Thursday, December 30, 2010

Lessons in Rational Selfishness That Alcoholics Anonymous Taught Me (Mostly) on Purpose

Stuart K. Hayashi


Despite its shortcomings, Alcoholics Anonymous has some ideas that reinforce the ethics of rational self-interest.  After addressing AA's major weakness, I want to talk about its good side.


Who or What Is This 'Higher Power'?

In many ways, AA acts as a front for religious proselytizing.  Its "twelve steps to recovery" are notorious for this.  Steps 2, 3, 6, 7, and 11 all mention obeisance to God (see PDF here) That's terribly problematic. Taking control over your own life and fighting your vices is your responsibility; not a supernatural entity's.

To me, one can only speak of a "higher power" in an intelligible sense if the power is physical reality itself -- that is, the scientific laws of nature.  The one form of humility I can accept is the idea of being humble before immutable facts, such as that "Existence exists" and that natural law does not contradict itself.  I think it does make sense to recognize that scientific law will always overpower one's own wishes and whims. Note that in her essay that makes this very point, "The Metaphysical Versus the Man-Made," Ayn Rand begins by quoting AA's Serenity Prayer: "God grant me the serenity to accept things I cannot change, courage to change things I can, and wisdom to know the difference."

Rand comments,

...omitting the form of a prayer, i.e., the implication that one's mental-emotional states are a gift from God -- that statement is profoundly true, as a summary and a guideline: it names the mental attitude which a rational man must seek to achieve.

With respect to the issue of AA's religious bent, someone once submitted this question to Leonard Peikoff for his podcasts:  "I'm a recovering alcoholic.  The program has many tenets that run counter to Objectivism, including letting a higher power relieve me of alcoholism.  How can I reconcile Objectivism but continue staying sober through AA?"

Peikoff replied in 2009,

I once asked an official in AA, "Did you have to believe in God in order to join?"
And he said, "No. We leave the higher power..." -- what they call a higher power -- "...to the interpretation of the individual. And if you want to make it objective external reality, that's OK with us. We want something that you can't manipulate by will. And, of course, since you can't manipulate reality by will, it basically plays to the same rule for an atheist that 'higher power' does."

I think, as far as I can tell, all of the steps that AA takes are actually interpretable in secular terms like that. ...

So I don't agree with a lot of their formulations.  But, as far as I can tell, the essence of their creed -- combined with the important social support that they offer -- makes it not necessary to choose between AA and Objectivism.


Where AA and Al-Anon Support Rational Self-Interest

AA is known not merely for providing social support to recovering alcoholics, but also for providing sound advice to those who care about alcoholics who either refuse to quit drinking or are having a difficult time doing so.  Suppose you know someone who has displayed the virtue of rationality in many ways, but increasingly comes to engage in forms of self-destructive behavior to a degree that you find frightening.  There are many examples of such self-destructive behaviors besides alcoholism -- other forms of substance abuse, gambling "addictions," and exhibiting signs of mental illness and refusing to seek treatment.  Many psychology books addressing this subject dispense forms of advice that seem to always be traced back to AA or a group inspired by it.

When you are in a situation where such a person is close to you and is behaving self-destructively, people in AA's circles will often remind you that when someone doggedly chooses such an irrationally self-destructive course, there is no way you can rationally persuade the person to change.  No matter how correct you are, you cannot rationally convince someone of the truth against her own consent.  You can reason with a person on a subject only insofar as she chooses to to be open toward your appeal from the outset.  Therefore, those in AA's circles say that rather than lose your bearings while trying to change the self-destructing person, you must "Take Care of Yourself First." Psychologists frequently use that expression for caregivers in this situation, and it seems the expression might have originated with Al-Anon -- an organization spun off from AA to help loved ones of alcoholics cope.

To me, "Take Care of Yourself First" is an expression of rational self-interest.  The implicit message is, Do not sacrifice yourself in futile attempts to protect people who refuse your protection.  Rather than sacrifice for them, focus on your own peaceable eudaemonia as much as you can.  You are not responsible for another adult's happiness, but you are responsible for your own. 


