Month: February 2009

Medicine, like science in general, attempts to classify behaviors into patterns, and patterns into syndromes, disorders, and ultimately into diseases. Thus the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has at one time or another in a person’s life, everybody’s number — literally. Presumably the exception is all those who are normal and all-wise from birth, with ideal parents, environment, and world, to the point of perfection as average and having no outstanding behavioral characteristics. Which is impossible.

The solitary personality has been nicely defined by Oldham, who rightly stresses that every so-called personality is a cluster of behaviors that we cite for convenience sake but that they are all normal behaviors, simply within the range of how people are.

Only with dysfunctional behavior do we look back and see how dysfunction is itself an exaggeration or abuse of originally normal behaviors. Thus the solitary, at the extreme of dysfunction or mental disorder, is schizoid. The ideal solitary (if such exists) is an ideal set of traits. The real solitary is checkered with presumed disorders from childhood that linger. What the real solitary needs to do is embrace their self, work honestly with their characteristics, and find the transcendent dimension that transfers their insights into values. That is another dimension to personality that, however, does not fall within the capacity of medicine as diagnosis and prescription.

(My favorite fact usefully described in Oldham is this: contrary to the popular view of the solitary personality as depressive, due to introversion, reticence or preferences for being alone, it is the extrovert who is more prone to depression due to dependence on feedback from the external world of people and things.)

Medicine has the tendency to aggregate symptoms and label them a disease, when, in fact, the symptoms may have entirely separate etiologies, and may be treated separately. This is especially the case with bodily disorders, where part of the tendency of modern medicine is to fit a pharmaceutical to a disease — which it cannot do if treating symptoms alone. Ironically, the cure or prescription is usually treating only a cluster of symptoms, not a disease, at least not until the outstanding characteristic of the disease establishes itself irrefutably.

Two “disorders” associated with the solitary personality (at least in the DSM-IV, not in Oldham) are “Social Phobia or Social Anxiety Disorder” and “Avoidant Personality Disorder.” The DSM has our number, literally: Social Anxiety Disorder is 300.23 and Avoidant Personality Disorder is 301.82 in its classification of mental disorders. The first is a phobia, and the second is a personality disorder.

The diagnostic features of social anxiety disorder are intended for physicians but are certainly of interest to the lay person in seeing how authorities judge behaviors. For example, it is cautioned that the fear of social or performance situations must be dysfunction for the individual, incapacitating them from regular functions. A preference for not eating in public, or being judged and criticized, or worrying in advance of a social event are features.

Individuals with Social Phobia … may manifest poor social skills (e.g., poor eye contact) or observable signs of anxiety (e.g., cold clammy hands, tremors, shaky voice). [They] … often have decreased social support networks and are less likely to marry. [They may] have no friends, … completely refrain from dating, or remain with their family of origin.

There are warnings about suicide and associated disorders like Anxiety Disorders, Mood Disorders, and Substance-Related Disorders.

At least the manual notes that

Fears of being embarrassed in social situations are common, but usually the degree of distress or impairment is insufficient to warrant a diagnosis of Social Phobia.

That, coming from authorities, is intended to the inadvertent layperson-reader as a solace.

Allusion is made to Korea and Japan for cultural context, but nowhere else. The term hikimoro does not occur (it not being clinical, presumably). The range of 3% to 13% of the general population are sufferers of Social Phobia. The conclusion is made that there are no laboratory tests to demonstrate the condition, and that without the presence of other mental disorders, there is not much to be done.

Another characteristic disorder of the solitary is Avoidant Personality Disorder, defined as

a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation …

Usually this disorder is identifiable from early in life with schooling, right on through work. Such people bristle at disapproval, criticism, or suggestion. Says DSM-IV:

They tend to be shy, quiet, inhibited, and “invisible” because of the fear that any attention would be degrading or rejecting.

In contrast to social phobics, the avoidant persons “often vigilantly appraise the movements and expressions of those with whom they come into contact,” essentially out of fear. They have low self-esteem, and like the social phobics, no social network. Again, like social phobia, there are related disorders usually present to warrant the diagnosis of dysfunction.

About .5% to 1% of the general population can be labeled as having Avoidant Personality Disorder. Only in the last lines of this section of the DSM-IV do the authors acknowledge that

Many individuals display avoidant personality traits. Only when these traits are inflexible, maladaptive, and persisting and causing significant functional impairment or subjective distress do they constitute Avoidant Personality Disorder.

Reading the DSM-IV can engender hypochondria, paranoia, or fear that one is losing one’s mind. There are enough problems in life that demand our coping. But, further, we can be aware that the behaviors we inherit from childhood are being vigilantly classified by medical authorities. Of course, such awareness on our part is necessary, and on the part of science if science is to attain its goal of complete knowledge of all empirical phenomena, with dubious probability of attaining this. But psychiatry and pharmaceuticals are, after all, industries. They require clients and consumers. We should purchase only what we need, enough to feed ourselves, correct ourselves, become more conscious of ourselves.

