Mental health in public discourse

Interesting and nuanced argument on a delicate topic.  From Are Twitter trolls mentally ill? A disproportionate amount of bad online behavior stems from psychological issues by Tom Chivers.

There’s a thing in the ethics of psychology called the Goldwater Rule. It states, in essence, that mental health professionals should not diagnose people from afar. It arose in the 1964 US presidential election, after the magazine Fact published an article quoting various psychiatrists saying that Barry Goldwater, the Republican candidate, was “psychologically unfit” to be president.

Reasonably and inevitably enough, Goldwater then sued the heck out of Fact. The American Psychiatric Association then made it a principle of their code of ethics that “it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorisation for such a statement”. In the UK, the Royal College of Psychiatrists “strongly supports” the rule.

I’m not a mental health professional. Nonetheless I think it’s a broadly useful principle to live by, especially if — as I do — you write a lot about mental health. Suggesting that some political opponent or other is mentally ill is often easier than wondering why a sane person in command of their faculties might believe something you disagree with.

Indeed.  Comprehending the errors in someone else's reason and logic is always taxing, not least because it can show up errors of our own.   

Though not much discussed in the West these days, there is always the miasma of focusing on mental health given how mental health services in the old Soviet Union were used to suppress and control dissidents.  

But there’s an opposite mistake to the one the Goldwater Rule guards against: acting as though mental health issues have no relevance to our political and cultural lives.

He uses a recent event as a case study.

Last week, the novelist Chimamanda Ngozi Adichie published a blog post called “It Is Obscene”. It referred to her experiences since she did an interview with Channel 4, in which she said that “trans women are trans women” — that is, she did not say that she thought that trans women are women, without caveats, although she has been a longtime campaigner on LGBT issues. Two young writers who she knew personally, she said, had accused her publicly of transphobia. One had called for people to “pick up machetes” to defend trans people from the “harm” she caused. 

This is not an uncommon arc in online discussions.  A topic is raised and eventually someone makes it an existential argument above everything else; then someone catastrophizes it by claiming damage and danger not in empirical evidence; quickly the argument is turned from an epistemic discussion to find answers into a moral purity test (do you believe); finally someone makes thinly veiled metaphorical threats to hurt or harm the holder of impure thoughts.  Sometimes they skip the veiling part.  

This is not normal behavior.  You rarely see this sort of arc among healthy members of a community.  You rarely see it at all.  The closest pattern you might find is bar fights fueled by alcohol rather than argument per se.  It is not normal, but is it evidence of mental illness?

Chivers continues:

Adichie did not identify the writers; I will follow her lead, although it was not difficult to identify them from her text. But one of them had publicly declared a few months earlier that they have “dissociative identity disorder”, DID. That is: they have multiple personalities within one body; they refer to themselves as a “system” of personalities rather than a single person.

This is where I bump up somewhat against the Goldwater Rule. DID is a personality disorder which often presents with, or is confused with, another disorder called borderline personality disorder (BPD). About 70% of DID patients are also diagnosed with BPD, and the two conditions are often considered part of the same spectrum. The diagnostic criteria for BPD include “identity disturbance with markedly or persistently unstable self-image or sense of self,” and “severe dissociative symptoms”. Goldwater notwithstanding, I think it’s OK to draw lessons across from one to the other; diagnoses of the various kinds of personality disorder are very fuzzy — often people are in several categories, or don’t fit neatly into any of them. Both BPD and DID are marked by extreme emotional volatility and a lack of a stable sense of self.

Further:

I think this helps make sense of a lot of what was going on with the subject of Adichie’s essay. That person had been a worshipper of Adichie’s: later, they considered Adichie a transphobe and a bigot. A neurotypical person might have been disappointed that their hero was using what they considered insensitive language about trans people, but for someone whose emotions are more easily blown around, it made their opinion swing from 180° from love to hate. The relationship is perfect and the person is wonderful; then, the person is terrible and the relationship is doomed.

The identity aspect makes sense as well. In one Twitter post the author called for people to “pick up machetes to protect us from the harm transphobes like Adichie & Rowling seek to perpetuate”. Those machetes are presumably metaphorical, albeit an astonishingly vivid metaphor, but in other posts they abhor the “violence” of Adichie’s (to me mild-seeming) language towards trans women. This looks like straightforward hypocrisy, but to someone who struggles to form a coherent self-identity, and then finds one with the trans community, any criticism of that identity might well feel like a violent attack on the very core of one’s being.

This is consistent with the inclination to catastrophize events.  

The Adichie incident is a recent and high-profile one, but I think a disproportionate percentage of the problems with online discourse stem from similar problems. I won’t link to or identify any individuals — they would not benefit from it, and nor would anyone else — but I repeatedly see analogous situations, often from people who in other tweets openly declare their diagnosis.

I want to be very clear about some things I’m not saying. I’m not saying that all online bad behaviour is because of mental health issues or personality disorders: lots of people are just dickheads, and there’s no need to pathologise them. And I’m not saying that all or even most people with BPD or similar disorders end up attacking people online. And — while this example is lifted from the trans activism/gender-critical forever war — I’m certainly not saying that all trans people have personality disorders or that being trans is a mental illness. 

All this fits with the measured reality that only some 25% of people have Twitter accounts and some 90% of twitter content is generated by 10% of account holders.  In other words, the tenor of Twitter tends to be shaped by a very small and virtually certainly very unrepresentative slice of the population.

But one of the cries of our age is to be more sympathetic and understanding of mental health conditions. The trouble is, I find that when people say things like that, they are often thinking of the more acceptable manifestations of mental ill health; people being depressed or anxious, staying home and making cute posts about being introverts.

Sometimes, though, mental health issues cause people to behave badly and cause harm to others, in ways that are not cute or sympathetic or easily understandable. An old friend with a personality disorder once wanted to write about this, on Mental Health Awareness Day: that we’re all keen to be Aware of Mental Health when it means someone being anxious or unhappy. But when it’s about psychotic episodes — or even less sympathetic disorders, such as psychopathy or narcissistic personality disorder — we’re less keen. My friend never wrote the post, but I think it’s true.

 There is a similar issue in environmental circles - it is easy to raise money for majestic giraffes or cute Koalas.  It is far harder to raise money for the spiky, dangerous, ungainly or simply plain animals which make up an ecosystem.  

Chivers concludes:

But we shouldn’t pretend that these issues aren’t a factor in the sometimes toxic online environment. Puritan attitudes, ideological dogma, hypocrisy and cant are all part of it as well, but, Goldwater Rule notwithstanding, we’re missing a part of the story of online discourse if we don’t find a way of addressing, sensitively and without stigma, the role of mental health.

It is an interesting article to read in full and ponder.