Thursday, August 18, 2016

Psychiatrists diagnosing public figures

I was reading an article today discussing the ethical problems involved when psychiatrists or psychologists apply a psychiatric diagnostic label to a public figure.

One big focus of objection in this article had to do with giving a "diagnosis" without actually seeing the person or doing a proper assessment.   Another concern had to do with the propriety of using a "professional voice" as a mental health care specialist to influence a political matter directly, possibly using diagnostic terminology that could have a pejorative quality.  In this case some of the terms of concern include "narcissistic personality disorder."

It's an interesting issue.  My addition to this debate may seem to support both sides of it!  First, I think it is somewhat arrogant on the part of psychiatrists to assume that they ever have some particular diagnostic wisdom, even with ongoing "assessment." Diagnostic terminology such as "narcissism" should be optional, informal language to be used, if at all, with the patient's consent and endorsement, for the purpose of helping the patient improve health.

One particular diagnostic label is arguably determined more exclusively by a person's observed behaviour, and that is antisocial personality.  Evidence about a pervasive pattern of past criminal acts, cheating, cruelty, etc. contribute to the use of the "antisocial" or "psychopathic"  label.  In this case, the motive of such terminology can go beyond that of offering the patient optimal care:  this type of "diagnostic" consideration relates to public safety, for example to evaluate the degree of risk a violent offender or abusive person might have to harm others in the future.

It may be that in some cases a professional such as psychiatrist might have more experience seeing people with potentially dangerous behavioural phenomena, such as antisocial personality, and have some ability to recognize and voice the risks associated with this.  With some cases of antisocial personality, it is possible for there to be an attractive and charming persona which can act as a sort of disguise, leading others to greatly underestimate risks.

I think it is deeply ethical to warn the public about such things.

But, I think it is unethical to wield a diagnostic label as part of some sort of pejorative, rhetorical attack against anyone.

I also think that specialists such as psychiatrists should be a great deal more humble about diagnostic opinions in any case.

A compromise, in my view, could be to voice general concerns about potentially dangerous behavioural syndromes, to share the opinion that such dangers can coexist with a charming and popular personality, and therefore to encourage great caution about following political trends, without very careful reflection on the cognitive biases that can occur in such situations.

This is the same kind of advice a marketing expert or a social psychologist might give to someone who is shopping for a used well-informed about the risks!  The seller may have great integrity, but there is the risk of the seller only having a "facade" of integrity, and of telling you whatever you want to hear, in order to sell you a defective car at a disastrously high price.  There are some ways to be more accurately informed about such integrity, such as by considering patterns of past behaviour involving the person in question.

Psychiatrists should be able to speak freely about political matters, but there are ways to do this without a potentially unethical and inappropriate foray into diagnostic labels.

Wednesday, August 17, 2016

Sugar and Mental Health

There are a lot of people who make dietary recommendations.  It can be hard to figure out whom to believe.

There is a huge amount of money involved in food marketing, weight loss marketing and programs, and books about nutrition.  According to ABC News, the U.S. weight-loss industry brings in about $20 billion of revenue annually.  Another source claimed a worldwide market of a staggering $500 billion or more, for industries related to weight loss.

The issue of weight loss and food policy is a sensitive one, given the high prevalence of obesity as well as eating disorders in the modern world.   These nutritional and metabolic problems are associated with strong feelings of depression and anxiety, negative thoughts and belief about self, guilt, shame, and frustration.   Of course, there are life-threatening physical consequences of obesity as well as of other eating disorders such as anorexia. 

There are now some good documentaries available describing the history and dynamics of the food industry, particularly the industries which supply sugar and corn syrup.  For example, the films "Fed Up" (2014) or  "Sugar Coated" (2015) introduce the viewer to troubling information about large corporations sweetening the world's diet, despite abundant evidence of dangers to health.  The sugar industry has been compared to the tobacco industry, in the way that health concerns have been minimized or suppressed.   A lot of commercial advertising and other marketing directly targets children from an early age; many children associate various sweet food products with play activities, friendly cartoon characters, free toys, etc.  Some fast-food manufacturers sponsor health-related events or even resources for terminally ill children; while such charitable work is admirable, recent documentaries encourage us to consider it comparable to a cigarette manufacturer or a cocaine dealer sponsoring similar charities.   If we associate these companies with such altruism, we may be more apt to feel good about consuming their products.

Ironically, sugar itself is a required component of human metabolism.  Glucose is the main fuel for the brain.

Yet, the best way for the brain to obtain this glucose is from a diet low in sugar!  Pure sugar or other simple carbohydrates in the diet cause a sudden surge in blood glucose, triggering a cascade of hormonal changes.  Aside from the insulin response, there is a surge of pleasure from consuming sugar, which triggers an addictive behavioural sequence.

A habit of consuming sweetened foods leads to a reduction in the consumption of other nutrients.  As one develops a habit of eating sweeter things, non-sweet food items are likely to taste more bland.  It is hard for many people (especially starting off in childhood) to nurture a taste for vegetables when there are candies, ice cream, cake, cookies, or chips to choose instead.

As a component of improving mental and physical health, it is worthwhile to greatly reduce the amount of added sugar in the diet.  This reduction would be satisfying, not only due to direct improvements in your health, but also because you would be shifting your financial support away from a massively wealthy and arguably corrupt food industrial complex, towards a more wholesome industry of local farmers.

Smaller intakes of sweets and simple carbs are likely to improve your appreciation of the esthetics of other food.  Cutting sweets is not some kind of spartan sacrifice!  It will lead to greater joy and hedonic pleasure in your meals!  As you reduce sugar, your "addiction" to it will subside, allowing you to savour the tastes of all other foods, without the flavours being swamped by sweetness.  If you do end up having an occasional sweet treat, you will be able to enjoy it more thoroughly, with a smaller amount of sugar needed in the recipe.