Luan Hassett

Enlightenment In Everyday Life

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  • The (Mis)Use of Probability In Psychiatry

    Probability is the backbone of evidence based medicine, but it doesn’t describe reality with the depth that explanatory theories provide.

    Let’s say that I am studying physics and I calculate the probability that earth will be struck by an asteroid in the next five years. I don’t know what a typical probability calculation would come to, but imagine it was 1 in 50,000. Now imagine that someone in the physics department comes to me and says they have finally replaced the lens on the best telescope in the building; I look through it and see an asteroid hurtling through the galaxy towards us. The probability then obviously changes. To take another example, anyone who has been involved in match fixing knows that the odds you get at the bookies are not an objective statement about reality.

    So probability has assumptions. But could you not say that all theories contain assumptions? Yes, but the point is that while they may use probability instrumentally, good theories do not speak fundamentally in terms of what will probably happen, but instead speak of what can and cannot happen, the conditions under which things happen, and why they do happen. In other words good theories provide explanations. Physics can explain why you cannot travel faster than the speed of light. Microbiologists can tell you the conditions under which antimicrobial resistance happens at a level that causes problems for doctors and patients.

    As it stands, psychiatry contains no explanations for why any major mental illness happens. We do not know the underlying cause of Depression, OCD, Bipolar Disorder, Schizophrenia, or anything else. This is despite (more accurately: because of) the copious use of probability in research. We know something about the genes and environmental exposures that are relatively tightly associated with developing those conditions. But there is no explanatory pathway for how any given gene or experience actually causes any given thought, be it an obsession, negative cognition or delusional belief.

    Now let’s talk about p values. When you do a study comparing an antidepressant to placebo, p values describe the probability that the effect that follows administration of the drug would have happened if the antidepressant had no intrinsic therapeutic capacity. A low p value refutes the null hypothesis stating that the drug has no effect above placebo. Some people would say that p values “falsify” the null hypothesis. But when you falsify a hypothesis using probability, you don’t get explanatory resolution.

    A ‘statistically significant’ result is saying that there is a systematic effect. It’s saying that antidepressants are doing something. That’s basically it. It doesn’t tell you what the systematic effect is due to. That’s left up to us psychiatrists to conjecture about. When it is left to us to conjecture, without a way of experimenting to adjudicate between the conjectures that each of us brings to the debate, then the knowledge category we’re working in is primarily philosophy rather than science. We can use probability statistics to assist in our criticisms of each other’s conjectures, and there is benefit in doing this, we just need to be clear what epistemic domain we are working in.

    It’s important to understand that we currently lack the experimental and statistical mechanisms to grow our knowledge quickly. What I have tried to show is that we don’t have scientific explanations for mental illness because our research methods aren’t trying to find them. What the methods are trying to do, without us being explicit about this, is assist us in philosophy. We treat patients using philosophy. And we often succeed. But the rate of knowledge growth in ours and many other biological fields pales in comparison with physics because physics historically made greater use of experimental falsification, where the aim was to find an occurrence that was in direct, logical, non-probabilistic contradiction of the theory being tested.

    There are reasons why physics found it easier than biology to do this, one of which being that there are limits to the experiments we can ethically perform on humans. By some accounts physics is also moving away from the use of falsification, which sounds to me like a bad thing. Furthermore, humans are more complex than planets and atoms. This makes falsification of theories pertaining to humans very difficult to do, and especially when the theory is meant to apply to humans in general. The clear solution to this is to see that each patient requires their own modified theory of mental illness, and the requisite approach to psychiatry is one of being epistemically energised. This might sound like advocating eccentricity, but actually most psychiatrists already understand what I’m arguing. It would not be rare for an experienced psychiatrist to look at a powerpoint slide and express skepticism about the usefulness of whatever the research is purporting to prove.

