Saturday, 25 June 2011

Ten: Marsha Linehan

Dr Marsha Linehan, renowned for her creation of a pioneering treatment for bpd, has spoken out about her own mental health difficulties. 

I was surprised, more at the revelation itself than her announcement of it.  Since I was first made aware of it maybe five years ago, I have held a rather disparaging attitude towards the therapy programme which became known as "DBT", or Dialectical Behaviour Therapy.  Primarily, my experience of this therapy took place during my admission to the Crisis Recovery Unit of the Royal Bethlem (Maudsley) Hospital.  The philosophy of DBT underpinned much of the work staff at the CRU tried to engage patients in, some more successfully than others.

It didn't work for me.  I resented what I saw as the "holier than thou" top-down way in which groups were conducted and the ward was run, and failed to see how I could be educated to better regulate my emotions when I felt I had perfect insight into my thought patterns and did not agree that splitting them off and beginning to change them could have any real impact on the way I felt.  Moreover, I was wary of the intentions and motives of the staff and was at times extremely defensive -  I was prone to "intellectualising" and could not resist getting into endless arguments over the logical fallacies I noticed in the cognitive exercises we were asked to perform.  I was (and still am) skeptical of the principle that changing behaviour can make profound and long-lasting changes to attitude and mood, particularly for people who have great difficulties with trust and find a six month admission period insufficient to form the relationships necessary to really engage in the work.  It is for this reason that I think the consistency and prolonged duration of psychotherapy has been most helpful in getting me to discover and examine parts of myself that lead me to self-destruct.

But back to Marsha.  Her admission that she had, as a young woman, struggled with the very difficulties she subsequently attempted to treat, made me wonder if I should reconsider my view of DBT.  At the very least, I am no longer able to understand it as the arrogant, proselytising model of good "health" I had so despised before.  I find it impossible to overstate the importance that feeling really heard and understood has for me in trusting someone enough to let them help me.  I am able to recognise this in psychotherapy, where A's integrity (or otherwise) is a constant feature in my assessment of our work.  That she has more or less consistently managed to sustain a genuine connection with me accounts in my opinion for much of the change she has helped me to achieve.   Since it is emotional work, I suppose it is unsurprising that "emotional" reactions not only to individuals but to treatment models themselves could play a large part in determining the responsiveness of patients, particularly those as wary as myself. 

This is well and good in hindsight. Unfortunately, at the time of my CRU admission, I was unable to recognise, or voice, the part of my frustration with the treatment that  emerged from distrust.  I only hope Marsha's courageous decision to speak out about her own experiences will help others to accept help, and feel less alone.

Wednesday, 22 June 2011

Nine: Four years

It's the fourth anniversary of his death today.  I don't feel much. Numb.  Anxious that I'll stop feeling numb.  My session at the Tavistock was not terribly gruelling.  I spoke minimally about my Dad, more about my relationship with my boyfriend which feels a more immediate issue.

In short I made it through the 55 minutes without crying, and I felt relatively okay until on the way out, I crossed paths with the inpatient psychiatrist who saw me through the whole ordeal four years ago.  I have seen her maybe once since, also at the Tavistock, and although I think she did nod at me on that occasion I had no expectation that she would engage in conversation with me if we encountered eachother again.  Perhaps it was the date that made her response today seem particularly heartless.  I know she noticed me, as I saw her scanning my face.  When I reached the bottom of the stair case (she was ahead of me on the floor below) she turned round to look at me again, and I said "hi".  That was all.  But she didn't nod at me, or smile, or do anything else to acknowledge the greeting.  She just walked away. 

It hurts.

I've been staying with my boyfriend for the past 6 days, during which time I have not cut myself or vomitted once.  I do however have to go back to my Mum's tomorrow, at least until Monday, and I'm not sure at all how I'll manage.  I'm trying to live very much in the present, and not let a moment's anger or sadness spoil the next.  Tonight we're going out for a Thai meal, and I know I'll feel safe at least until tomorrow night.  If not, the poster campaign I keep noticing around York may (with a certain irony) serve to remind me of why I should not hurt myself:

A visit to A&E costs on average £117 per patient, so Dr Lethem tells us.

