Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Thursday, June 19, 2014

The Core

Jefferson Market Branch NYPL

One of the many things I love about NYC is the public library system. It has one of the best smartphone apps I've encountered, completely intuitive and user friendly, does exactly what it should-not more, not less. There are many library  branches throughout the city, and the really wonderful thing is that you can use the app, or your computer, to search for a book, put it on hold, and have it delivered to the branch of your choosing. They email you when it gets there, and also when your books are due, and you can renew online. I love it, and if you ever have a hankering to donate some money to a worthwhile public institution, please consider the NYPL.

Today, I happily went to the branch near my office (in photo), and picked up my reserved copy of Bad Boys. Bad Men: confronting antisocial personality disorder, by Donald Black, MD. Reading is one of the few perks of my long daily commute on the NYC subway system, which is over 100 years old and boy can you tell. I started the book on the way home yesterday. 

So far, I can say that it's engaging and well written, and I'm looking forward to reading all of it. From what I can tell from the cover, Black makes a biological argument, "that some people are simply born bad."

In the Introduction, he writes," It is as if a vital part of the antisocial's character-his moral judgement, is somehow absent or underdeveloped. This essential part of our humanity makes us adhere to social rules and obligations."

This line made me recognize the perspective from which I'm approaching the book.  
I know I've already made one plug in this post, but here's another- for the value of a traditional liberal arts education. Because as little as I actually remember from college, there are some concepts that have truly influenced my Weltanschauung, concepts that were developed in intense discussions between multiple people sitting in the same room. Maybe I would have come away from a virtual classroom with the same outlook, but I doubt it.

The concept I have in mind is that of the social contract. From Hobbes' Leviathan:

NATURE hath made men so equal in the faculties of body and mind as that, though there be found
one man sometimes manifestly stronger in body or of quicker mind than another, yet when all is
reckoned together the difference between man and man is not so considerable as that one man can thereupon claim to himself any benefit to which another may not pretend as well as he. For as to the strength of body, the weakest has strength enough to kill the strongest, either by secret
machination or by confederacy with others that are in the same danger with himself

The idea that I find important is that anyone can kill anyone, so in order to make this a livable world, people have agreed not to harm each other. And we've set up all kinds of rules and policing of these rules to maintain a social structure.

I think this is why the argument about how it's not morally justifiable to murder, but it is to kill someone in war, misses the point. It's not about right and wrong, it's about protecting the social structure. A murderer is a threat to that structure from within, and an enemy country is a threat to that structure from without.

 We call these our rights-to a world where one can reasonably expect to be safe, but they're only rights because as a whole, we've decided to make them so. We call these morality, but they're only a way to make it possible to function in the world. We talk about right and wrong, good and bad, but these properties are not in our nature. Spend an hour watching small children, and this becomes obvious. We have simply chosen to forego some of the options available to us so we can sleep at night and expect our children to grow up safely.

It's like the group version of Freud's reality principle. People want to maximize pleasure and minimize unpleasure. And at some point, most people realize that while they may want to take the candy bar without paying for it, if they do, they could end up with a lot more unpleasure than the pleasure they would get from the candy bar. So they concede to reality and pay for it.

I don't think a sense of right and wrong is an innate part of our humanity. I think expedience is an innate part of our humanity. Black doesn't claim that morality is innate, just that it's essential. 

Then the question I need to keep in mind, while reading his book, is, "Why do people with antisocial personality disorder lack the ability to control their behavior in ways that would benefit them?" rather than, "Why do people with antisocial personality disorder lack a sense of right and wrong?"

I'll update as I read more. 

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