  • Disagreeing With Kapil Gupta On Prescriptions

    In this essay I am assuming some prior familiarity with Kapil Gupta’s arguments about prescriptions, which he defines as shoulds, how-to’s, 5 step plans and emphasis on method and technique. He’s worried about disempowerment of the student, saying that once you ask a teacher how something is done, you are placing your capabilities in the hands of your teacher, and will be forever returning after practice to ask “did I do that correctly? how should I do it differently?”

    But there is a form of prescription which is suggestive and experimental and which does not claim to hold some final truth worthy of the student suspending their intuition. For example, a meditation instructor could say “for one week, spend 5 minutes twice a day observing the energy movements in your body.” The student could follow this instruction slavishly, and when they don’t notice anything they could conclude that something is wrong with them and return to the coach for help. Or, they could think, “that’s an interesting experiment, I’m excited to see whether I notice any energetic blockages when I find myself in a recurring negative situation this week.” If the student doesn’t notice anything interesting, they can simply move on to whatever is the next experiment that piques their curiosity.

    What is important to understand in this example is that it’s not inevitable that the student becomes dependent on the teacher. If after a succession of experiments the student doesn’t find anything interesting, if he doesn’t develop any new capabilities, he will naturally lose interest in what the teacher has to say. Certainly the teacher could try to manipulate the situation so that the student doesn’t realise that his instructions are useless. The teacher could say “keep trying, one day it will come” (a phrase that Gupta often uses as an example of how teachers can keep students on the hook). But many teachers don’t. Gupta promises to speak in absolute truths; he is not doing so here. In reality many students are highly skeptical, and teachers are constantly having to renew their proof of benefit.

    I bought into Gupta’s message because it does have sociological accuracy. People do throw ‘Shoulds’ at each other. People indeed rarely stop to consider why the person hasn’t already done what they are advising them to do. Many coaches do exploit their clients. But these dynamics are not intrinsic to prescriptions, which are simply the introduction of a possible course of action that hasn’t already been taken. Mark Manson’s article ‘The Point Is To Stop‘ is one of many examples of how mainstream writers acknowledge and guide against the very risk that Gupta thinks he is unique in warning against.

    With some effort I am avoiding the devaluation of Gupta that so often comes after one has idealised a teacher in the way that I did. He is a genuinely unique voice and speaks profoundly about existence. But he too is human. As Adyashanti put it when talking about Osho’s terrorist behaviour, one can be profoundly well-developed along certain dimensions of personal growth while being stunted along others. He says:

    “Enlightenment… that’s part, that’s part of the game. That doesn’t guarantee you’re going to know how to be in good intimate relationships, that doesn’t mean you’re not going to be able to delude yourself, doesn’t mean you’re not going to be seduced by power or desire necessarily. It doesn’t guarantee that.”

    I wonder how Gupta’s lack of sociability has affected the trajectory of his significant and impressive personal development. He describes himself as a hermit. He does not like people. I wonder whether he is projecting the disempowerment he feels in relationship onto others who are more thoroughly socialised and who have learned to work through dynamics of dependency rather than make them a pretext for distancing themselves. But then, that might be my own projection. To Gupta’s credit, he always points out that everything that a person counsels arises out of their own specific circumstances, and that the most important thing in hearing his words is never to take them on faith.

    As a closing message, I would also like to acknowledge that for all that I have said defending prescriptions, the teacher-student relationship is indeed fraught with the risk of dependency even when the teacher is actively working to mitigate the risk. I have hopefully demonstrated that the reliance on the teacher can be time-limited, but the element of reliance does indeed assume a life and momentum of its own, and the overall direction of our culture is to add to it. As the Buddha apparently said, one of the core tenets of seeking enlightenment is to not buy into society’s prevailing belief systems.

  • Notes On Welcoming Fear

    I signed up for Art of Accomplishment’s Groundbreakers retreat, and then realised I probably didn’t have enough money.

    Already on the verge of burnout, paying north of 10 grand would mean reneging on my promise to take the next month and a half off work which I had made to myself. The decision to pay or not to pay is cutting to the core of an identity question: am I going to change my priorities and start doing normal people things like saving for a deposit on a house? Or am I going to continue pursuing this off-piste spiritual journey which I seem to have designed in such a way that no one around me has the necessary context to be able to tell me that it is a bad idea?