Wednesday, 15 June 2011

Eight: A Cigarette is Like a Kiss

A return to the personal.

A cigarette is like a kiss.
Each toxic puff wastes dizzyingly
Into the stratosphere,
The light getting shorter, you fight for breath
Alone in the fag-end of morning.

One kiss is never enough.
Cling to my lips in familiar grip,
Cling and never let me go.
Who hears  our kisses,
Who holds us to account?
An-ever changing sky watches, receives,
Arranges its clouds in storm-spun silence.

Taste, and taste again the death of morning.
Let you into my heart, my mouth, my lungs
You burnt out too fast for a possible last time -  
But It  did happen.
I  have the smell of you.

The Personality Police would be happy with this one, I think.  It ticks all the borderline boxes.  Which is fine, since it’s a nonsense diagnosis anyway.  Is it not the case that I feel only what every other bloody human being on this planet feels?  I love my transience and despise it at the same time, I want to hold on to all that keeps me fixed and safe,  but I have to let it go or risk a living death.  Somewhere in the holding on or the letting go lies the problem.  It is a problem for me.  But I won’t accept that it could ever be solved – no one has the solution, just the offer of a thicker skin.  And that will come to me in time.
Last week (when I wrote the above) was an angry one.  From (another) letter that I didn't send, the following:
I am horrifically angry at the moment.  I feel let down by everyone and everything.  It disturbs me how angry I am.  I’ve been having some really nasty, graphic thoughts.  Violent images that seem to leap into my mind from nowhere like dreams (I wish they were).   One of these flashes involved me turning up to the Tavistock in a wheelchair, having amputated both my legs.  In another I saw myself  slash one of [ my consultant psychiatrist in the adolescent unit's] arms.  Possibly exhaustion is the cause.  My conscious mind doesn’t usually make such savage leaps to the unacceptable – of if it does, it contains the violence firmly within the boundaries of my own body.  I enact my fury bodily without ever really having to confront it.  Sometimes I think self-harm is the safest outlet for me after all.  The safest for the people who I co-habit this planet with too.  Something must insulate the live wire, or impede the flow of current it conveys.
I come to this conclusion, and then I remember Dylan Thomas: 
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Rage for raging’s sake, even if all I will ever have to make a fuss about is a storm in the smallest of tea cups?

Instead of sending the above to my therapist, as intended, I ended up writing a letter to the psychiatrist aforementioned.  When I left the adolescent unit, she told me that I could write to her and that she would always write back.  Over the years, I have written less.  I had sent her one letter previously this year.  But we are now well and truly in anniversary month (My Dad would have turned 52 today, and next wednesday is the 4th anniversary of his death), and I wanted to send her a card.  Enclosed in the card was a letter, mostly focusing on my achievements and other positive aspects of my life, though I couldn't resist whinging a bit about the psychotherapy funding situation.
I'm still reaching out, however cautiously.

Seven: "Ghosts in the Machine" - Locating the Soul in the Bionic Age

Parts of a group presentation I'm giving tomorrow, for my "Bodies and Minds" module.  Since I ended up writing nearly the whole thing myself (which I'm bloody annoyed about, but hey, these things happen...), there shouldn't be a problem with me putting it up here.

Metropolis - Fritz Lang, 1927

The phrase "ghost in the machine" was coined by the philosopher Gilbert Rye in his book, “The Concept of the Mind”.   Rye criticised Descartes' mind-body dualism, arguing that the terms "mind" and "body" should not be considered as belonging to the same category, and that mental and physical states are inseparable.   In the film “I, Robot”, the phrase is used to refer to inexplicable actions by robots that possibly hint at the existence of a soul or mind that works beyond their mechanical bodies.

