Category Archives: mania

Catch 22: Psychosis, Culture and the Mind Wars

While the original catch 22 was about a person not getting interned for military service on a premise that one is insane and thus incapable; and on the flip side the fact that only a sane person , who wants to avoid military service , would use such an insanity defense; this post is more about the fact that if psychosis/delusion is defined in cultural terms, then a society of affected individuals who form a community/culture in which their beliefs/ behavior is not considered bizarre would have cured themselves of their malady by just forming a community.

Thus the paradox of defining psychotic symptoms in relative terms –

  • socially inappropriate behavior- As an example – if a person gets nude, it is a socially inappropriate behavior; but if he joins and starts living on a private nude beach- that becomes an acceptable behavior.
  • delusions as beliefs not shared by the community/culture – as Vaughan from Mind Hacks points out in his original research – here people with mind control delusions form an online community and thus logically within their community/ sub-culture- their beliefs are no more illogical or delusional.
  • Hallucinations as visions/ voices not heard/seen by others– This has an inherent problem as the qualia one experiences cannot be shared by others. Suppose one sees a magical performance in which something impossibles happens in front of one’s eyes – like a man cutting himself in two-is that a real phenomenon as all the audiences have witnessed it. Conversely if someone sees or hears things that seem more real than real to him/her but are not perceived by others should he doubt his subjective experience? If many psychotic patients come together and by synchronising in some sense of the word , get an auditory/ visual hallucination simultaneously – would that make their case strong that they are not listening to imaginary voices? As the diagnosis is made based on the presence of hallucinations and the psychiatrists are usually least bothered about the content, should it matter that the voice they hear says the same thing?

I concur with Vaughan that diagnosis not be made on relative terms – it should be in absolute terms. A behavior of being nude in public is no more appropriate- it once was when we were evolving- but now that we have clothes we better cover ourselves and if we have to reveal , reveal in a socially acceptable context (for eg Jain Munis or other saints at times go about naked, because the culture/ community of these holy men is very different from ours).

Similarly, delusions may just be an attempt to weave a coherent narrative around their unusual experiences- if the prevailing culture’s main values are things like warfare/ exploitation/ mind control experiments , then when faced with immense stressful situations that may lead to physcila and chemical changes in the brain and behavior and sensorimotor gating, one may cope by rationalizing one’s state as due to mind-control . Alternately one may consider oneself a victim of alien abduction and as being controlled by Aliens if the culture of that person values more of science and futuristic scenarios. Alternately the person from religious and spiritual cultures may believe themselves to be controlled by God or Satan and being juts the vehicle for their wishes. I have my own preferences and prejudices as to which interpretation is more desirable, but I’ll leave that for now and caution that it is best to consider a delusional belief as efforts to make sense of their unusual experincecs an tackled as such. One knows that the psychosis gets triggered by stress and emotional turmoil and one should address that to prevent the emergence of symtoms and then address the delusional beliefs.

I would now like to draw attention to an article I read in Washington post today. The author meets up with some Targeted Individual (TIs) of mind-control community and comes up with some very interesting observations.

The callers frequently refer to themselves as TIs, which is short for Targeted Individuals, and talk about V2K — the official military abbreviation stands for “voice to skull” and denotes weapons that beam voices or sounds into the head. In their esoteric lexicon, “gang stalking” refers to the belief that they are being followed and harassed: by neighbors, strangers or colleagues who are agents for the government.

I am currently reading a book Mind Wars by Moreno and one reason I am a bit reluctant to do a quick review is because it brings to light many such mind-control and man-machine intelligence experiments that may fuel mind-control delusions in those at risk and those trying to make sense of their stressful and emotional experiences . The book has similarly been written on a very cautious note, and I would love to review it also in a cautious mode. For now on to the Washington post article.

For all the scorn, the ranks of victims — or people who believe they are victims — are speaking up. In the course of the evening, there are as many as 40 clicks from people joining the call, and much larger numbers participate in the online forum, which has 143 members. A note there mentioning interest from a journalist prompted more than 200 e-mail responses.

It is interesting to note that the number of forum members is close to 150 – the number most frequently associated with any active community- as is also the number of nodes that cluster together in a real small-world network. Vaughan also points that the social network they discovered , by analyzing online mind-control sites, was a small-world network.

