Sunday, January 12, 2020

"Deaths Of Despair", Why Believe in Hell?, Short-Term Memory & Age, Submitting Trump To A "72-Hour Mental Health Hold"


Nicholas Kristof and Sheryl WuDunn, New York Times, January 9, 2020:
Who Killed the Knapp Family?
Across America, working-class people — including many of our friends — are dying of despair. And we're still blaming the wrong people.

Chaos reigned daily on the No. 6 school bus, with working-class boys and girls flirting and gossiping and dreaming, brimming with mischief, bravado and optimism. Nick [Kristof, one of the authors] rode it every day in the 1970s with neighbors here in rural Oregon, neighbors like Farlan, Zealan, Rogena, Nathan and Keylan Knapp.

They were bright, rambunctious, upwardly mobile youngsters whose father had a good job installing pipes. The Knapps were thrilled to have just bought their own home, and everyone oohed and aahed when Farlan received a Ford Mustang for his 16th birthday.

Yet today about one-quarter of the children on that No. 6 bus are dead, mostly from drugs, suicide, alcohol or reckless accidents. Of the five Knapp kids who had once been so cheery, Farlan died of liver failure from drink and drugs, Zealan burned to death in a house fire while passed out drunk, Rogena died from hepatitis linked to drug use and Nathan blew himself up cooking meth. Keylan survived partly because he spent 13 years in a state penitentiary.

Among other kids on the bus, Mike died from suicide, Steve from the aftermath of a motorcycle accident, Cindy from depression and a heart attack, Jeff from a daredevil car crash, Billy from diabetes in prison, Kevin from obesity-related ailments, Tim from a construction accident, Sue from undetermined causes. And then there's Chris, who is presumed dead after years of alcoholism and homelessness. At least one more is in prison, and another is homeless.

We Americans are locked in political combat and focused on President Trump, but there is a cancer gnawing at the nation that predates Trump and is larger than him. Suicides are at their highest rate since World War II; one child in seven is living with a parent suffering from substance abuse; a baby is born every 15 minutes after prenatal exposure to opioids ...

We have deep structural problems that have been a half century in the making, under both political parties, and that are often transmitted from generation to generation. Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of "deaths of despair." [Note: The phrase was coined by economists Angus Deaton and his wife Anne Case, to describe the surge of mortality from alcohol, drugs and suicide.]

The kids on the No. 6 bus rode into a cataclysm as working-class communities disintegrated across America because of lost jobs, broken families, gloom — and failed policies. The suffering was invisible to affluent Americans, but the consequences are now evident to all: The survivors mostly voted for Trump, some in hopes that he would rescue them, but under him the number of children without health insurance has risen by more than 400,000. ...

If you're only a high school graduate, or worse, a dropout, work no longer pays. If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it's $7.25. ...

"I'm a capitalist, and even I think capitalism is broken," says Ray Dalio, the founder of Bridgewater, the world's largest hedge fund.

Even in this presidential campaign, the unraveling of working-class communities receives little attention. There is talk about the middle class, but very little about the working class; we discuss college access but not the one in seven children who don't graduate from high school. America is like a boat that is half-capsized, but those partying above water seem oblivious. ...

We have to treat America's cancer.

In some ways, the situation is worsening, because families have imploded under the pressure of drug and alcohol abuse, and children are growing up in desperate circumstances. One of our dearest friends in Yamhill, Clayton Green, a brilliant mechanic who was three years behind Nick in school, died last January, leaving five grandchildren — and all have been removed from their parents by the state for their protection. A local school official sighs that some children are "feral." ...

America is polarized with ferocious arguments about social issues, but we should be able to agree on what doesn't work: neglect and underinvestment in children. Here's what does work.

Job training and retraining give people dignity as well as an economic lifeline. Such jobs programs are common in other countries.

For instance, autoworkers were laid off during the 2008-9 economic crisis both in Detroit and across the Canadian border in nearby Windsor, Ontario. As the scholar Victor Tan Chen has showed, the two countries responded differently. The United States focused on money, providing extended unemployment benefits. Canada emphasized job retraining, rapidly steering workers into new jobs in fields like health care, and Canadian workers also did not have to worry about losing health insurance.

Canada's approach succeeded. The focus on job placement meant that Canadian workers were ushered more quickly back into workaday society and thus today seem less entangled in drugs and family breakdown.