    A lot of fear has come up. AoA (Art of Accomplishment) make a big thing of welcoming fear, since it’s a signpost to authenticity. It’s a sign that a part of your identity is under threat, which they say is a good thing because identity is what blocks out your more expansive, evolving, essential self.

    I’ve been wondering about what part of me is being faced with annihilation. The part of me that says “hell yeah I’m going to pay loads of money, why wouldn’t I, with all the pain I’ve been through?” The part of me that is such a good customer whose praises all the coaches gather around after hours to sing, and deserves to be seen as a sincere seeker (wait til I leave them scrambling to fill the space when I drop out…) The part of me that thinks he knows what’s going on, thinks his judgement is better than other people’s and he’s really on to something with this AoA stuff, which everyone will look back and recognise in wonder, 10 years hence.

    There is something self-disparaging in how I’m characterising the identity that might be departing me. This itself is probably the identity of The Self Aware Person. Fear bursting through all of this. The thing about genuine fear, I’ve come to believe, is that if I know it’s healthy then I’m only on the edge of it. If I know it’s going to lead to something better, ultimately, then there are layers left for me to feel.

    I need to be held in my fear, and I don’t know how to reach out for that.

  • Is All Thinking Management?

    Is all thought management? (But then what about poetry, what about revolutionary philosophies)?

    How would you know it; what would it mean?

    It would be a delay, a dysrhythmia.
    It would cause a contraction in awareness, like “wait, what was I saying again?” as you expand back outwards.

    Even epiphanies in their final form have been fixed in a formulated phrase. Their sparks are preverbal. Life on the outside is for them soon to become the canned goods of the intellectuals. A lower fractal of management is cooing at apercus like this one.

  • The Art of Circling

    The whole world is looking for a test
    Craving it, in fact.

    Because people crave the truth.
    Truth is not what you have been told it is.
    It is something far, far, far
    more
    delicate.

    Golden snitches
    Whispers of insight
    Grasp too tight and you lose it.

    People crave it.
    The whispering changes that tell you
    who you are
    in relation to this strain

    These are the whispers that guide the expansion.
    Humans jolt to get away from them
    seconds after contact with desire.

    Between the craving & the leaving falls the shadow.
    The shadow that thwarts us
    even while
    The flat wafer fails to nourish.
    The flat fact sequence doesn’t enliven.
    Rubber estranged from road.

    And so we come to Circling. 

    The present, the capacity for presence, deepened.
    Non-striving tempted into… therein lies the
    discovery.

    Can the coming to rest sustain itself in the midst of the inducement to workfulness?
    It is good to have purpose, good to aim, good
    to set goals.

    But like all things human
    where the concept is laid down on paper
    it must rise again & be integrated

    into the evolutionary unfolding of selfhood—
    the silent space after the finished chapter.

  • A Wish List for Psychiatry

    This is a list of things I wish were different about psychiatry. I am following the spiritual principle of owning my experience, which means that I am not stating these as necessary improvements. I am not implying blame of anyone. I am simply expressing wishes, not opinions.

    • I want to be able to choose who I hire and fire. I want to be able to assess their character. How much energy do they bring to their work? How much creativity? Capacity for effective conflict resolution?
    • I want personal development opportunities instead of research obligations. I wish the experiments we were expected to run were ones whose results we could feel for ourselves.
    • I want better financial incentives for doing the job well.
    • I want to be able to write more colourful character descriptions in the patient’s files, free from legal imputations of malice or malpractice.
    • I want to work with people who are committed to their own emotional evolution. It would be cool to develop training programs for this, and watch the expansion of consciousness permeate all levels of the organisation, through to the patients. This is what the book ‘Reinventing Organizations’ explores.
    • I want weekly teaching sessions to be way more dynamic. See above for ideas on how to achieve this. They’re not always bad, but without compulsory attendance they would amount to little more than a failed book club. Enjoyment is one of the best signs of efficiency. Obligation is an error signal.