Compassionate Detachment

"Take Care of Yourself First" has an important corollary -- the idea of "Detaching With Love."  Hypothetically, say that you know someone who has earned your respect by exhibiting many rational virtues. For a time, this person listened to you discuss your philosophy while most everyone else, for years, dismissed your intellectualism as boring.   Maybe this person shows an admirable, new ambitiousness in forming a career.  However, this person engages in at least one form of behavior that is so disturbingly self-destructive that you cannot ignore it in good conscience; you cannot witness such behavior without being overcome with horror, disgust, bewilderment, or a combination of these reactions.

When you confront your own inability to tolerate that person's self-destructive behavior, other people might advise you, "That person is worthless.  Just forget about that person.  Stop caring."  I think that such a decidedly dismissive approach is quite silly.  Even if the other person is self-harming in one respect, that doesn't necessarily erase all of the person's good points.    A much more logical, selfish approach is to "Detach With Love."

When you Detach With Love, you acknowledge to yourself that you can still have valid reasons for caring about this person, and you have every moral right to continue caring.  With the acknowledgment of those facts comes this corollary:  such continual concern and worry must not be allowed to reach a point where they come at the eternal expense of your own long-term happiness. Whether you say it aloud to the self-destructive person or not, this is the basic approach you take toward him:
I still care about you, and I have every right to continue caring.  I still have every appreciation for the virtues of yours that made us close in the first place.  What I am doing is taking a stand against the behaviors of yours that I find so disturbingly self-defeating that I must make my objection obvious to you.  I will not try to nag you out of the behavior.  By the same token, I refuse to pretend that I condone the behavior, that I find it acceptable.  I am withdrawing my sanction in this context.  I refuse to tolerate any abuse or disrespect associated with the disturbing behavior.  Should there come a day when you do decide to commit to changing the behavior -- perhaps by committing to a form of treatment for it -- I will proudly stand by you.  Until that time, I must distance myself from the objectionable behavior.
There are many ways you can detach yourself from the behavior.  You can still remain in contact with that person, but set up firm boundaries.  That is, you set up explicit rules.  You let that person know at which point the behavior becomes so intolerable for you that you must remove yourself from that person's presence or even from that person's social circle.  And if the self-destructive person balks at those rules, you might have to distance yourself even farther, maybe even cutting off all contact for a while (or possibly forever).

Such advice is commonly attributed to Al-Anon, and I agree with it.  I have struggled to teach myself that that stand is not inhumane and that it is not a form of abandonment.  It is a boycott against irrational behavior and an act of rational, peaceable self-preservation.  As Jennifer Seitzer writes, "Loving and caring for yourself is the most healthy *selfish* thing you can do for another."

I wouldn't say that this situation is necessarily like Hank Rearden finally leaving his brother Philip to fend for himself, as he had zero respect for Philip by then.  I would say that this situation can be compared to John Galt understanding that he could not force Dagny Taggart and Hank Rearden to join his strike before they were ready.  Even though he knew that their taking a position opposite to his own -- continuing to sustain the looters' lives -- would only cause them more grief, Galt left Dagny and Rearden alone all those years to face the harsh consequences of their own actions.  He knew it was the only way.  You can "Detach With Love" from even those whom, in many ways, you deeply respect.

I am very thankful for learning about the expression and idea of "Detaching With Love."  Such ideas contradict the choice to abdicate responsibility over your life to an omnipotent deity.  Stripped of the omnipotent deity aspect, though, the ideas of "Taking care of yourself first" and "Detaching With Love" make a lot of sense.


Me posing with the book that taught me the expression "Detach With Love" -- Stop Walking on Eggshells by Paul T. Mason and Randi Kreger; photo taken on Friday, December 10, 2010


UPDATE from November 13, 2015:  In recent years, I have seen critiques, such as the one put out by Penn & Teller, of twelve-step programs as pseudoscientific.  Alcoholics Anonymous was named specifically in these critiques. For the most part, I think the critiques are correct; you do not  need to acknowledge a God to recover.  However, I still think Leonard Peikoff's advice remains applicable, because acknowledging the absoluteness of reality is important, and objective reality is indeed bigger than oneself.  For the record, I don't recommend Alcoholics Anonymous in general, but I do think the principles of nature remain a "higher power."

Wednesday, December 29, 2010

It Doesn't Have to Be That Way

There are some people caught in self-destructive patterns whom I think will never actually "hit rock bottom." I think that if they continue on their present course, they will live in relative physical safety and financial security but nevertheless spend most of their future in needless misery. But it doesn't have to be that way. I wish they would live up to their highest visions of themselves and resume the helpful treatment that they need.