Another successful strategy is investing not just in prisons but also in human capital to keep people out of prisons. ...

For individuals trying to break an addiction, a first step is to face up to the problem — and that's what America should do as well.

[This essay is adapted from Tightrope: Americans Reaching for Hope, to be published January 14, 2020.]
David Bentley Hart, New York Times, January 10, 2020:
Why Do People Believe in Hell?
The idea of eternal damnation is neither biblically, philosophically nor morally justified. But for many it retains a psychological allure.

Once the faith of his youth had faded into the serene agnosticism of his mature years, Charles Darwin found himself amazed that anyone could even wish Christianity to be true. Not, that is, the kindlier bits — "Love thy neighbor" and whatnot — but rather the notion that unbelievers (including relatives and friends) might be tormented in hell forever.

It's a reasonable perplexity, really. ...

For a good number of Christians, hell isn't just a tragic shadow cast across one of an otherwise ravishing vista's remoter corners; rather, it's one of the landscape's most conspicuous and delectable details.

[O]nly recently, in releasing a book challenging the historical validity, biblical origins, philosophical cogency and moral sanity of the standard Christian teaching on the matter of eternal damnation [That All Shall Be Saved: Heaven, Hell, and Universal Salvation], have I ever inspired reactions so truculent, uninhibited and (frankly) demented.

I expect, of course, that people will defend the faith they've been taught. What I find odd is that, in my experience, raising questions about this particular detail of their faith evinces a more indignant and hysterical reaction from many believers than would almost any other challenge to their convictions. Something unutterably precious is at stake for them. Why? ...

No truly accomplished New Testament scholar, for instance, believes that later Christianity's opulent mythology of God's eternal torture chamber is clearly present in the scriptural texts. It's entirely absent from St. Paul's writings; the only eschatological fire he ever mentions brings salvation to those whom it tries (1 Corinthians 3:15). Neither is it found in the other New Testament epistles, or in any extant documents (like the Didache) from the earliest post-apostolic period. There are a few terrible, surreal, allegorical images of judgment in the Book of Revelation, but nothing that, properly read, yields a clear doctrine of eternal torment. Even the frightening language used by Jesus in the Gospels, when read in the original Greek, fails to deliver the infernal dogmas we casually assume to be there.

On the other hand, many New Testament passages seem — and not metaphorically — to promise the eventual salvation of everyone. For example: "Therefore, as one trespass led to condemnation for all men, so one act of righteousness leads to justification and life for all men." (Romans 5:18) Or: "For as in Adam all die, so also in Christ shall all be made alive." (1 Corinthians 15:22) Or: "He is the propitiation for our sins, and not for ours only but also for the sins of the whole world." (1 John 2:2) (Or: John 13:32; Romans 11:32; 1 Timothy 2:3-6; 4:10; Titus 2:11; and others.) ...

[O]nce the Christian Church became part of the Roman Empire's political apparatus, the grimmest view naturally triumphed. As the company of the baptized became more or less the whole imperial population, rather than only those people personally drawn to the faith, spiritual terror became an ever more indispensable instrument of social stability. ...

How can we be winners, after all, if there are no losers? Where's the joy in getting into the gated community and the private academy if it turns out that the gates are merely decorative and the academy has an inexhaustible scholarship program for the underprivileged? What success can there be that isn't validated by another's failure? What heaven can there be for us without an eternity in which to relish the impotent envy of those outside its walls?

Not to sound too cynical. But it's hard not to suspect that what many of us find intolerable is a concept of God that gives inadequate license to the cruelty of which our own imaginations are capable.

An old monk on Mount Athos in Greece once told me that people rejoice in the thought of hell to the precise degree that they harbor hell within themselves. By which he meant, I believe, that heaven and hell alike are both within us all, in varying degrees, and that, for some, the idea of hell is the treasury of their most secret, most cherished hopes — the hope of being proved right when so many were wrong, of being admired when so many are despised, of being envied when so many have been scorned.
Daniel J. Levitin, New York Times, January 10, 2020:
Everyone Knows Memory Fails as You Age. But Everyone Is Wrong.

I'm 62 years old as I write this. Like many of my friends, I forget names that I used to be able to conjure up effortlessly. When packing my suitcase for a trip, I walk to the hall closet and by the time I get there, I don't remember what I came for.