As a group, we examined our own beliefs about the soul, or more generally, what it is that for us separates man from machine.  Of those that we examined, we selected the ability to love and make ethical decisions as the most “human” of human aspects, or those that a machine would find hardest to imitate.  As our presentation will demonstrate, however, the increasing sophistication of Artificial Intelligence problematizes this assumption.  

We have placed the examination of these issues within the context of the "Bionic Age", which we define as an age in which machines and mechanical parts are used by humans to carry out tasks that are difficult, intricate, or dangerous.  The question of where and how we locate the soul as man and machine become ever more closely linked continues to be explored in science fiction film and literature, and across the fields of science, philosophy and psychology.


Karel Capek coined the term 'robot' in his 1920 play "R.U.R." in defining his artificially created creatures, the word 'robota' in Czech literally meaning "work", or "labour". Traditionally, "robota" was the term used for the work period of a serf, an unpaid member of the lower classes required to work for their superiors. Serfdom was banned in Bohemia in 1848, but this obsolete term would have carried its meaning across to Capek's early 20 century audience. This immediately colours the way in which the artificial beings of R.U.R. are viewed, reduced by the concept of slavery. They are introduced as "goods"(p3), and are a highly demanded product: willing slaves in attaining the ultimate human ideal of an elevation to a god-like status where "Man will do only what he loves doing, free and sovereign, with no other task than to better himself"(p23), unfettered with the need to labour. From Domin's point of view, this is ethically sound. The robots' intended purpose is to work; they are "without will, passion, history or soul"(p20).
However, young Helen arrives, adamant to dispute this. She is determined to see their usage as exploitation, her "League of Humanity"(p17) extending to the "liberation of the Robots" (p20). Immediately the audience is posed with a contradiction. The robots seen are apparently soul-less, unable to comprehend human emotion, yet their complete assimilation of outwardly human manifestations staggers her. "Can't tell the difference, eh? Feel this hair we gave her! Soft and blonde! M-mm, lovely!" (p11). JD Humphries, in his introduction to "The Robots are Coming", draws attention to the problematic nature of " 'other minds' ". Humans "cannot be directly aware of any other consciousness in other human beings […] One has, therefore, to assume, in terms of similarity of appearance and overt behaviour, that other people are in fact much the same as oneself." (p18)
 Helen is unable to come to terms with the fact that "they're not bothered what you feed 'em […] And no-one's seen them laugh yet!"(p20), when they appear so absolutely human. By her understanding it must be unethical to treat those who appear so similar to ourselves with such flippant disregard for their welfare. Yet apes are similar to humans, and we treat them also as soul-less. Humphries continues his introduction by stating that "Theologians argue that though man's thinking processes may be similar to those of an ape, the man possesses something extra - his 'soul'. In “R.U.R” it seems unethical to treat the robots as if they have no consciousness, or personality, or however our sentient conscious "soul" is defined, yet unless the existence of such a soul can be empirically proved, their status as slaves cannot be contested.

Play – intro. 
One possible way that we could attempt to measure and quantify the soul in articulate beings is via the “Turing Test”, an idea introduced by Alan Turing in 1950.  Designed to  discern intelligence, a human judge engages in conversation with one human and one machine, programmed to appear human.  If the judge cannot correctly guess which is the machine, it is assumed to be an “intelligent” entity.   The concept of the test has inspired the short play that follows, in which we attempt to distinguish human from robot by posing a series of ethical questions.


Class questioned.

                                                                              Play – conclusion
As our scenarios illustrate, finding a universal definition of what it means to be human is exceedingly difficult.  It is not possible to say that being able to adapt to new situations, communicate and interact with others, feel love and empathy, and respond appropriately to ethical questions are characteristics shared by all humans. If it were possible to create an organic, intelligent robotic being, would we be able to differentiate it confidently from one of ourselves?