And for that we can find psychiatric research useful. But no more than philosophical or psychological or spiritual work, which can take us as far or further, rightly understood. We need to go the distance with both, but no further in the case of allopathic medicine and the perilous divide between a self as bundle of behaviors and a self as fully realized.

What science writer John Horgan calls rational mysticism (the title of his 2003 book, Rational Mysticism) is a set of tentative alternatives to historical forms of mysticism: religious, spiritual, philosophical, aesthetic, and natural. (There may be other forms.) The very effort to find alternatives shows the enduring attraction of alternative states of consciousness, even when the aspiration is not entirely legitimate.

Horgan pursues scientists’ assessments of mysticism as either brain chemistry, physiology, or self-delusion. Diehard “ultramaterialists” dominate the scientific opinions of spirituality. Expeditions to disprove or unmask claims to mysticism preoccupy the parallel thinkers — atheists — obsessively dependent upon the existence of religious fundamentalism or the simplicity of less intelligent believers easily mocked and discarded. It is a symbiosis.

But religious thinking is not easily disposed. Bypassing the content of religions, materialists and scientists propose the psychological and physiological argument that the brain is hard-wired to be gullible, wishful, and delusional. When Freud attacked religion as an “illusion” his arguments were respectably philosophical and psychological as much as cultural, but he did not imagine a device like a “meme.” The “meme” has become the code word for a kind of mental virus, easily disposed to being used against whatever one happens not to like.

Harder it is to dispose of James Austin’s famous pursuit of Zen and the brain because his notion of mysticism — if it is really mysticism — differs from the Western one, despite Austin being a scientist. To many Westerners, mysticism is still ecstasy and pleasure, the eroticism of the biblical Song of Songs, Teresa of Avila, or Rumi. Or Horgan’s seekers are just looking for fun (he even calls it “the problem of fun”), a substitute for the above-mentioned mysticism substituting a light show.

Ironically, the pursuers of rational mysticism in Horgan’s chapters are testing the stereotype of Western mysticism against the cool measurements of reason and science. They are a little frightened of Zen (and Eastern) vocabulary of formlessness, void, and emptiness. So they back-peddle to the problem of fun, falling short of any comprehension of subjective experience. They turn to drugs.

Albert Hofmann created LSD in 1943, but the use of intoxicants and mind-altering substances has been a cultural feature since the dawn of human beings, probably starting with shamans and co-opted by the average person seeking wine, created by God (as the biblical Psalm puts it) “to gladden the heart.” And that has been the postmodern difference. The shift to pharmaceuticals (whether LSD or DMT or brewed fungi and plant poisons, the highbrow choice versus abused pharmaceuticals) shows the intervention of science to essentially find devices to control the minds of others, as much as to entertain the select.

Pharmaceuticals have been used, like nuclear radiated material, to justify helping the few and destroying the many, granting enormous cultural power to elites. In this light, the scientific search for a chemical (not “rational”) mysticism has a darker side than just brain chemistry. As I write, the use of pharmaceuticals to treat populations from children to soldiers reveals the inimical nature of the mind-altering agenda, however naive the earliest takers may have been.

What the hallucinogens do is to reveal not a mystical world but an artificial world that takes the predispositions of the psyche and distorts them into either heightened fear or heightened visuals. Horgan recalls his use of ayahuasca as revealing colorful geometric shapes and a sharpened lunar presence on an etched nighttime landscape, perhaps a mental equivalent of staring at the sun or putting on a sharper pair of lenses (“Better with or without? Better now or … now?”).

What all of these seekers have sought, but usually refused to admit, is that they crave the mystical experience of the conventional religious and spiritual mystics — on their own terms. Perhaps they have craved the experiences of Teresa and Rumi more than of the sublime Eckhart or John of the Cross, and found them absent in their own lives. Of course, they would reject the premises of how such mystics enter their states, and that is entirely their perogative. Yet the parallels are suggestive. The desire for mysticism, for a leaving of nature and the mundane, for an indefinite state of ecstatic exuberance is unmistakable.

In turn, this desire is fed by a more fundamental desire to understand the nature of the universe, and here is common ground. As the subtitle of Horgan’s book hopefully frames it: “spirituality meets science in the search for enlightenment.” But enlightenment eludes science as much as it eludes spirituality, with the exception that spirituality knows where not to look. And this is where science and rational mysticism will have to find common ground in nature, to look at nature for patterns, not laws, for insights, not reasons, for glimpses not revelations.

The author and others will have to abandon “the problem of fun,” as Horgan puts it in his last effort to salvage the utility of drugs — which one suspects is the chief motive of advocates of drugs — and just abandon the concept of a problem. Useful, too, will be to look eastward for the calm and equanimity that transcends the tumult of ecstasy while never really transcending the universe of which we are a part, and which is as much ours to treasure as to transcend.