And yet my long-term memories are fully intact. I remember the names of my third-grade classmates, the first record album I bought, my wedding day.

This is widely understood to be a classic problem of aging. But as a neuroscientist, I know that the problem is not necessarily age-related.

Short-term memory contains the contents of your thoughts right now, including what you intend to do in the next few seconds. It's doing some mental arithmetic, thinking about what you'll say next in a conversation or walking to the hall closet with the intention of getting a pair of gloves.

Short-term memory is easily disturbed or disrupted. It depends on your actively paying attention to the items that are in the "next thing to do" file in your mind. ... [A]ny distraction — a new thought, someone asking you a question, the telephone ringing — can disrupt short-term memory. Our ability to automatically restore the contents of the short-term memory declines slightly with every decade after 30. ...

I've been teaching undergraduates for my entire career and I can attest that even 20-year-olds make short-term memory errors — loads of them. They walk into the wrong classroom; they show up to exams without the requisite No. 2 pencil; they forget something I just said two minutes before. These are similar to the kinds of things 70-year-olds do.

The relevant difference is not age but rather how we describe these events, the stories we tell ourselves about them. Twenty-year-olds don't think, "Oh dear, this must be early-onset Alzheimer's." They think, "I've got a lot on my plate right now" or "I really need to get more than four hours of sleep." ... [E]very lapse of short-term memory doesn't necessarily indicate a biological disorder.

In the absence of brain disease, even the oldest older adults show little or no cognitive or memory decline beyond age 85 and 90, as shown in a 2018 study. Memory impairment is not inevitable. ...

So how do we account for our subjective experience that older adults seem to fumble with words and names? First, there is a generalized cognitive slowing with age — but given a little more time, older adults perform just fine.

Second, older adults have to search through more memories than do younger adults to find the fact or piece of information they're looking for. Your brain becomes crowded with memories and information. It's not that you can't remember — you can — it's just that there is so much more information to sort through. A 2014 study found that this "crowdedness" effect also shows up in computer simulations of human memory systems.

[This essay is adapted from Successful Aging: A Neuroscientist Explores the Power and Potential of Our Lives]
Chauncey DeVega, Salon, December 23, 2019:
How to understand Trump now: Wounded child, drug addict or delusional gaslighter?

Conversation with Dr. Justin Frank, a former clinical professor of psychiatry at the George Washington University Medical Center and a physician with more than 40 years of experience in psychoanalysis. He is the author of the bestselling books Bush on the Couch, Obama on the Couch, and Trump on the Couch: Inside the Mind of the President.

What was your initial reaction to Trump's impeachment letter to Pelosi?

It was a letter written by a person who is making a very clear statement to everyone that he is a victim. Without lauding too much praise on this president, in a way it is actually a brilliant letter. Trump's letter to Pelosi is a clear example of how obsessive victims think about world because he blames everyone. Trump projects. Trump criticizes other people. Some of his projections are in fact delusional — and then he justifies how great he is with that long paragraph about all of his accomplishments, such as the economy, etc. But Trump's letter is laced with not just lies and self-aggrandizement, but a feeling that made me think of a little child who says, "Not fair! What you're doing is not fair! You shouldn't do this to me. It's not fair, Mommy! It's not fair, Daddy! You shouldn't do this!" That is what Trump's letter sounded like. A little child.

Trump's letter is also similar to what one would expect from a drug addict. Blaming others, the false victim narrative, the grandiosity.

You are correct. Trump's letter is similar to how a drug addict's mind works. We see this in addicts who are in recovery. When there is stress and pressure on drug addicts, they revert to their earlier state of anxiety and accusations. They act like they're cornered. As Donald Trump becomes more and more cornered, he behaves exactly the way addicts behave, which is to accuse other people. Drug addicts make themselves into victims. Trump is doing something else that drug addicts do: They try to make other people anxious. In this case, Trump is trying to make the public, Nancy Pelosi, members of Congress and other people nervous and full of anxiety, as a way of denying it in himself. ...

What is the clinical definition of "delusional"? How does such a state of mind present itself?