Friday, December 17, 2010

'Your Attempt to Explain Me Is So Patronizing'

When someone who cares about me tries to explain my behavior to me, the most important question I can ask myself is not whether the explanation's tone is patronizing, but whether the explanation is supported by observable evidence.

Tuesday, December 14, 2010

When Borderline Personality Disorder Goes Untreated

Stuart K. Hayashi






Introduction
I'm going to discuss what I know about Borderline Personality Disorder (BPD), or at least my interpretation of what I have read on the matter. For the sake of readability, I shall refer to people who exhibit BPD symptoms as "Borderlines"; I do not intend for the term to be derogatory. It's too cumbersome for me to repeatedly employ the phrase "people with BPD."

I make a distinction between those who have taken the initiative to seek treatment for this condition versus those who show symptoms but have not chosen to seek professional help in a number of years ("untreated Borderlines"). When this blog post makes a generalization about "Borderlines," it is primarily referring to those who have not recovered from their condition and are not currently in treatment. I have communicated with individuals who have informed me that they have been diagnosed with this condition and are receiving the medical attention they need. Bear in mind that they might disagree with much of what appears in this post and on this blog. I know that not everyone with this condition is the same; there is variation.

As I am not a psychologist, one may question the veracity of the information contained in this post. For that reason, I shall provide links to online documents written by those who are more knowledgeable about this subject than I am.

I understand that if someone claims to be able to explain to me what is wrong with me psychologically, I can interpret that explanation as patronizing. Such attempts by someone else to explain me usually are. What is most important, though, is not whether any such explanation comes across as condescending, but whether or not it is actually supported by facts.

First off, if someone is able to go to work or school every day and appear perfectly normal to most acquaintances, that it not proof of any absence of BPD. That may only indicate that someone is a high-functioning Borderline.

Secondly, I want to address 4degreez.com's online "Personality Disorder Test." As the test itself admits, the test cannot be used to determine whether someone has or does not have any particular disorder. That is, you can have BPD and still score "low" for BPD on that test. This is particularly because, as I shall explain later, the test questions measure the extent to which you fit the profile of an outwardly aggressive "raging" Borderline, as opposed to the inwardly-focused "Quiet Borderline." Someone who is a severe "Quiet Borderline" will score "low" in the test's BPD category.


The Nine Criteria
To be diagnosed with BPD, one must possess at least five of the nine following traits over a considerable period of time.

1. Unstable sense of identity -- According to PsychCentral, Borderlines can have "sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends." Such changes can often seem arbitrary and perplexing to those who know the untreated Borderline. With respect to gender identity, the Borderline may feel uncomfortable with her own gender, and there may be times when the Borderlines wishes that she were a member of the opposite sex. While I do not consider bisexuality, as such, to be unhealthy, it is noticeable that bisexuality commonly occurs in Borderlines (note that recovered Borderlines, who have managed to gain control over their lives, often remain bisexual; to learn more about the fluctuations in sexual orientation, read this). On a related note, it is not unusual for some Borderlines to feel alienated from their own bodies and to see themselves as "ugly." That condition is known as Body Dysmorphic Disorder.

2. "A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation" (quoted section from here) -- Here, the Borderline has black-and-white feelings, where you are either everything to her or nothing to her. In relationships, the Borderline may initially only feel comfortable in the "honeymoon" stage of the relationship. Beyond that point, the relationship can feel like a burden and become a source of an inordinate quantity of anxiety. It is Borderlines who have stuck with treatment that are the most able to sustain loving long-term relationships. If someone clings to the same clique of people for six years, the relationship with the group's members can still be considered unstable if it is marred by serious personal betrayals.

3. Suicidal imagery, suicidal gestures or physically self-harming behavior, such as in the form of cutting one's wrists with a knife -- To quality for this criterion, one need not make serious attempts to commit suicide, or even be at a strong risk for committing suicide (however, 1 in 10 persons diagnosed with BPD do commit suicide; compared to the general population, that is a high suicide rate).  One who qualifies in this category, of having "suicidal ideation," at least has frequent and disturbing contemplations about death, or fixates on imagery relating to death.  If one consistently tries to make oneself look like a dead body experiencing pallor mortis, ready for burial, that might qualify. 

