Review: Shrinking Violets: The Secret Life of Shyness, by Joe Moran

 Joe Moran's book is a nice exploration of various historical figures (such as authors, poets, and musicians) who had what he calls "shyness."  Moran alludes to his own shyness as well.  

A thematic goal of the book is to understand shyness as a part of the tapestry and variety of human life, as opposed to a pathology that requires treatment, or that is even treatable at all.  

Moran is a good writer--he's an English professor, and it is always a delight to read a book in this type of genre written by someone with a mastery of the language.  

This book is interesting as a historical or biographical journey, but I found it quite limited as a serious study of shyness from a psychiatric point of view.  First of all, "shyness" is a very limited term to describe the many varieties of anxiety, introversion, personality styles, and autistic traits likely present in some of his case studies.  

Near the end of the book, Moran encourages a position of gentle acceptance of shyness, but this acceptance seems to disparage the potential value of attempting to help people manage or change their social anxiety or avoidance using therapeutic techniques.  One chapter is even called "The War Against Shyness," which is a pretty strong condemnation of the therapeutic culture.    

There are many shy people, who have what might be considered social anxiety or autistic traits, who might find therapy helpful, to improve social skills, to find ways of facing fears more comfortably, or even to reduce anxiety a notch (including with the help of medication).   We should always have modest or limited expectations of therapy; also we need to take care to affirm an accepting rather than a pathologizing stance, particularly when social behaviour and experience always exists on a spectrum.  Yet the best of modern therapy is affirming and accepting; it just helps people to suffer a little bit less, to help people have a little bit more freedom in their lives to do things they might find meaningful, enjoyable, or essential for survival or prosperity.  

Review: Blueprint by Nicholas Christakis

 I am happy to have discovered Christakis and his work, in an area I would call “evolutionary sociology” or “mathematical sociology.”  

Blueprint: The Evolutionary Origins of a Good Society is an excellent companion to books by Steven Pinker, Jonathan Haidt, and Richard Dawkins, and even behavioural economists such as Kahneman, looking at issues concerning the genetic components of individual and group behaviour, and the intersection or interplay between “genetic” and “environmental.”     Christakis shares Pinker’s general optimism about human progress, though through a social and anthropological lens rather than a strictly individual, rationality-based one.  Haidt and Christakis both look at dynamics of group differences, Haidt as a psychologist, Christakis as a sociologist.  And Christakis looks at gene-environment interaction on a group level, a continuation or elaboration of Dawkins idea of an “extended phenotype.”  

Near the beginning of the book, there are very interesting case studies presented about small groups that isolated themselves from the rest of society, either through choice (e.g. the Shakers), or through disaster (shipwrecks), then having to develop some means of survival, stability, or happiness.  Some organizational styles were successful, especially when there was some form of effective but not overly rigid leadership, combined with respect for individual differences, and a culture encouraging playful interactions.   Some styles led to failure (a very low survival rate), such as if warring factions developed, “Lord of the Flies” style, or if the community was either too anarchistic, too insular, or too tyrannical.  

Christakis introduces network analysis of groups, which I would like to learn more about.  I consider this to be in the mathematical discipline of “graph theory,” another nice example of pure mathematical concepts and modern data science allowing us a deeply insightful view of aspects of human nature.     I consider this type of analysis especially important in this age of online connectivity, which has the potential to amplify or distort connectivity phenomena, leading to powerful forces of social change, leadership, and spread of ideas or culture.  

After finishing this, I am motivated to finally start Christakis’ next book, Apollo’s Arrow, which is about  the COVID pandemic, again studying it through the lens of sociology and group dynamics.  

A general takeaway point from this book, from my perspective as a psychiatrist, would be to even more strongly value an understanding of social and group dynamics in a person’s life, to understand the nature of connections, connections of connections, group memberships, friendships, communication, and community, in much greater detail, as a component of understanding psychiatric phenomena and strategizing about therapeutic help, rather than stopping at the level of individual psychology only.  