    For balance, here are some of the things that Psychiatry is currently doing really well:

    • Having done a fair amount of therapeutic and spiritual exploration over the last three years, it is clear that Psychiatry is where the most profound personal transformation occurs, given the starting point.
    • By the end of their training, most Psychiatrists have a very high level of competency at running a complex system.
    • There is a deep care and attunement that most Psychiatrists extend to their patients.
    • There is a strong emphasis on data. Coming from someone who loves intuition, this is a good thing.

  • On All the Myriad Healing Modalities

    How many thousands of personal development modalities do you reckon there are? Modalities for exploring trauma, releasing tension, expanding awareness, reframing limiting beliefs

    Therapists have a term called ‘purple hat’ practices. These are newer forms of therapy that are only effective because they incorporate older therapies. I recently spoke to the Clinical Psychologist I work with, who said that when she trained in EMDR the trainer used elements of at least five other modalities in order to deliver his presentation.

    It is difficult not to be cynical about the latest copyrighted practices that come with warning labels to seek sessions with a certified practitioner before trying on one’s own. Or in which to become certified if one seeks to go deeper. If I am starving, I want the steak. If food has been in short supply, I don’t care about whether it’s topped with garlic butter or pepper sauce.

    But wait. I notice I don’t feel like carrying this skepticism any further. A sentence is coming back to me, imperfectly remembered, from Adolf Guggenbühl-Craig’s ‘Power In the Helping Professions’: the shadow of the therapist and the shadow of the client constellate together. Observing a flash of charlatanry, my apathy comes out to meet it. The part of me that resists change has its perfect excuse. The reality is that if you shut down claims to novelty you will have impaired your excitement, a crucial force in the early stages of transformation. Whatever the truth about whether there is anything new under the sun, there certainly is to you.

    The danger is that you mistake the novelty for the transformation, so that when the new becomes the familiar you think that nothing really changed. This is why I think it’s important to not collapse onto what a modality can do for you. There are deeper matters of character that must be considered. How badly do you want it? How clear are you on what “it” is? What would be a sufficient test of whether you have it? And to clarify your relationship with these tools – what are you, essentially?

    I will finish with a take home message. If you are in the fight you are in the resistance. There are gimmicks out there that you don’t blink twice about indulging. There is some brand of coffee or type of house plant that isn’t fundamentally much different from the others, but you needed caffeine or a spruced-up living room and so you went ahead and bought it, no questions asked. No aspersions cast about the business owner. Of course it is a little different in the case of personal development. You need to trust the practitioner at a deeper level. So the question becomes, how do you resolve the matter of trust such that you can entirely focus on the work?

  • Freedom Is an Embodied State

    There is no opposition between freedom on the one hand and success and material wealth on the other.

    The opposition is between freedom and any conditioned idea. Whether that be success, or romance or a steady income.

    A conditioned idea is a circumstantial one. If it were not for a specific set of good or bad feelings associated with an idea, you would not believe it. Whereas truth is enduring, and does not depend on belonging to a given time or culture in which an idea is hitched to some inner pleasure (the pleasure of being right, moral, important or ‘in the know’). Truth is also intricate, innocent and recognizes non-linearity. A conditioned belief keeps firing whenever the original stimulus is repeated.

    Even though the listener is not the same man, and it is not the same stimulus.

    People’s confusion lies in the fact that they see freedom as a concept. A concept is fungible: just like two 100 dollar bills, freedom for a 20 year old man in Somalia is seen as having the same properties as for a 78 year old woman in the US. In each case, freedom is supposed to be a removal from whatever (also fungible) idea the person has of worldly success.

    But freedom is not a concept. The word ‘freedom,’ as opposed to the state, merely allows for a reminder to shift position and look in that direction. Freedom is an embodied state. To me, it is a pervasive absence of tension in the body. Since an absence of tension attests to getting beyond conditioning, and beyond the need to manage the movement of emotion, this makes it very useful for earning money and making friends.