As we have tried to do with ethics, could we design a Turing Test for love?  If a machine behaves in a way that suggests loving emotion, should we assume that it is capable of loving, whether it is itself, other robots or even human beings?

In understanding how our attitudes towards robots who love are shaped, it may be helpful to examine the ways that love is conceptualised in Western philosophical tradition. 

Rousseau’s second Discourse, in which he discusses the views of Thomas Hobbes, proposes three different kinds of love:  amour- propre (base self-love), amour de soi (gentle or at least benign self-love), and charite (love of God and things public).

In stating that charité is a "natural repugnance at seeing any sentient being, and particularly those similar to us, suffer pain or death",  Rousseau placed the capacity to suffer above the ability to reason in describing what makes creatures worthy of compassion. 

This view is one that is widely held today, but love in the philosophical tradition has not always been held to emanate from compassion.  In the thirteen century, Thomas Aquinas picked up on the Aristotelian theories of friendship and love to proclaim God as the most rational being and hence the most deserving of one’s love, respect, and considerations.  Accordingly, in the Summa Theologica, he states: “Each human being has a share of the eternal reason, whereby it has a natural inclination to its proper act and end: and this participation of the eternal law in the rational creature is called natural law” ( Summa Theologica, 1a2ae, 90.2)

 Could YOU Share a bed with your Robot?

Perhaps the real question is not whether robots, possibly the most rational creatures of all, are able to love, but whether we, as humans, have an appetite for robots to have this capability.

Extolling the virtues of sexbot cyborgs trained to help humans improve their sex lives, David Levy hypothesises that marriage with robots will be legalised in some countries by 1950.
Even if this rather outlandish prediction is fulfilled, however, our creation of beings that are allowed access to our deepest needs and desires has profound implications for how we understand ourselves as human beings.
As Sherry Turkle says, in her book “The Second Self”,
"We ask [of the computer] not just about where we stand in the world of nature, but about where we stand in the world of artefact.  We search for a link between who we are and what we have made, between who we are and what we might create, between who we are and what, through our intimacy with our own creations, we might become".

The darker side of robotic, soma enhanced and psyche reduced love is explored in Aldous Huxley’s 1931 novel, “Brave New World”, where soulless, impersonal love is a form of social control.  Unlike R.U.R, the protagonists of Huxley’s novel are all ostensibly human, and yet in Brave New World it is only in the past that “there was a thing called the soul and a thing called immortality”.  The tragic irony at the heart of the novel is that the marginalised “savages” appear more human than those that inhabit the civilised, sanitised world where physical pleasure is maximised and love forbidden.   The novel warns of the danger of a creator becoming engulfed by his creations – where love is deemed redundant and unnecessary, there is no place for a soul – it is literally destroyed by the machine of society.

In recent years, attempts have been made to tackle our anxiety and distrust about machines that too closely approximate humans.  In Pixar’s Wall-E, the love between two robots (Wall-E and Eva) is redemptive, and leads to the recolonisation of Earth.  The film does not attempt to deny the robots’ mechanical nature, incorporating it instead into the way they communicate their love for each other.  Despite this, it must be acknowledged that the degree of anthropomorphic animation of the robot characters that the film-makers indulge in does not really challenge popular, human-centric notions of what it is to love.

Whilst our terror of hypothetical “ghosts in the machine” must be balanced against the growing needs and demands we have for artificial intelligence and the ways it can serve humanity, it is important to remember that the problem does not end here.  It is not simply a question of whether ethical and loving robots could live alongside their human counterparts.  As we make the transition from the post-modern to the bionic age, we must use the privilege that human status grants us wisely to negotiate the ethical and moral dilemmas we will face in the coming century. We must accept that as we adapt and change the world around us, our conception of ourselves will inevitably change too.     Some of us, none of us or all of us may have souls in the bionic age –but if we are to retain them, they must be guarded fiercely.