The Urge: Our History of Addiction, by Carl Erik Fisher

The Urge: Our History of Addiction, by Carl Erik Fisher is a good book about the history of addiction, weaved together with a story of the author's own alcohol use problems and rehab.  

The original use of the word "addiction," as Fisher shows us, was more general or broad, referring to situations we might now consider "behavioural addictions," habit problems, or just very strong preferences.    This usage of the word, despite objections from some addictions specialists, may be most accurate from a neurobiological point of view, according to recent evidence.  

He emphasizes many times how addictive phenomena lie on a continuum of severity in different people and within the same person at different points in time, and are influenced strongly by social, economic, and political circumstances.   For some people addiction is a symptom of, or a means of coping with, horrible environmental circumstances.  For others, it is a trap leading to loss of control even when environmental circumstances have improved or are normal.  

Understanding and helping addiction problems has had an interesting history, with some compassionate medical and community help approaches evolving since the 1800s, but often interrupted or negatively influenced by social factors such as stigma or criminalization.  

I agree with his conclusions, that addiction treatments need to be individualized, and that there can be various different causes or problems which underlie addiction for different people.  AA or other 12-step groups can be valuable for many people, but this is not the only effective approach.  Other group styles, such as the "SMART" program, can be preferred.  Abstinence-based models of treatment may be preferred or necessary for some people, but for others it is effective to aim only for moderation without abstinence.  Some people do not want or need peer or group support, and prefer one-on-one counseling.  Others may prefer to manage their addictive problems alone; Fisher cites data showing that many people with addictions can recover without any therapeutic treatment at all.   There are medications that can help, such as naltrexone.  

Fisher acknowledges the importance of loss of control in addiction, and of the phenomenon of denial which delays or prevents many people from seeking help.  

There have been big problems in addiction management that must change.  First, there needs to be much more availability of addiction treatment programs for those who desire or need them.  There should not be economic biases causing some groups to have less access than others.  For opiate addiction in particular, there needs to be easier availability of methadone or buprenorphine maintenance for those who would like to try this approach.  Harm reduction strategies in general have a very strong evidence base.  

Second, public health interventions can be simple and effective, such as restricting the advertising or marketing of addictive products (such measures have been useful for reducing tobacco use in the population).  There is still a big corporate influence on policy (from the alcohol or gambling industries, for example), which should not be allowed to continue.   Third, there should be less focus on prohibition and criminal punishments, which in general have often made addiction problems worse, particularly by focusing expensive social resources on law enforcement rather than on community improvement and rehabilitation.  

Belief Bubbles, Delusions, and Overvalued Ideas

 One of the most important posts that I've written on my blog, in my opinion, has been "Political polarization, propaganda, conspiracy theories, and vaccine hesitancy: a psychiatric approach to understanding and management," initially published on September 1, 2021 but edited and updated numerous times since then.   I check periodically how many people visit my blog, and I see that there are relatively few.  If I could recommend just one of my articles to be published widely, it would be that one, since I think it is so important regarding individual and public mental and physical health issues in the world today.  

The topics in that post focused on misinformation, propaganda, and deluded beliefs regarding the pandemic.    

I frequently see similar issues at play in my daily work as a psychiatrist.  

What causes fixed false beliefs?  When would we call these "delusions" as opposed to overvalued ideas, or simply examples of erroneous thinking?  

In psychotic states, the mind creates delusional beliefs without any reinforcement from a social community.  This is caused by genetic factors, abnormalities in dopamine circuitry in the brain, magnified by psychosocial stress.  As a result of the individual nature of psychotic illness, fellow members of the community can easily recognize the problem, and hopefully attempt to help.  Such delusional beliefs are unlikely to spread in a social network.  

There are examples of "shared psychotic disorders" in which an individual may have a primary psychotic illness, leading to close associates or family members adopting the same beliefs.  But this is a relatively rare phenomenon.  