It's a distortion of reality. It is also what is termed as a "false belief" that is based on an internal fantasy life. For example, the simplest delusion that we see in this letter, and that we've seen with Trump in the last few weeks, with the Ukraine scandal, is his saying over and over again, "It was a perfect phone call." There's no such thing as perfection, first of all. Trump's repeated insistence that he had a "perfect phone call" is a false belief. To keep saying that is both psychotic and sincere because the person who is deluded does not know they are delusional. When a person is full-blown deluded, they are possessed by their feelings, and their feelings are a fact to them.

In one of our previous conversations, you explained that Donald Trump is afraid of Nancy Pelosi. Is that dynamic present in this letter?

Fear is turned into attack in this letter. That is what is so frightening about Trump's letter to Pelosi. ... It is unconscious. He has converted his fear into claims that it is she, and not him, who is destroying America. She's the one who's ruining everything and trying to undo his election. Trump has a deep unconscious fear of Nancy Pelosi. ... Trump fears Nancy Pelosi because he can't seduce her. He's afraid of her because she is not distractible. Pelosi reminds Trump of his father, someone he cannot trick, seduce or bully, a person who is not afraid of him.

In this letter, Trump accuses Pelosi, the Democrats and in general anyone who opposes him of being a traitor, participating in a coup against him, betraying democracy, etc. Is this an example of Trump consciously accusing others of what he knows he is guilty of? Or is this projection, and Trump really believes he is a patriot and a great president?

Again, this is about projection. Is projection something that is conscious or unconscious? It's unconscious. When you accuse a person of something that is really about yourself, you do not realize what you are doing until someone points it out. Projection is an unconscious defense. The other aspect of Trump's behavior is that with him we are dealing with a person who is mentally decompensating. Trump has a decompensating character structure right now, and it is public and right in front of the world. Trump is going to a rally on the same night as he is being impeached. This will allow him to re-compensate his mind. He needs other people to help him get back on track and realize what a great person he is. But the delusional part of what is happening with Donald Trump, as shown in this letter, is that when a person is cornered and very regressed emotionally and mentally they go from projection — which is what we all do to some extent at times — to an unconscious process that includes what we call "delusional projection." Delusional projection is something you see in very disturbed people. I only see this behavior in hospitalized patients. Their projections are so out of touch with reality that everybody can see that they are delusional. ...

What of Trump's comments in the letter about how much he has endured, and that few people could have done everything that he has done in the fact of such attacks?

Trump is letting his most loyal followers know how strong and powerful he is. He is trying to inspire them to stand with him and not be cowed or intimidated by these supposed slanderous lies that Pelosi is spreading about their leader. Trump's claims about his strength and power are also compensatory for feelings of terrible inadequacy that he has had from the earliest stages of his life. He had problems with reading. He couldn't understand what people were saying when he was in class. He was unable to control his impulses. ... Trump is always trying to let people know that he can stand on his own and that he is healthy and strong.

Impeachment is a type of public shaming. But is Donald Trump even capable of feeling shame?

No, he is not. But Donald Trump is afraid of shame. Trump is terrified of being shamed. He's terrified of being humiliated. The terror that Trump has of being shamed should make all of us nervous.
Igor Derysh, Salon, January 4, 2020:
Yale psychiatrist urges Pelosi: Request 72-hour mental health hold on Trump after Iran attack

A Yale psychiatrist who has warned of the dangers of President Donald Trump's mental health for years urged House Speaker Nancy Pelosi to request a mental health hold of the president after he ordered a drone strike that killed a top Iranian general.

Bandy X. Lee, a professor of psychiatry at the Yale University School of Medicine, founded the World Mental Health Coalition after convening a conference at Yale on the president's mental health. She is the editor of the book The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President and more recently was joined by psychiatrists at universities around the U.S. in calling for the House of Representatives to convene a panel of mental health experts to weigh in on the president's impeachment proceedings.

Lee recently told Salon that Pelosi has not done enough to respond to the president.

"As a co-worker, she has the right to have him submit to an involuntary evaluation, but she has not," she said. "I am beginning to believe that a mental health hold, which we have tried to avoid, will become inevitable."

Lee told Salon this week that the president's decision to order the drone killing of a top Iranian general was further evidence that Pelosi should do more to rein in Trump. ...

"This is exactly the kind of dangerous event we foresaw as Donald Trump's response to the impeachment proceedings..." Lee told Salon. "This was why more than 800 mental health professionals petitioned Congress to consult with us, since, without intervention, this kind of crisis was a matter of time, not just a possibility."

