Showing posts with label Psychiatry. Show all posts
Showing posts with label Psychiatry. Show all posts

Thursday, March 4, 2010

SEEING, HEARING AND REMEMBERING : PATHWAYS TO UNDERSTANDING

AN ESSAY

In ancient China, Confucius allegedly said: "Tell me and I will forget; show me and I may remember; involve me and I will understand." I had never heard this proverb before. It captivated me because it encapsulates many of my views about sense, speech, memory, experience and empathy. All these things relate to each other. And they all aim for one thing: Understanding.

What does it take to understand another person? Is it enough to hear a person describe problems with words? How about observing something firsthand? What is the most effective way to find understanding and empathy?

I have often written that we humans are subjective creatures. We know only what we sense. Unfortunately, we must also depend on language because our senses have a limited range. After all, we only feel certain about something when we perceive it directly. We would prefer to see something with our own eyes rather than hear about it in words from someone who saw it. We want to understand our surroundings and the people in our lives. And the only pathway to understanding is sense.

But it is a troubled pathway. For what can we really know, let alone understand? Knowledge is not the same as understanding. Knowledge is more banal than understanding. Knowledge means that we merely manifest a subjective belief that something is true because we perceived it. Yet understanding is more subtle. Understanding means that we not only know things, but we intuitively arrange our knowledge to tell a larger story. Knowledge is about details. Understanding is about narrative. Knowledge is just an actor. Understanding is the whole play. And we don't feel truly fulfilled until we really understand something: What good are isolated facts unless they tell us something more significant?

Confucius recognized that human sense opens the door to both knowledge and understanding. Yet he also recognized that there is a hierarchy in human sense. He says: "Tell me and I will forget," implying that hearing is a weak sense. How right he is. How often do we hear language and immediately forget what we just heard? It is difficult to glean knowledge from language, let alone understanding. It is incredibly easy to forget words. After all, words are a poor substitute for actual perception. But in many cases they are all we have to reconstruct our perceptions.

Sight is better than hearing. Confucius confirms this when he says: "Show me and I may remember." Here, he does not say he "will forget." If he perceives something visually, he says he "may remember" it. Again, Confucius is right. Sight links intimately to memory. Our eyes leave "visual impressions" on our minds long after images leave our present view. When we reminisce, we engage our "mind's eye." We attempt to re-see images that have long since disappeared from sight. We may not precisely remember what we see; indeed, with time, memory weakens. So in that way, Confucius correctly points out that we only "may" remember something after we see it.

And we see all the time. It is simply impossible to recall every single thing we visually perceive every day. Our memory works best only after we see something worth remembering, namely, something exciting, unusual, captivating or appealing. To a large extent, our own subjective desires color what we remember. If we are infatuated with someone, we remember how they look with great detail. We hang on their words and even remember what they say. Yet those subjective desires obscure other details. We don't remember many things we see because we are distracted with our love interest. We are not paying attention; our emotions cloud our perceptions. Thus, while sight may be a better way to acquire knowledge than hearing, we will never remember everything we see. There is just too much going on. We cannot know everything because our senses are imperfect.

But Confucius does not end his proverb with knowledge. He goes beyond. He ends with "understanding:" "Involve me and I will understand." Understanding is the ultimate goal; the proverb builds up to it. He does not equivocate here, either. He says: "I will understand."

What is going on here? And why is understanding better than knowledge?

Anyone can know facts. You must merely have functioning sensory organs to know whether something is hot, cold, smelly, coarse, green or blue. Some facts require complex sensory deductions and inferences, but deductions and inferences are just mechanical mental conclusions. Anyone with rudimentary reasoning power can infer one fact from another.

But understanding is more transcendent than that. Understanding combines knowledge with experience and intuition. It is one thing to know whether another person is sick, obligated, depressed or happy. It is quite another to understand a person who experiences those circumstances. Understanding requires a person not only to listen, observe and infer facts about another. It also requires him to put that knowledge in the light of his own experience and honestly try to feel what the other person feels. That is no easy endeavor. It takes time to assemble experience. That is why we tell young people: "When you're older, you'll understand." After all, how can you understand a complicated emotional problem if you've never experienced the emotions that make it a problem in the first place? If you do not have experience, you cannot truly understand. You can know, but you cannot understand.