A much more challenging problem occurs when false beliefs are spread in a social network.  In this case, the beliefs may or may not have anything directly to do with the other beliefs or values within the social network .  For example, extremist anti-vax beliefs are more common in particular religious or political groups, but vaccines have very little to do with theology or ideology.   The process of ideological spreading in these cases is analogous to what Dawkins calls a "meme", though driven not by a natural selection process, but by a process akin to "sexual selection."   In "sexual selection" traits such as peacock feathers propagate together with traits for recognizing and desiring the initial trait.  For example, bird songs or feather colours are sexually selected due to the song or feather itself and the desire of other birds to recognize or value the song or feather.  The song or feather comes to be an emblem of the species itself, rather than having other adaptive or communicative value (bright or decorative feathers do not lead to improved flight).  Many examples of "mass delusion" such as anti-vax beliefs are likely similar; they have become emblems of membership in particular religious or political communities, which are found to be attractive by those within the communities, even though the beliefs are harmful to the group and contrary to the group's positive values.  In this way, they are ironically similar to a virus:  anti-vax dialogue and behaviour has become much more prevalent or even dominant in these religious or political groups, such that the groups' core values or policies are utterly neglected or contradicted.   People from outside these groups would be disgusted by this phenomenon, leading to the groups becoming more insular, decried as hypocritical and immoral by outsiders, and obviously less able to offer charismatic outreach.  In particular, values such as love, care, and freedom are profoundly contradicted by beliefs which decry life-saving public health protections.  

Anti-vaccine and other "anti-public-health" propaganda is extremely harmful to society; it causes needless suffering, death, and economic hardship.  The propagation of such ideas is shockingly dissonant with the core values of many of the groups associated with it.  Disparate groups have endorsed such beliefs, leading to an unusual medley of fundamentalist religious groups, biker gangs, and racist groups joining in protests or defiance against vaccine and public health mandates. 

It is very difficult to address or improve problems of this sort.  When beliefs have been adopted as an emblem of a tight-knit social community, they are strengthened greatly by group association, and group members will defend these ideas from outsiders, almost like people might defend their home or family from invaders.   These ideas become adopted as almost sacred core values,  as though the beliefs (in this case about vaccination, wearing masks, etc.) were enshrined in a sacred religious text such as the Bible.  

As with psychotic illness, there are degrees of severity.  In mild cases of psychosis, affected people may be able to question their beliefs or request help; in more severe cases they have the insight to know that others would see their beliefs as paranoid, so they are able to refrain from discussing their beliefs, even though they still are fully believing their delusions.  In more severe cases, people will start expressing, or casually "slipping in"  the paranoid ideas in casual conversation (even with a psychiatrist) almost as though to test or evaluate the conversational partner, perhaps to seek a kindred believer or to be warned about a "nonbeliever."  As with some examples of religious practice, "believers" may seek to attempt to "convert" others as though expressing the delusion has a sacred value.   

I think it's pretty important as a psychiatrist to gently inform people that there are delusional beliefs going on.  With entrenched delusions this may need to be done with the greatest care and empathy, but I do think it needs to be discussed at least a little bit, otherwise there is a risk of the person feeling their delusions have been endorsed.  In the case of socially-spread overvalued ideas, it's a more difficult process to address in a therapy setting.  In some cases the discussion risks spreading to a focus on ideas concerning religious or cultural beliefs, which are generally off-base.  But when new "contagious" beliefs are spreading in a social network, straddling the boundary between a "cultural belief" and a "delusion," unbridled and harmful spreading is more likely.  This is similar to the epidemiological dynamics of COVID itself:  COVID is deadly, but its death rate is low enough to insert itself into populations in a seemingly harmless way, until a few weeks or months later when hospitals and ICUs are overflowing with severe cases.  Ironically, if the mortality rate of COVID was much higher, it might be easier to control at a community level, because there would be more unity of action.