Girard sought advice from this then-girlfriend, a practicing psychologist, whom he declines to identify. He says she told him, “Nobody can become psychotic in their late 40s.” She said he didn’t seem to manifest other symptoms of psychotic behavior — he dressed well, paid his bills — and, besides his claims of surveillance, which sounded paranoid, he behaved normally. “People who are psychotic are socially isolated,” he recalls her saying.

This exposes some of the frequent myths associated with Psychosis. As one relates psychosis most with Schizophrenia, one believes that it cannot occur later- if one thinks of schizophrenia as a extreme manic episode of a bipolar disorder, one would not have a bias. Interestingly, of the blind psychiatrist that analyzed the online sites in the Vaughan study , most made an outright diagnosis of schizophrenia and not a delusional or psychotic assessment. Again, those having bipolar disorder may not be socially isolated. Even bipolar patients can suffer from mind-control or other delusions.

He got the same response from friends, he says. “They regarded me as crazy, which is a humiliating experience.”

When asked why he didn’t consult a doctor about the voices and the pain, he says, “I don’t dare start talking to people because of the potential stigma of it all. I don’t want to be treated differently. Here I was in Philadelphia. Something was going on, I don’t know any doctors . . . I know somebody’s doing something to me.”

Again notice the downward spiral – to avoid stigma and humiliation (at both being diagnosed as mad and putting one’s family to risk and shame(genetic defect) and as being not able to cope with external stresses( a perceived character defect) one takes the other more acceptable alternative of explaining one’s predicament as a result of prevalent cultural values. This leads to loss of touch with reality and pardoxically leads to social unaccepatnce. Here it is imperative to note that in some other psychological conditions like Mass hysteria too- the content of the abnormal behavior comprises of and is affected by prevalent cultural values. One may thus have a control-by-god ‘delusion’ or a control-by-govt/machines delusion or a control-by-aliens delusions. nbe may even see visions accordingly- some of a deity, others of Significan Others and still others of Govt agents (remember A Beautiful Mind).

Girard, for his part, believes these weapons were not only developed but were also tested on him more than 20 years ago.

What would the government gain by torturing him? Again, Girard found what he believed to be an explanation, or at least a precedent: During the Cold War, the government conducted radiation experiments on scores of unwitting victims, essentially using them as human guinea pigs. Girard came to believe that he, too, was a walking experiment.

As long as things like these have happened historically, one should not be surprised if one becomes suspicious after meeting top govt personnels at a stressful and vulnerable time. Also remember the LCD experiments!

GIRARD’S STORY, HOWEVER STRANGE, reflects what TIs around the world report: a chance encounter with a government agency or official, followed by surveillance and gang stalking, and then, in many cases, voices, and pain similar to electric shocks. Some in the community have taken it upon themselves to document as many cases as possible. One TI from California conducted about 50 interviews, narrowing the symptoms down to several major areas: “ringing in the ears,” “manipulation of body parts,” “hearing voices,” “piercing sensation on skin,” “sinus problems” and “sexual attacks.” In fact, the TI continued, “many report the sensation of having their genitalia manipulated.”

Again psychiatrists typically ignore the content of delusions/ hallucinations, but it is apparent that their is a pattern. I hope I was qualified enough to comment on what may be behind this pattern, but hopefully others more qualified would take a lead here and start examining why the etiology should be like this. One explanation, that is apparent is , treating one’s body reactions as being caused by others.

What made her think it was an electronic attack and not just in her head? “There was no sexual attraction to a man when it would happen. That’s what was wrong. It did not feel like a muscle spasm or whatever,” she says. “It’s so . . . electronic.”

Again, it is plausible that the attraction is unconscious and one is trying to make sense of a consciously undesired sensation.

Like Girard, Naylor describes what she calls “street theater” — incidents that might be dismissed by others as coincidental, but which Naylor believes were set up. She noticed suspicious cars driving by her isolated vacation home. On an airplane, fellow passengers mimicked her every movement — like mimes on a street.

Again if we have cultural artifacts like Bertolt Brescht type street theatres, MTV bakras or the concept of psychodramas, then it is quite possible that these delusions of conspiracy may get woven in the narrative.