Confucius was right to extol understanding as the "higher result" of knowledge. Why do we learn? Simple: So that we can understand. And why do we want to understand? Because understanding enlightens us. It makes the world more comprehensible. Understanding equips us to help others. Understanding counteracts prejudice and shortsightedness. Violence springs from misunderstanding and ignorance. It is hard to go to war with someone if you actually understand them.

Yet the fact that human beings constantly make war on each other bespeaks a sad truth: Understanding is not common. It is hard enough to acquire reliable knowledge through hearing and sight, let alone to understand larger implications about life. Most people never even acquire the knowledge they need to understand others. Understanding is impossible without knowledge. And only a patient person takes the time to obtain the knowledge needed to find understanding.

Who has time for that in our society? Who has time to listen? And most importantly, who has time to get involved with others in order to understand them? Confucius' proverb said that involvement results in understanding. That means living with others and experiencing their lives first hand. That means living with their problems, too. Involvement is not just a pervasive sensory journey; it also is an emotional one. When you involve yourself in another person's life, you eat, drink, sleep and breathe their problems. You sense what they sense. You obtain knowledge at an astronomical rate. And because you combine your experience with theirs, you necessarily will understand them. Once you understand them, you can empathize and comfort. Or you can turn away. In either event, you are enlightened. You are no longer ignorant.

But that takes a very long time. It takes a lot of energy. To achieve understanding, then, a person must not only have experience and knowledge. He must also be patient enough to involve himself in others' lives in a compassionate way.

Sadly, neither patience nor understanding are highly prized virtues in modern American society. Yet people yearn to be understood. In most cases, they must pay others to understand them. After all, time is money in the United States. No one has time to sit down and listen to another person's deepest thoughts, let alone get involved in their lives in a meaningful way. This is one reason why people are desperately unhappy in this country. They want to be understood, but no one has the time, patience or intellectual capacity to "learn" their woes. This leaves many people feeling isolated and forgotten. Even married couples never take the time to really understand each other.

I venture that understanding offers its own rewards. It is satisfying to understand others and to understand yourself. True, it takes time, learning and effort. But it feels so good to know another person understands you. By the same token, it feels good to give back by understanding others. It is an enlightened and compassionate way to live. Despite all the impulsions to the contrary, sometimes it is good to be patient in our society.

Wednesday, January 20, 2010

DOMINIC CARTER, CRIME AND CHANGING PUNISHMENT IN AMERICA

AN ESSAY

A few months ago, I wrote a short article about Dominic Carter, the former New York 1 anchorman who allegedly beat his wife. I used Mr. Carter's story to illustrate how difficult it is to "prove" things in our empirically-based evidence system. Now, a State court in New York has sentenced Mr. Carter to an unusual punishment for attempted assault. This presents compelling new issues.

Just as Mr. Carter's case provided an excellent vehicle to discuss evidence law, his sentence now provides an excellent vehicle to discuss criminal penalties in modern America. Put simply, criminal penalties are changing in America. And they are drifting far from their traditional purposes. In my view, this is not a good thing.

According to the New York Post, Mr. Carter was convicted of attempted assault for pervasively abusing his wife since 1997. See N.Y. Post, Crying shame of jailed NY1 journo, Jan. 15, 2010 at 5. Although his wife denied that Mr. Carter beat her, the trial judge--Arnold Etelson--referenced police reports detailing marital strife in the Carter home for over a decade. Id. He sentenced Mr. Carter to 30 days' imprisonment. Id. He also ordered Mr. Carter to "stay away" from his wife for two years unless "he is prescribed medication by a psychiatrist able to assure the judge that [he] is well enough to see her." Id. Additionally, the judge gave Mr. Carter an article from New York Magazine detailing Matt Damon's views about "honesty and humility." Id. During sentencing, he told Mr. Carter: "Try some humility and honesty--it goes a long way." Id. Finally, the judge gave Mr. Carter's wife a sticker with the words "Attitude Makes the Difference. " Id. He instructed her to affix the sticker to her bathroom mirror so that Mr. Carter can see it when he visits. Id.