As I discussed in my "political polarization" post, there are many social actions that can help this situation.  It is most valuable for rational, persuasive pro-vaccine, pro-public-health members of affected social groups (such as religious leaders, truckers, political leaders on both sides of the political spectrum, police, military personnel, alternative health care providers, and people formerly part of the anti-vax movement but who have changed their position) to speak out as educators and leaders.   Scientists and public health officials, etc. should still do their best to offer effective public communication, with efforts to reach out to these groups, but they are less likely to have a substantial impact in these communities, since they will be dismissed or derided as threatening outsiders.   Some of the communicative efforts from scientific leaders could at least involve building a better rapport with disparate communities, so that scientists would not be seen as elitist or part of an "ivory tower," out of touch with the rest of the population.    Meanwhile, there is evidence that the rest of us should continue to do our best to combat the spread of misinformation, and to do our best to speak the truth, rationally, resisting the urge to give up in frustration.  

Recommended Reading 2021: an updated book list

 Updated list of interesting books that I encourage checking out:

Steven Pinker: Better Angels of Our Nature: Why Violence has Declined  (2012)

Steven Pinker: Enlightenment Now (2019)

Hans Rosling: Factfulness (2018)

These three books, aside from being enjoyable and informative to read, also give a message of hope, that there are things actually getting better in the world, thanks to science, reason, and progress in justice, despite the world's many ongoing gravely serious problems.   They do not discount the gravity of ongoing problems, but are a nice antidote for the resignation or despair that can set in when faced with an onslaught of depressing daily news about politics, environment, disease, war, etc.  

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Thomas Picketty: Capital in the Twenty-First Century (2017)

This is a masterpiece, a historical analysis of wealth disparity and taxation, making an extremely compelling moral and economic case for introducing a better progressive system of wealth, income, and estate taxation.  This is not "socialist" as Picketty does not advocate state control of the market, but does advocate for fair regulation and progressive taxation in order to prevent regression to a pre-20th century societal style of wealthy aristocrats idly owning an increasing majority of national wealth, while most others work hard to hover near the poverty line, with little chance to progress beyond that level.  I find this issue of great importance as a psychiatrist, because it touches on the issue of managing poverty and fairness, permitting access to personal and community growth, in a way that is grounded in freedom and justice.  

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Richard Prum: The Evolution of Beauty (2018)

Almost every book or documentary I've seen dealing with evolutionary biology has emphasized natural selection as the main force of evolutionary change, while often only mentioning sexual selection in passing.  This book deals with sexual selection, a phenomenon first described by Darwin but relatively neglected in the next century.  This is of interest because Prum argues that sexual selection leads to a type of "co-evolution" in which esthetic choices lead to changes in culture which often improve autonomy, especially for females.  As a psychiatrist I think it is interesting as another emphasis of the cultural and biological foundations of esthetic choice-making in humans.  At the very least, interesting ideas to think about.  

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Daniel Kahneman: Thinking: Fast and Slow (2013)

Daniel Kahneman: Noise: A Flaw in Human Judgment (2021)

Kahneman's books are must-reads for any person.  His 2013 book is a masterpiece, an introduction to the subject of biases which influence human judgment.  I can't emphasize enough how important this subject is in the modern world, where our judgments are constantly influenced by factors within ourselves, and from external sources, which we are not aware of.  It is of relevance in psychiatry or mental health because of the importance for wellness to make healthy, well-informed, unbiased judgments, and because of the exaggeration of biases caused by depressive or anxious states.  

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Jonathan Haidt: The Righteous Mind: Why Good People are Divided by Politics and Religion (2013)

This is an incredibly important book, of the greatest relevance for the problems we face in the world in the past few years.  It is a compassionate look at the psychology underlying political, ideological, and religious difference, with recommendations of ways we can mend these differences and reduce polarization.  

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Paul Bloom: Against Empathy: The Case for Rational Compassion (2016)

This is a nice application of the psychology of bias, as described by Kahneman and others, to the practice of altruism and of caring for other people.  Bloom is a brilliant Yale psychologist, initially from Montreal, who has shown that typical reflexive emotional biases can cause our altruistic behaviour to be surprisingly misdirected, or unfair to those who need it most.  I don’t agree with all of his points, but I think this book is essential reading for a person interested in fairness, compassion, altruism, and justice.  