Lee said Trump's actions were "exactly what someone who lacks mental capacity would do. ... [H]e is extremely drawn to actions that would help him appear as if he has mental capacity, such as a 'presidential strike' against an enemy, while avoiding the proper procedures, such as briefing with Congress, that might expose his lack of capacity. What we do not expect from someone who lacks mental capacity is rational, reality-based decision making that is non-impulsive, non-reckless, and cognizant of consequences."

Lee also noted that Trump had repeatedly accused former President Barack Obama of planning to attack Iran in order to help his re-election.

"Since he is incapable of putting himself in another person's shoes, he projects his own thoughts entirely onto others," she said. "Hence, we can deduce that what he has said about Mr. Obama has nothing to do with the former president but has only to do with the way he himself thinks."

Lee's comments that Pelosi has the right to request a mental health hold of Trump have drawn criticism. Lee spoke to Salon this week about her comments and reiterated her call for Pelosi to submit Trump for an "involuntary evaluation." The transcript that follows has been edited for length and clarity.

You recently told Salon that House Speaker Nancy Pelosi can request an involuntary mental health examination of President Trump, which prompted a lot of questions. Can you clarify what you meant and what that would look like? How might the president respond?

Given what has happened, my critics do not have an argument. There are many situations where I hoped that my formulation would be wrong — but now that my hypotheses have been tested so many times, we would be remiss to ignore the certainty. Psychological dangerousness is the only criterion we need, and I hope now that even ordinary people will see that the Syrian and Iraqi examples are psychological, not political, responses and not the result of a productive strategy!

What would an involuntary evaluation look like? We have to apply the same principles to an unprecedented situation, not rely on "this looks different than what I am used to seeing." In the case of family, members can call 911; in the case of a president, citizens could draw up a demand. Numerous citizens have approached me about this since our last interview, and I have recommended a petition. If millions sign, it cannot be ignored. ...

Is there a constitutional provision for this?

Yes. In this country, no one is above the law, and as far as mental health laws and the president are concerned, there is no Office of Legal Counsel memo, no exceptions and at this time not even confidentiality, since he has yet to be a patient. Before it is a political matter involving impeachment or the 25th Amendment, it is a medical matter. ... A 72-hour hold does not require court intervention and is enough for a solid evaluation. There is no shortage of mental health professionals willing to put their names to commitment papers, and multiple legal groups have offered to file for a court order for security staff to cooperate. All we need are auspices so as to show it is not a coup or something nefarious. This is common in mental health settings ...

Under this scenario, what would stop lawmakers or even voters from trying to have their opponents involuntarily evaluated?

This is the great misconception that has stemmed from a lack of education of the public. Psychiatry is a science that is evidence- and fact-based, just like the rest of medicine. If we leave everything to politics alone, without grounding in evidence, facts, science and established expertise, it becomes an area where anything goes to meet partisan ends. We should serve as a buffer against this, not act as an agent of the state, the way the American Psychiatric Association done.

Do you think presidential candidates should be required to undergo some sort of mental health assessment to prevent potentially dangerous individuals from taking office in the first place?

Absolutely — this is what we have been advocating from the start! Every military officer, and particularly those handling nuclear weapons, is subject to a mental health screen before they take their positions. Their commander in chief should at least be held to the same standards. Implementing mental health screens would, in fact, eliminate most of the atrocities in history that have befallen nations because of a compromised leader. We have set up a non-governmental, independent expert panel with rigorous criteria that is ready to do fitness-for-duty tests of presidential and vice-presidential candidates, as well as the current president, any time we are called.

Why haven't more professionals spoken out about this?

I hold the American Psychiatric Association responsible for this, and I have criticized it from the moment I recognized what was happening. By choosing to protect a powerful political figure over society, it not only stigmatized an entire field through the secrecy and strangeness it imposed, but I believe it has doomed itself to infamy for refusing to act on perhaps the greatest mental health crisis possible, unless it corrects itself ... Pretending that something does not exist — not just mental compromise in the president, but mental health issues in general — disarms and victimizes us, while giving our enemies the chance to take advantage. It also abandons those who are suffering from the very serious problem of mental illness, and may hurt them by encouraging the conflation of dangerousness with mental illness.

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