For almost four years, Naylor says, the voices prevented her from writing. In 2000, she says, around the time she discovered the mind-control forums, the voices stopped and the surveillance tapered off. It was then that she began writing 1996 as a “catharsis.”

Colleagues urged Naylor not to publish the book, saying she would destroy her reputation. But she did publish, albeit with a small publishing house. The book was generally ignored by critics but embraced by TIs.

Naylor is not the first writer to describe such a personal descent. Evelyn Waugh, one of the great novelists of the 20th century, details similar experiences in The Ordeal of Gilbert Pinfold. Waugh’s book, published in 1957, has eerie similarities to Naylor’s.

Again notice the stigma and the similarities.

Embarking on a recuperative cruise, Pinfold begins to hear voices on the ship that he believes are part of a wireless system capable of broadcasting into his head; he believes the instigator recruited fellow passengers to act as operatives; and he describes “performances” put on by passengers directed at him yet meant to look innocuous to others.

“One tries to convince friends and family that you are being electronically harassed with voices that only you can hear,” he writes in an e-mail. “You learn to stop doing that. They don’t believe you, and they become sad and concerned, and it amplifies your own depression when you have voices screaming at you and your friends and family looking at you as a helpless, sick, mentally unbalanced wreck.”

Moore, like other TIs, is cautious about sharing details of his life. He worries about looking foolish to friends and colleagues — but he says that risk is ultimately worthwhile if he can bring attention to the issue.

More stigma. And More courage, but perhaps in the wrong direction.

Alexander acknowledged that “there were some abuses that took place,” but added that, on the whole, “I would argue we threw the baby out with the bath water.”

But September 11, 2001, changed the mood in Washington, and some in the national security community are again expressing interest in mind control, particularly a younger generation of officials who weren’t around for MK-ULTRA. “It’s interesting, that it’s coming back,” Alexander observed.

“Maybe I can fix you, or electronically neuter you, so it’s safe to release you into society, so you won’t come back and kill me,” Alexander says. It’s only a matter of time before technology allows that scenario to come true, he continues. “We’re now getting to where we can do that.” He pauses for a moment to take a bite of his sandwich. “Where does that fall in the ethics spectrum? That’s a really tough question.”

When Alexander encounters a query he doesn’t want to answer, such as one about the ethics of mind control, he smiles and raises his hands level to his chest, as if balancing two imaginary weights. In one hand is mind control and the sanctity of free thought — and in the other hand, a tad higher — is the war on terrorism.

Does 9/11 justify a preparedness for Mind Wars? Or is the root of all evil in the culture that puts inappropriate stress on vulnerable individuls. It is interesting to note that some people got rid of their symptoms after joining online support groups.

Clancy argues that the main reason people believe they’ve been abducted by aliens is that it provides them with a compelling narrative to explain their perception that strange things have happened to them, such as marks on their bodies (marks others would simply dismiss as bruises), stimulation to their sexual organs (as the TIs describe) or feelings of paranoia. “It’s not just an explanation for your problems; it’s a source of meaning for your life,” Clancy says.

In the case of TIs, mind-control weapons are an explanation for the voices they hear in their head. Socrates heard a voice and thought it was a demon; Joan of Arc heard voices from God. As one TI noted in an e-mail: “Each person undergoing this harassment is looking for the solution to the problem. Each person analyzes it through his or her own particular spectrum of beliefs. If you are a scientific-minded person, then you will probably analyze the situation from that perspective and conclude it must be done with some kind of electronic devices. If you are a religious person, you will see it as a struggle between the elements of whatever religion you believe in. If you are maybe, perhaps more eccentric, you may think that it is alien in nature.”

A step towrads the right solutions.

Being a victim of government surveillance is also, arguably, better than being insane. In Waugh’s novella based on his own painful experience, when Pinfold concludes that hidden technology is being used to infiltrate his brain, he “felt nothing but gratitude in his discovery.” Why? “He might be unpopular; he might be ridiculous; but he was not mad.”

So is it better to be deluded or better to be Mad (psychotic).