This is highly irregular judicial work. As a general rule, the criminal law forbids specifically defined conduct. The criminal justice system decides whether the defendant engaged in that conduct, then neutrally decrees the legal consequences. While morality animates all criminal codes, it is not for judges in the criminal justice system to pontificate about it, let alone publicly scold criminals for sport. This New York judge transformed his courtroom into an entertainment circus. And the spotlight was not on Mr. Carter--it was on the judge.

To start, it is strange that Judge Etelson characterized these facts as "attempted" assault. At common law--and under New York State law--an assault means an intentionally harmful or offensive touching. See, e.g. NYPL § 120.00, et seq. Any intentional crime can be "attempted" if the defendant intends to achieve the bad result envisioned in the criminal code, then takes some action corroborating that intent. But it is no longer "attempt" when the defendant achieves exactly what the law forbids. Here, the judge relied on police reports that detailed Mr. Carter's abuse. They all but verified that he had routinely hit his wife since 1997. If the judge believed those reports, then he should have convicted Mr. Carter of assault, not attempted assault. If Mr. Carter succeeded in harmfully or offensively touching his wife, it was no longer attempted assault. It was just plain old assault--and it's a worse crime than attempted assault.

But Judge Etelson's legal errors pale in comparison with his bizarre approach to criminal penalties. Traditionally, criminal penalties in America--as in all Western countries--target the body and property. The law assumes that people do not want to suffer bodily pain or lose their property, so penalties targeting those things ostensibly dissuade potential criminals from making "bad choices." The death penalty, imprisonment, fines and corporal punishment encompass everything a State can realistically do to penalize crime.

In modern America, imprisonment is the preferred penalty. Fines follow in second place. Most consider corporal punishment an archaic penalty; it really never happens anymore. The death penalty is more common. Still, State-ordered death is quite a rare punishment, too.

Judge Etelson did not give Mr. Carter a traditional punishment. Rather, he theatrically used Mr. Carter as an instrument. The only traditional part about Mr. Carter's sentence was his imprisonment. To some, thirty days in prison for attempted assault might appear harsh. But no one would call it bizarre. People expect either fines or imprisonment for crimes in America. The criminal justice system works in part because the public knows what to expect for certain transgressions. They trust judges to declare penalties that everyone expects. At the same time, they understand that even a convicted criminal is entitled to some dignity before the law. He need not be publicly humiliated, ridiculed or belittled in the courtroom. His prison term and social ostracism accomplish that on their own. It is not the judge's role to morally grandstand or scold. He simply must pronounce sentence. Legislators moralize when they write the laws. Judges should not.

What does a New York Magazine article or a sticker have to do with the law? When did Matt Damon become a legal authority? True, "honesty, humility and a good attitude" are virtues. But it is not the law's role to chastise people for failing to be virtuous. The law's only role is to decree whether a person acted in a defined way. It does not matter whether he was virtuous or not when he did. A defendant suffers enough when a judge declares the penalty for violating the law; he does not need to "rub it in" by acting the moralist. In fact, I argue that judges overstep their bounds when they do.

I understand that people like to see criminals squirm. But their convictions should make them squirm, not a judge's moralizing antics. If every judge took it upon himself to act like Judge Etelson, our criminal justice system would look more like a Catholic school than a neutral forum for just laws. In a word, it is not a judge's job to castigate a convict's moral failings. Moral failings are irrelevant to the law. And the law is the only thing that judges are constitutionally empowered to decide. Anything else they say is unauthorized fluff.

Judge Etelson-style grandstanding is not the only abomination that occurs in our criminal justice system. Now, criminal penalties also increasingly intertwine with psychiatry. Mr. Carter's case is no exception. In his sentence, Judge Etelson conditioned Mr. Carter's future with his wife on his agreement to take psychiatric medications. He also retained discretion whether to permit Mr. Carter to see her, depending on whether a psychiatrist could assure him that he was "well enough."

Are these judicial inquiries? If they are, do they not negate the State's moral outrage against Mr. Carter? After all, if the court believes that Mr. Carter needs psychiatric medication, that means he is mentally ill. If he was mentally ill at the time he struck his wife, that makes him far less morally blameworthy. After all, the criminal law depends upon free, rational choice for its moral strength. It is easy to condemn someone who knowingly makes a bad choice. But it is not easy to condemn someone who lacked the mental composure to make choices, let alone recognize they were wrong.