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Nicholas Christakis, Blueprint: The Evolutionary Origin of a Good Society (2019)

Nicholas Christakis, Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way we Live (2020)

I'm pleased to have discovered Christakis.  Blueprint is a great sociological study of group dynamics-- interesting descriptions of groups surviving on their own in remote locations or after shipwrecks; or groups separating themselves from the rest of society, including small religious enclaves, and an interesting introduction to the mathematical structure of group dynamics in communities.  

Apollo's Arrow is a nice review of the sociology of pandemics, including those from long ago as well as Covid since 2020.  The only critique is that it was published in late 2020, which is only about halfway through the Covid story as we know it today.  

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Robert Sapolsky, Behave: The Biology of Humans at our Best and Worst (2017)

Of course, on a psychiatrist's reading list, pretty important to include a title on neuroscience!  This is a great, detailed but readable introduction to how the brain works, with a particular focus on neuroanatomy and neuroendocrinology.  There are a few shortcomings, but overall highly recommended.  Everyone should be introduced to this subject matter.  

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Maria Konnikova, The Confidence Game: Why We Fall for it, Every Time (2017)

Konnikova is a psychologist who has studied con artists.  This book is an entertaining story of spectacular con artistry over the past century, with some commentary on the psychology of con artists and their victims. This subject is incredibly important today, because we are not only prone to being conned by financial scams, online fraud, etc. but also in choice of political leaders, as we have seen beginning in 2016.   We see that con artists can often be so persuasive that even after they are exposed and prosecuted, victims sometimes still support them, because of how effective the con was, and how humiliating it could be for a victim to admit or understand what happened.  Once again, we see this in particular political leaders since 2016.  

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Ellen Peters, Innumeracy in the Wild: Misunderstanding and Misusing Numbers (2020)

Ellen Peters show us the extent to which the majority of people have poor understanding of mathematics, even at a basic level of interpreting simple data.  This is of great importance because so many of the decisions we have to make in the world today, both on a personal and a political level, require clarity of understanding of issues that are best described in a quantified way,  and an ability to understand and question data intelligently.  

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Judea Pearl, The Book of Why (2018)

This is a book about the science of causality, which could be considered a branch of statistics.  This subject is important in order to understand information in such a way as to guide decision making rationally, and to overcome biases.  The first half of the book is most interesting, with a survey of the history of statistics, stories of particular important theorists whose ego unfortunately slowed down progress in the field (a common theme in history!), and with an introduction to thinking of problems through a lens of causality.  There is some discussion of the theory underling AI (artificial intelligence) which is going to be an extremely important area in all of our personal and cultural lives, from this point forward in history.   The second half of the book gets more technical, and in my opinion this material would be better presented in a textbook with worked examples, rather than in an ordinary text.  

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John Kelly, The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time (2006)

This is an exploration of a very important historical event, arguably the worst thing ever to have happened in human history.  The Black Death, starting in 1347, killed, quite suddenly, up to 50% of the population.  The scale of this pandemic was hellish beyond anything we can imagine.  It is obviously relevant in the context of our current pandemic.  Even though the Black Death occurred over 650 years ago, we still see the same extremities of human behaviour showing itself during our present pandemic, despite all the wisdom we've accumulated over the centuries.  This includes fanatical groups with bizarre theories of causation about the problem; racist extremists who blamed minority groups for the disease, leading to mass killings; and some heroic figures who tried to help, at tremendous risk to themselves.  

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Robert Cialdini, Influence: The Psychology of Persuasion (2006)

Cialdini is a psychologist who specialized in persuasion, initially by studying the tactics used by successful salesmen.  He identifies six major factors increasing the effectiveness of persuasive communication.  This subject matter is relevant for scientists, community leaders, and health care professionals, in order to convey health information in a way which is more likely to lead to positive change.  Obviously, this is incredibly relevant during the pandemic.  The other reason to be acquainted with this area is to be empowered to identify unwelcome persuasive techniques being used by marketers, politicians, or pundits, to avoid being conned or manipulated.   Unfortunately, I see that Cialdini's subsequent work has been of similar material directed mostly towards businesses and marketers, without further major contribution as a psychologist. But this initial book remains as a must-read.  