In general, the outlook for TIs is not good; many lose their jobs, houses and family. Depression is common. But for many at the rally, experiencing the community of mind-control victims seems to help. One TI, a man who had been a rescue swimmer in the Coast Guard before voices in his head sent him on a downward spiral, expressed the solace he found among fellow TIs in a long e-mail to another TI: “I think that the only people that can help are people going through the same thing. Everyone else will not believe you, or they are possibly involved.”

In the end, though, nothing could help him enough. In August 2006, he would commit suicide.

Grave lessons. Psychitric help is needed and required. An online community may prevent you from insanity; it doesnt prevent death and suicide.

Is there any reason for optimism?

Girard hesitates, then asks a rhetorical question.

“Why, despite all this, why am I the same person? Why am I Harlan Girard?”

For all his anguish, be it the result of mental illness or, as Girard contends, government mind control, the voices haven’t managed to conquer the thing that makes him who he is: Call it his consciousness, his intellect or, perhaps, his soul.

“That’s what they don’t yet have,” he says. After 22 years, “I’m still me.”

The last words of hope. At least we are not lobotomizing people now and making them a different person.

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Schizophrenia and Bipolar disorder: The propensity towards psychosis

Schizophrenia, as we all know, is one of the most dibilating psychological disorder. It was primarily conceived of as a behavioral disorder, characterized by socially inappropriate and bizarre behavior, but much attention has been focussed nowadays on the cognitive component and the cognitive pathology underlying schizophrenia and it is not unusual for it to be characterized as a thought disorder nowadays .

Bipolar , or Manic Depressive disorder, on the other hand, has been primarily conceived of as a mood or affective disorder , characterized by excessive swings of emotion and motivation. One of my earlier post had tried to analyze the cognitive components involved in the Bipolar condition, and relate it to that found in unipolar depression.

While in my earlier posts, I have discussed the differences between the social and communicative difficulties of Autistic and Schizophrenic probands, especially in relation to their different cognitive styles, and how a milder form of such thinking can lead to different types of creativity, I had also promised for a similar dichotomous discussion of bipolarity at one end of the spectrum and depersonalization/ derealization/ ‘Alienation’ on the other hand- this time the important dimension being the feeling/emotion/motivation dimension.

While that discussion still awaits, I have come across a fascinating article by Lake et al(freely available, registration required) that tries to analyze the schizophrenic and bipolar type I disorders and concludes that there is no such thing as schizophrenia – the psychosis underlying schizophrenia, schizoaffcetive and Bipolar disorders is actually due to a not-yet-diagnosed Bipolar disorder in the patient. The extreme case of a Bipolar manic behavior would be a full-blown psychotic episode and in absence of proper assessment is likely to be diagnosed as schizophrenia. The article hopes, that identifying Bipolar in early stages would prevent unnecessary neuroleptics / anti-psychotics administration to the patient and prevent the significant side-effects of such medications and the rapid-cycling of the bipolar disorder itself, as mood stabilizers like Lithium and Valproate would not be given early on in the absence of bipolar diagnosis.

The other rationale for a single unified diagnosis of Bipolar is to prevent stigma associated with a diagnosis of schizophrenia. There has been well-documented research on the creativity-bipolar linkages; a similar research exists for creativity and schizotypal individuals- but due to the chronic, dibilating and adverse effects of a full-blown schizophrenic diagnosis , the literature about creativity and full-blown schizophrenia is limited (and perhaps inconclusive). The comprehensive ill-effects of a wrong diagnosis are given below:

For patient

  • Less likely to receive a mood stabilizer or antidepressant

  • Without a mood stabilizer, cycles increase and occur more rapidly; symptoms worsen

  • More likely to receive neuroleptics for life, increasing risk for severe and permanent side effects

  • Greater stigma with schizophrenia

  • Less likely to be employed

  • More likely to receive disability for life

  • More likely to “give up”

??For clinician

  • Increased risk of liability if patient given long-term neuroleptics instead of mood stabilizers develops tardive dyskinesia or commits suicide

The article takes a case study of a patient named Mr. C and tries to analyze how and why different diagnosis are made for the same patient depending on the presented symptoms and why Bipolar diagnosis occurs late in the cycle. Going through the case study may prove disheartening to many, and may make them skeptical of the whole psychiatry profession-leading to some anti-psychiatry rants too- yet one should realize that psychiatry is both an art as well as a science- asking the right question to get the patient (and disorder/ medication) history is very important. To appreciate this I would strongly recommend every body to read the “Selection of Antidepressant ‘ series on Corpus Callosum, which gives a fairly good idea of how psychiatrists make diagnosis in practice.

