong idea take on a pathological flavor? How does a metaphysical crisis morph into a medical one? At what point does our interpretation of the world become so fixed that it no longer matters “what almost everyone else believes” [part of the definition of ‘delusion’ in the DSM]? Even William James admitted that he struggled to distinguish a schizophrenic break from a mystical experience. (Aviv 2010: 37)

Aviv wrote in the December issue of Harper’s MagazineWhich way madness lies: Can psychosis be prevented? (UPDATED: The original is now locked, but you can download a pdf of the story here. Thanks, Deidre!)  As Aviv told me in an email, the story arose, in part, out of following young patients at clinics who might be in the prodrome to psychosis, the early stages of experiencing intermittent breaks from shared reality that might lead up to schizophrenia.  Based on interviews with patients and clinicians, Aviv explores how both seek to cope with the warning signs that someone may be sliding toward a definitive break, or ‘conversion’ as it is termed in psychiatry, bolstering the individual’s sense of self and reality against corrosion.

The piece is a powerful, troubling, and thought-provoking read.  Aviv explains:

It is impossible to predict the precise moment when a person has embarked on a path toward madness, since there is no quantifiable point at which healthy thoughts become insane. It is only in retrospect that the prelude to psychosis can be diagnosed with certainty.  (36)

What I particularly appreciate about Aviv’s account is that she writes extensively about the nature of the delusions themselves, about the flow of delusional ideas, their relation to the collapse of a clear sense of self, and the challenges facing an individual who begins to feel the implausible welling up in everyday reality.  She writes that much of psychiatry has tried to get around the specificities of the delusions — Who’s putting thoughts in your head?  How are you being watched?  What sort of ghosts or angels or aliens are following you?

Patients and some clinicians alike have a vested interest in discrediting the content of delusions, dismissing the ideas as errant chemicals or glitches in brain function.  But as Aviv so clearly demonstrates, the specificities of the delusions are both what the patients struggle with daily and the source of the leverage that some of them find to fight off further drift into idiosyncratic worlds.  The delusions matter, both because patients search in them for signs of their truth or unreality, but also because the details of the delusion, not just the fact of having them, arise from our shared reality.

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