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Richard Dawkins: The Selfish Gene (1987)

Richard Dawkins: The Ancestor's Tale (2004) 

Richard Dawkins: The God Delusion  (2006)

Dawkins is one of the greatest science writers.  The subject of evolutionary biology should, in my opinion, be familiar to everyone.   This is not a dry subject--Dawkins' stories of animal life cycles are often fascinating and beautiful, akin to watching an Attenborough nature documentary.   And the scientific thinking is often spectacularly incisive.   In my opinion, Dawkins' often scathing critiques of religion are really critiques of fundamentalism in all its forms, and in my opinion are really just challenges to people of faith to be able to accommodate scientific understanding of the world into a belief system which is not rigid or unjust.  This is relevant for psychiatry and mental health, both because evolutionary factors obviously contribute to the existence of all human traits and problems,  but also because the subject matter itself, and the way in which it has been received by society in the past two centuries, has been impacted by psychological factors including ingroup biases.  

I specifically mention The Ancestor's Tale because at the time I read it, it struck me as my favourite Dawkins book.  

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Steven Pinker: Rationality: What it is, why it seems scarce, why it matters (2021)

This book is nice review of other material that would be familiar if you've read some of the other books suggested here, such as by Haidt, Kahneman, and others.  The genre is extremely important because our country and the whole world has been afflicted by waves of what Pinker calls "my-side-ism" or "motivated reasoning," driven by ingroup biases, tribalism, polarization, magnified by partisan news sources and misinformation.   Pinker is always carefully rational, a pleasure to read, with measured optimism and suggestions of ways we can improve the dire problems we are facing.   

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Astronomy Today 

Steven Hawking; A Brief History of Time (1998)

I include these books here, because I just think everyone should know something about astronomy and cosmology.  It's a foundation of understanding the universe and its history, it's wonderfully interesting, and as a psychiatrist I find that it helps us to cultivate a sense of awe and wonder about nature, the world, and reality, in a way which is deeply enlivened by the science, and which does not require superstitions or mystical thinking.   In my opinion, it is an example of how scientific understanding rather than pseudoscience deepens our experience of the world, of nature, and of our humble role as humans in the universe around us.   I think it's pretty important to know what the sun is made of, how far away it is, how old it is, what will happen to it in a few billion years, how far away the stars are, where they came from, etc.  For me it is an intersection of the existential with the scientific, something of great importance to psychological well-being.  

I would like to add similar titles relating to science subjects such as quantum mechanics, relativity, chemistry, paleogeology, and pure mathematics, as I think these are also sublimely interesting, in the same way that astronomy is, with similar existential impacts on mental health and well-being.  

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Video Documentaries

All of David Attenborough’s nature documentaries are, in my opinion, essential as part of enjoying nature and understanding the world.  Starting with Planet Earth, in 2006, the photography is spectacular.  A great way to learn, to be inspired, to enjoy nature, and hopefully to be motivated to do more to protect our world’s environment.  I consider an appreciation and personal experience with nature to be an important component of maintaining good mental health.  Another reason to watch Attenborough is because he is one of the great people, one of the great souls, of the past hundred years, in terms of character, integrity, values, and intellect. 

Neil deGrasse Tyson’s 2014 remake of Carl Sagan’s Cosmos series is another great documentary looking at the history of science, with a particular personal look at interesting people, many of whom you might never have heard of, who made great contributions to understanding and improving the world.  

The Mind, Explained is a good series of short documentary episodes (20 minutes each) looking at particular aspects of how the mind works (including subjects such as anxiety, focus, attention, etc.).  I’m impressed how much information they are able to pack into such brief episodes.  They might not always give a full picture of each issue, but are a great introduction.