In this case, Judge Etelson tried to wear too many hats. He wanted to punish Mr. Carter for doing something that violated the law. But then he stepped back and ordered Mr. Carter to take psychiatric medications for his "mental problems." Put simply, judges are not psychiatrists. They are not social workers. It is not their job to monitor people's behavior once they serve their sentences. Nor is it their job to declare whether people are "normal." Rather, they are mere judicial officers, and it's not a complicated job. It is not about management; it is about judgment: Did the defendant do this or not? If he did, he goes to jail. If he didn't, he goes free.

There is undoubtedly a relationship between law and psychiatry. But a judge's only concern with psychiatry is to determine whether a defendant is mentally well enough to be criminally responsible. If he is, that ends the inquiry. In fact, judges must be extremely wary when dealing with psychiatry in criminal cases. After all, the entire rationale for criminal punishment collapses as soon as psychiatry shows that the defendant cannot make rational choices. In that light, judges should tread lightly when tampering with psychiatric issues. They might just discover that the "evil defendant" is really no ogre at all. He might just be "sick." And it is not proper to morally condemn sick people, let alone jail them for choices they could not make. For better or worse, the law only works on sane people.

I doubt that Judge Etelson understood all these issues when he entertained the news media during Dominic Carter's sentencing last week. From his perspective, he was in the spotlight and he was going to relish the moment. He was not content to play the neutral magistrate who calmly decrees the legal consequences of statutory violations. No, he had to play the scolding father, too, as well as the psychiatrist and the actor.

I do not like this. While it may be impossible to separate law from popular morality, judges should consciously try to do so. True, laws enshrine popular morality. But they are not moral weapons. They are technical guidelines. It does not matter whether a law-abiding citizen is moral; he must merely not violate the technical guidelines. Morality is about character. Law is about conduct. It is much easier to control conduct than character. And a judge simply declares whether the individual in question violated the conduct guideline.

Well, at least that's what a judge is supposed to do. American criminal law is changing for the worse because the distinction between morality and law is eroding every day. Just look at the Carter case. It's all right there to see.

Monday, September 21, 2009

UNCONDITIONAL LOVE IS A PRECIOUS COMMODITY--AND PSYCHIATRISTS SELL IT

A REFLECTION

I know a lot of people in therapy. Pretty soon I might join them. In one way or another, everyone deals with emotional disturbance and unhappiness in our society. Life can be incredibly painful. After all, we live in a competitive world. We basically contend with two types of people: (1) Indifferent people who want to outdo us; and (2) people we love who are biologically bound to die one day. It is stressful to cope with high stakes and loss all the time. We suffer defeats, losses and setbacks every day. Freud said that it is "much easier to experience unhappiness than happiness." Civilization and its Discontents, 26 (Strachey trans. 1961). Sometimes unhappiness grinds us into submission, no matter how optimistic we try to be. In brief, life takes a toll, even if you had a relatively stable childhood. And that's a rarity.

Yet for all our vulnerability to unhappiness and emotional pain, we strive for love. See generally Civilization and its Discontents, 33-34. We think that love will counteract our unhappiness, or at least make it more bearable. But we seek a very specific kind of love: Love without conditions or qualifications. We want love without first fulfilling others' demands or acceding to others' conceptions about "what we should be." As simple as it sounds, we want people to love us "for who we are," without manipulation or expectation. Generally speaking, expectations result at least in stress and at most in unhappiness. Expectations create a disparity between our conceptions about the future and reality. When reality does not match the expectation, we feel failure or worse. "Love with expectations" results in serious emotional pain. But love without expectations--simple, unconditional love--results in emotional satisfaction, even euphoria. That is what we want from life--strongly positive emotions--because when we feel that good, nothing else can bring us down.

But this is exactly the problem. After all, it is almost impossible to find unconditional love in society. First, our entire social structure does not really value individual happiness. Rather, it merely expects objective economic productivity and "service." Those two basic goals do not require happiness. Quite the contrary, they typically induce unhappiness. Very few people are ever happy about being "objectively economically productive" for someone else, nor are they ever happy about serving some domineering economic master. Yet "success" in our society flows from "productivity" and "service." It does not matter whether a "successful man" feels happy while he productively serves. It does not affect the bottom line. Subjective, individual feelings, in other words, simply do not matter in this objective social scheme.