It is instructive to recall that we have earlier reported on a study that leads to common genetic markers for Psychosis and Mania– implying a single diagnosis, rather than a separate diagnosis of bipolarity or schizophrenia.

The article cites the following DSM-IV diagnostic criteria for Schizophrenia and explains how each is explicable as symptoms of extreme manic episode resulting in psychosis /depression.

Schizophrenia diagnosis6

Seen in psychotic mood disorders

Criterion A

??Hallucinations and delusions

50% to 80% explained by mood16,21

??Paranoia

Hides grandiosity4

??Catatonia

75% explained by mood7,8

??Disorganized speech and behavior

All patients with moderate to severe mania1–5

??Negative symptoms

All patients with moderate to severe depression4

Criterion B

??Social and job dysfunction

All patients with moderate to severe bipolar disorder5,13

Criterion C

??Chronic continuous symptoms

Patients can have psychotic symptoms continuously for 2 years to life5,6,13

I would like to pause here and group the symptoms of schizophrenia according to the basis they have:

  • A sensory basis (hallucinations etc, which may be due to senosrimotor gating as well as a lack of proper inhibition mechanisms; delusions of reference which may be due to inability to gate the inputs and thus end up treating everything as salient and consequently referring to self),
  • A cognitive basis (delusions – which may be due to extremes of normal cognitive biases that we all have – a manic delusion of grandeur- that may also lead paradoxically to delusions of paranoia( fear and suspicion) as one thinks of oneself as very special and hence vulnerable to the evil out there in the world)
  • A motor basis (catatonia – which may be due to problems with volitional control of motion- either too much control or too little- in one case ending up in the positions in which someone else has put them in- in the other remaining in the same position (samadhi in religious contexts) by exercising the will to move. Here again dopamine dysfunction would be relevant as it is involved in motor pathways.
  • A social/theory of mind basis (disorganized speech(flight of ideas) as one assumes too much ToM abilities in others and believes that the specifics one has left unsaid- and the abstract way in which one is talking – is comprehensible to others; disorganized behavior- which may be due to not taking social appropriateness into account as one is presumably on a very important mission on Earth.
  • An embodiment/ grounding basis and problems with agency(religiosity as one thinks of oneself as not grounded in the body and thus may lead to delusions of control and persecution (as a shadow that is embodied elsewhere is trying to control one) . Here metaphorical thinking and use of symbols as symbols for something else (an overarching idea) rather than referring to something out in the world may lead to loss with reality and magical thinking that takes too much correlation-is-causation kind of thinking and extends it to non-material and non-living things.
  • An Affective basis ( related to the fifth point for those who believe that emotions are due to body states) : the characteristic anhedonia , alogia and avolition. Symptoms that are similar in many ways to the symptoms of depressive state.
  • A Volitional basis (social and job dysfunction may be due to disturbances in the volitional system- too much goal direction (and where the goal happens to be not socially or work-place acceptable) leads to job dysfunction as does too less of goal-directed behavior.
  • Chronic nature: once neuroleptics are started one gets caught in the downward vicious circle. Also the nature of the disorder is cyclic just like the Bipolar with Positive symptoms more prominent in one phase and negative symptoms more prominent in the other phase. In between there can be remission and proper functioning.

Thus, I agree with the broad assessment of Lake et al, that most cases of schizophrenia may be juts an undiagnosed psychotic bipolar episode. Yet, I believe that schizophrenia is a heterogeneous disorder and there may be one or more sub-types. In my view schizophrenia proper leans more towards ToM/ social/ cognitive/ agency dysfunctions while Manic depressive is more about affective and volitional and recurrent dimensions. In my developmental framework; while the schizophrenic struggle with the first five developmental tasks; the bipolar struggle with the next three. Yet their common psychotic style confers susceptibility to psychosis in both cases. This would be as opposed to the same developmental challenges also faced by those with Autism/ depersonalization/ derelaization etc., who have an entirely different take on these issues. While one leans towards science (whose utility is well established); the other leans towards arts (whose utility is doubted sometimes), but which in my view is very important.