4. Emotional instability

5. Feelings of emptiness -- Feeling hopeless, as if life has no meaning.

6. Inappropriate anger -- This is where people often get the idea that Borderlines yell and scream a lot. A Borderline does not have to outwardly exhibit anger to fulfill this criterion. The anger can be repressed and unexpressed. A Borderline who holds her anger in, or tries to deny that she has strong anger, can be a Quiet Borderline, as described here.

7. Transitive paranoid ideation or dissociative symptoms -- "Dissocation" refers to mysterious forgetfulness and/or feeling alienated and remote from one's own feelings.  If someone "zones out" a lot -- as if sleeping with one's eyes open -- that might qualify as dissociation. Someone might be exhibiting transitive paranoid thoughts if she complains "All men only like me for my hair color and want to have sex with me" (and says this in a very serious, offended manner) or if she keeps switching back and forth between praising an acquaintance as friendly and accusing him of being criminally dangerous.

8. Potentially self-damaging impulsive behavior in two areas other than suicide threats and deliberate self-harm (like cutting) -- These potentially self-damaging impulsive behaviors typically come in the form of substance abuse, gambling, reckless driving, or eating disorders. However, there are other forms. One possible example would be playing an online video game for many hours on end, as if being addicted to it.

9. Abandonment issues -- If someone constantly claims that everyone abandons her, or if she is very clingy and emotionally needy toward someone while she is infatuated with him, it may be a sign of BPD abandonment issues.


Other Concerns
There are other matters that must be addressed. Remember that to be diagnosed with BPD, you need to fit 5 out of the 9 criteria listed above. Imagine that in the years 2003 and 2004, I fit all nine criteria. That means that, even if I was not diagnosed with BPD, I probably should have been. Also imagine that I did have psychotherapy, but I was not, to my knowledge, being specifically treated for BPD. Maybe I discontinued this treatment and thought about going back in 2006, but eventually decided against it. Now suppose that by 2010, I can only fit three of the criteria -- the unstable self-image, the unstable relationships, and the paranoid thoughts -- but that I exhibit such symptoms in very extreme and disturbing ways. Technically, because I fit fewer than five criteria now, that means that I would not be able to be diagnosed with BPD anymore. That would not mean, however, that I should be considered "recovered." If someone manifests any of these criteria to such an extent that it interferes with her long-term life goals and happiness -- or if it prevents her from even holding onto any long-term life goals -- then she should keep in mind that she still may possess harmful BPD traits and that she may benefit from resuming treatment with a mental health professional.

Also note that BPD is often mistaken for Bipolar Disorder. If someone compares your moodiness to a business cycle in that it will go up and down like the stock market, that is his not-so-subtle way of hinting to you that he thinks you might be bipolar. Naturally, the two conditions are not mutually exclusive; almost 20 percent of BPD sufferers are also diagnosed with Bipolar Disorder.

If someone acts confident most of the time, that is not evidence that she does not have BPD. Psychologist Paul Mason and author Randi Kreger provide this apt description of high-functioning Borderlines.
They may hide their low self-esteem behind a brash, confident pose that hides their inner turmoil. They usually function quite well at work and only display aggressive behavior toward those close to them (high functioning). But the black hole in the gut and their intense self-loathing are still there. It’s just buried deeper
Repeatedly proclaiming oneself to be some great real-estate investor, for instance, may be attempted as "proof" that one is responsible and stable, but that is meaningless and empty if one continues to hate oneself.

Finally, infidelity is not unheard-of among untreated Borderlines. When looking at the high percentages of non-Borderlines who have been unfaithful, I don't have scientific evidence that untreated Borderlines are statistically likelier to commit adultery than are non-Borderlines. However, in the case of untreated Borderlines, the emotional instability and abandonment issues make the "cheating" far less surprising. Something else that might be recurring among a disproportionate number of Borderlines is "serial monogamy." Again, the Borderlines who have had the most successful long-term relationships have consistently been those who have been diagnosed with BPD and have remained committed to their treatment.  Rather than boasting that one is a big-shot real-estate investor, one might consider the gains that come should one invest in a return to psychiatric care.


One book on the subject I recommend






Copyright (C) 2010 Stuart K. Hayashi