Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts

Friday 10 September 2021

Aidan Shingler, collecting, and finding some things (valuable), but ignoring others wholescale

Aidan Shingler, collecting, and finding some things (valuable), but ignoring others wholescale

More views of - or before - Cambridge Film Festival 2019 (17 to 24 October)
(Click here to go directly to the Festival web-site)

10 September

Aidan Shingler, collecting, and finding some things (valuable), but ignoring others wholescale








Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

Thursday 23 January 2014

Skinner and Sanity

More views of - or before - Cambridge Film Festival 2013
(Click here to go directly to the Festival web-site)


11 January


For Lucy Johnstone (@ClinpsychLucy) - written on a train into King's Cross

Some will be familiar with the idea of what is called (after the experimental psychologist of this name) a Skinner box, essentially a maze for rats, designed to test them (the rats) under different regimes and so make inferences about their psychological state, based on how they navigate the box.

Imagine such a box (or, rather, a series of them, say ten), on a relatively small scale, but designed to be resistant to the ingress of water. The experimental subject sees water (or a coloured liquid might be more effective) enter the system, and it is his or her job, each time, to direct it to a specified goal, either to the centre, or to one of a number of dead-ends, where there is a sink : the flow is such that, if the subject does not act reasonably quickly, the liquid will start to flow over the channels of the maze, which counts against him or her.

The subject directs the water by using baffles, i.e. insertable barriers that block the water from following any given route, and they represent means for closing off options that, once taken, cannot be undone. He or she is marked on criteria such as how quickly and effectively he or she directed the flow, whether the flow (and, if so, how much) ended up exiting from other sinks, and whether the flow ran over the channels. Say five times with each of ten target sinks, and this over ten boxes of different layout – no opportunity to run any one box successively, but in randomized order in which the five chances to tackle any given sink in any given box is allocated over the total runs, n = 500.

Analyse these data as one likes, say giving a weighting on which out of the five runs on this target in this box the results are for. Some statistically significant comparisons will result. Then imagine doing another 500 runs, and this just as training, but with the subject now told that he or she can operate freestyle, i.e. choosing the target sink, but, perhaps with penalty sinks (which might or might not be specified (beyond their existence and their number), which, if any liquid reaches first, stops the run and imposes a penalty, based on various criteria such as time elapsed, sinks blocked at that point, and a qualititative analysis of strategy. The subject would then be penalized, sometimes, for directing the water to a given sink, because it is an unstated penalty sink.

Now extrapolate all this to, say, human behaviour. X has been tested, for example, on the autistic spectrum, and been given a diagnosis. Does that mean, if the liquid is the flood of stimuli, inputs and other people’s behaviour, that we have done any more than establish that, over a thousand runs in life, X has adjusted to trying to deal with it in a number of symptomatic ways ? Maybe life has baffled X, and X has tried to understand or adjust to it, coming to find some strategies that are, if not better, than at least less bad than others for being effective, given the task specified – because of the flow, and the need to direct it, X was forced to block off some choices, and become more habituated to others.


Subject A has an experimental profile, over the two regimes of 500 runs apiece, which corresponds to what we might think of symptoms, and the tendency to exhibit or experience them, so does a similar Subject B. Otherwise, A and B may actually be more dissimilar than similar, seen in the round (outside these tests), but their test results bring them together into the same place on the spectrum – their humanity, interests, values, become valued less than what they happen to have in common :
A may resemble B, but also, otherwise, resemble C, but compare B and C and the match may not be statistically significant on a chi-squared analysis that compares their data. We could have an alphabet of subjects and more cases where the statistically significant comparisons do not predict the match with another who also matches one of the matching pair.

We could consider a tendency to depression, bi-polar disorder, schizophrenia as other test-results, other matches or mismatches. Do they tend to persuade us that diagnosis is perhaps no more than picking and choosing between bundles of what we call symptoms, and inferring the existence of a diagnosable condition, when a rigid experimental testing such as imagined might throw us back on our common humanity, battling the flow of money, relationships, stress, etc., against time and other objectives ?




Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

Tuesday 22 October 2013

Mental-health in-fighting

More views of - or before - Cambridge Film Festival 2013
(Click here to go directly to the Festival web-site)


22 October

There is a well-worn claim that a person with an experience of schizophrenia is called a schizophrenic, whereas a person who has cancer is not called a cancerist.

But we do call people diabeticshaemophiliacs, coeliacshypochondriacs, hysterics, alcoholics, etc., and half of those nouns relate to physical conditions.

Yes, it is nicer not 'to define someone' by reference to their health, but the cancer argument employed is a bogus one, not least since I believe that people do sometimes relate to hearing that someone has cancer on an irrational level, of its being karma / punishment, or as if the cancer is infectious, or the person can no longer be related to as a person, but as only a substrate for a deadly disease : dehumanizing the person, by only seeing him or her in terms of the spread - or remission - of the cancer(s). (In another posting, I suggested how mental ill-health is not different from, but exactly like, a broken leg.)

Some people object to the term service-user, saying that they did not choose to have mental-health services (they were cajoled, coerced, sectioned, medicated against their will, mistreated (when they were supposed, ironically, to be treated in the system's own terms)), others simply do not care, even if they have had the same experiences, and are not worried about a need to challenge use of the word.

In similar ways, some have a diagnosis thrust upon them, and struggle to feel content with someone else defining their experience in that way, whereas others, refused a service unless they have a diagnosis, embrace one, and feel that it validates.

Of course, that sense of validation, of finally being believed, could relate just as much to the situation of someone with what turns out to be a brain tumour, who succeeds in persuading someone to carry out a scan and whose findings account for their bizarre or troubling symptoms, previously discounted on supposed medical grounds.

Or there could be a person who is happy with his or her body-shape at 22 stone, and who rejects the notion of being obese - and, if it is not interpreted as a mental-health issue (with implications for a forced admission), but, say, as a lifestyle choice, he or she is free (subject to these irritating medical promptings) to do as he or she pleases with his or her body.

So, returning to the question of diagnosis, one person might be able to get help, because of a diagnosis, whereas a person, supported with a diagnosis of bi-polar disorder, might then be denied support, if it is claimed that it was a misdiagnosis and that he or she has borderline personality disorder (and vice versa, the latter likely to be a case where he or she is pleased with the new diagnosis, which he or she has probably been fighting to have recognized as 'a better fit').

And then there is so-called depression (because I believe that the word has outlived its usefulness - unless it can be 'reclaimed' - when too many people think that it just means being a bit sad, that the person described as being depressed is lazy, shamming, not trying as they would, and that they know what it means, when they do not). I took issue with @StephenFry likening depression to a meteorological cold front, which, like the wind, rain or snow, just is until it is over :

I honestly thought that having that debate might make people question whether low mood and negativity really just are, or whether some people might be helped - some of the time - by psychological intervention, as practitioners and writers such as Paul Gilbert want to say (e.g. Gilbert's self-help book, Overcoming Depression). Fry's message of waiting for the good days to come may work at one level, where crashing for two or three days may allow one to regroup and feel restored / revived, but what if that crashing could be avoided, or, at least, postponed to a less critical time ?

It is this polarity of the discussions in mental-health circles that frustrates me : Fry was no doubt wishing to be helpful, but seemed didactic in his statement, as if to the exclusion of the possibility that sessions with a psychologist might make an improvement such as described. Likewise, those 'saddled with' a diagnosis (and, maybe, poor or no treatment) seem to be at odds with those who, as suggested, might have had their beliefs about themselves confirmed by one.

When one person, wanting to feel safe from impulses to commit suicide (which I maintain is an acceptable expression), might benefit from feeling safe on an acute psychiatric ward, someone who is at a level of depression not just to be numbed to what is happening might equally experience it as too lively, too fuelled by the activity of those whose mood is at the opposite extreme to be a therapeutic environment - and they, too, might find each other's psychotic assertions frightening and disturbing, which is hardly likely to lead to peace and a lowering of anxiety.

Is a ward such as that, then, a microcosm of the flare-ups that the mental-health element of Twitter seems to accommodate, perhaps even invite or spark ? Or is it no different from any topic where feelings are running high on both sides ?




Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)