We are getting evidence of how emotions can affect decisions towards a better outcome and how having a framework that gives one a sense of meaning and purpose is essential. Science and evolutionary thinking at times robs us of these finer appreciations of life- at that time we do need a counter-dose of Art to keep us more grounded and to make life more enjoyable and worth living- even if that costs some people their sanity!! Maybe we need both GOD and evolution; both science and faith to keep us sane and on the right course.

Hat Tip: Neurofuture

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Depression and Mania: The Bipolar thinking style

PsyBlog has recently posted an article on Cognitive Therapy (CBT) and how it is useful in Depression treatment. this therapy has been shown to be equally effective in Depression as is medication, though this woks in a top-down fashion in the brain (revealed by brain scans), while anti-depressants work in a bottom-up fashion.

PsyBlog quotes the following irrational beliefs , as outlined by Beck, that are prominent in Depression.

* Over-generalization. Drawing general conclusions from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come.
* Minimalization and Maximization. Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event.
* Dichotomous thinking – Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.

To me all of these beliefs are equally relevant for Manic thinking, although in the Manic case these beliefs would be about positive events and have a different spin.

  • Over-generalization: a single instance of success at some endeavor disposing one to think that one can achieve anything in unrelated fileds. Also more co-incidence detection and more correlation-is-causation type of thinking that may ultimately lead to the Magical Thinking of full-blown Psychosis.
  • Minimalizations and Maximizations: Here, again, things go out of perspective: Overestimating one’s own performance and underestimating the importance of external happenstances that might have led to success.
  • Dichotomous thinking: thinking that things are mostly good/bad and unfounded optimism/faith/trust – the opposite of the depressive feeling. Although the reverse thinking that things are mostly bad (external environment is bad, I am good) can also kick in. The point is seeing the world in Black/white but not in shades of gray.

PsyBlog also has an earlier post on depressive thinking style in which it elaborates on the internal-locus-of-control predisposition in depressive probands. Thus, the depressive style is marked by the following internal, global and stable attributions: :

* It is my fault that I didn’t get the job. Here I have made an internal attribution.

* I think I am worthless: a thought that is likely to affect all areas of my life. Now I am making this attribution global.

* I see no reason for the fact that I am worthless to ever change. Now the attribution is stable


It is clear that the Manic person too makes the similar attributions: His success (maybe a single, lucky success) is due to his genius(internal attribution). His genius is not limited to one field- he is generally the most valuable, productive and creative genius and is an all-rounder(global attribution). His genius is not a short-lived entity- he will continue to remain a productive genius no matter what external circumstances / reality (stable attribution). He may thus have no drive to learn about external reality as he suspects that the external reality is not relevant and he can predict outcomes (which are bound to be good) based on his skills, expertise, grandiosity alone. An extreme form of this thinking may lead to the loss of reality characteristic of a full blown Psychotic episode.

While the minimalisations and maximizations are explained by the internal locus of control, the over-generalization is explicable by a propensity of jumping-to-conclusions sort of thinking that leads to global, stable over-regularizations. Another feature important in my view would be the mixing of contexts, where things from one context are referenced in another, dissimilar context. One could call this mixing up of metaphorical thinking where wrong analogies are applied and thus wrong (positive or negative) conclusions are arrived at. The third factor of dichotomous thinking is also very important though hard to pin down. Why should everything appear black and white in depressive or manic thinking and why in one case(depressive ), black is the color of self, while in Manic white is the color of self, remains a mystery. Answering how and when the switch from a grayish-world to a black-me-world(I’m a piece of shit) or white-me-world(I’m the next Einstein) happens would go a long way in making the bipolar patient control his moods and if he has to be sick then enable him to go for a manic episode (where the price may be insanity- a psychotic episode) instead of a depressive one (where there is a real risk of life).

Although the other wrong attributions and thinking styles also need to be addressed, the mechanism of the switching of mood/ black-white world view would help the most and should be the first one targeted in CBT/ medications.

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