But what are human beings if not feeling creatures? In the final analysis, every man and woman is a unique entity with emotions and thoughts. Emotions and thoughts are entirely subjective. While they might mean nothing to society or the economy, they mean everything to the individual who thinks and feels. Unconditional love is one of the best feelings a person can experience. Society, however, could care less about it. It is not essential either to productivity or service. This is why unhappiness is so rampant, even among people who appear "successful" and "content." They may reach "objective" standards for social success, but miserably fail to satisfy their own "subjective" emotional needs. In a word, there is much more to life than success.

We should not be surprised that it is hard to find unconditional love in our society. After all, everything has conditions attached in the merciless commercial crucible of life. A condition means something that must be fulfilled before something else is given. It is "bargain-like:" "If you cut my grass, I will give you $100." It channels behavior: You don't get the $100 if you don’t cut the grass. No one does anything for anyone else in our society without imposing some condition on performance. Conditions allow people to induce behavior in others. They allow people to tyrannize and manipulate others for their own gain. This might be perfectly appropriate in cutthroat commerce. But conditions attach not just to contracts and business deals. Rather, they attach just as often to human affections.

We want unconditional love because we are accustomed to conditional love. I read an article in the New York Times last week arguing that modern psychiatry can be explained by reference to "selling unconditional love" in a society that rarely loves, and only conditionally when it does. According to the article, living with conditional love cripples us emotionally. It said that even our parents do not often love us unconditionally. Much to the contrary, they typically want to "control our behavior" by baiting us with love. The article claimed that parents could warp their children not just by scolding and criticizing them, but also by excessively praising them. Each case implicates "conditional love." Praise creates an internal urge for conformity in a child, leading him or her to modify behavior in order to win the praise. Parents only give praise when the child acts "as they wish;" that is conditional love. Without fulfilling the condition, the parent does not praise--and does not love. Praise, then, can be just as damaging as critique.

If parents do not love unconditionally, who will? That is a serious question. If our closest relatives do not love us "for who we are," can we expect commercial actors, bosses and clients to do so? Certainly not. In fact, in commerce we never expect unconditional relationships. We always know that someone wants something from us in return for what they give. As fundamental as that "bargain imperative" may be in commerce, it is anathema to our emotional needs. We might steel ourselves to conditional relationships as we move through life. But in the process we deny ourselves the one thing that might bring us happiness. We will never find unconditional love in commerce; we will never find it in our careers. We never even find it within our own families. People always want us to act in some way that benefits them, or at least matches their sentiments. It is never enough to "be who we are." To fulfill conditions, we must always "be someone else." That leads to emotional ruin in the end.

This is the psychiatrist's niche. The psychiatrist, unlike the boss, the parent, the admirer or even the sometime friend, staunchly empathizes with his patient no matter what. He listens attentively. He does not impose his own moral or family-based judgments on the patient's choices or lifestyle. He offers the love that the patient's own parents refused to give without conditions. This is modern therapy. It is a dose of unconditional love in a world without unconditional love. Perplexingly, however, it is also a commercial relationship. Therapists do not support their patients because they genuinely want to give unconditional love; they do it because they are on the clock. In this sense, they offer "unconditional love conditional upon payment," but even that is better than purely conditional love.

Unconditional love is a precious commodity. The fact that so many people turn to therapy testifies to its pricelessness in our emotional lives. No matter how much we cynically harden ourselves to commercial realities and its myriad conditions, we always must attend to our own emotional health. Unconditional love makes us feel really good. It makes us feel better than any hard-won, competitive victory. Nothing can match it because it affirms our own personality without any effort on our part. It feels good to be loved "simply for who we are" without having first performed a song and dance to placate some demanding taskmaster.

Taskmasters surround us in life. They come in many guises. Even our own spouses and parents might force us to act in unappealing ways to win their love. When it comes to love, no one wants to compete. If we compete for love, it is not really love. We want others to love us because we are who we are, not because we do things for them. But this is a hard thing to do in a world that consistently heaps us with conditions and expectations. This society does not make individual happiness a primary goal. So it leaves us to struggle--often vainly--to obtain it.