Monthly Archives: October 2017

Avant Garde Psychiatry

October 31 2017 by Dr. Kaminski

I see my early life as divided into distinct stages: the first decade was a time of innocence and wonderment, the second decade a grand rehearsal for adulthood. Young adulthood had not begun until I turned 20. That order of my early life seems quaint today. In our 21st century Western society, we have a “cultural growth spurt”: innocence gives way at 6, adulthood rehearsal occurs in preteens, which turns into “adulthood” in middle and late teenage years. Consequently, many arrive at their actual young adulthood jaded, wizened and bored.

While young people experience maturity at an accelerated pace, our instincts cannot be pushed to match the rapid social and cultural changes. Thus, the juxtaposition of contemporary experience and ancient instincts is more a collision course than a harmonious shared journey.

This interplay between nature and nurture is made even more discordant by the breakneck, exponential progress of modern technology. This is a very recent phenomenon. In the past 10,000 years, from early agricultural society until 300 years ago, every member of a generation could expect to live life analogous to the previous generation or the future one. Every generation was identical in all aspects of daily life: The velocity of travel, life expectancy, the total dependency on the elements; all have barely progressed throughout the millennia. Humans lived in moving frames of a “perceptual here and now”, invariably bound by the limits of their senses. The elders were seen as a possessing trove of information by experience, something that the “Google generation” finds useless and quaint.

In recent time, and especially over the last 50 years, we have advanced so far, that other than the laws of physics nothing seems to limit our senses, and our perceptual experience, from endlessly expanding. The artificial expansion of our senses, the ability to hear and see far distances and into the past, the velocity of travel, the boundless communication, the immediacy of information all give us powers unimagined a hundred years ago.  But what about our instincts? They have had no chance to correspond in similar expansion. They take a very long time to change: in fact, only a thin veneer of culture separates us instinctually from other mammals. Our emotional life, while sophisticated compared to other primates, had not been challenged by rapidly added abilities until the industrial revolution. The discrepancy that exists between our everyday life and our inner world is growing: we are emotionally akin to a toddler operating a space shuttle. The automatic pilot is on and as long as nothing unusual happens, and the toddler does not touch anything detrimental we have the illusion of adequacy.  But it seems to me that handling adversity has become increasingly inefficient. Further, there are numerous new challenges, some developed as recently as 10 years ago. The contemporary psychiatrist cannot take comfort from the permanence of human nature. In a way, human nature is struggling under the increasing assault on what used to be our boundaries. I made up the notion of “Avant-garde psychiatry” in order to examine this unprecedented friction between nature and nurture – between our mammal core and technological abilities.

Instant messaging gets a prominent place in “Avant-garde Psychiatry”. Anyone who ever waited for an important letter to arrive would have had a particular wait time in mind – several days – and particular time frame – once a day for mail delivery.  The agonizing anticipation got resolved once a day – the letter has either arrived or not. If not, the anticipatory clock would stop until the next mail delivery.  Now, an unanswered text (and to an extend an email) starts annoying within minutes of sending yours and continues unabated until you get an answer.  Anything other than an immediate response starts a little nucleus of discomfort in the back of your mind.  This discomfort is often minimal and replaced eventually with similar, newly unanswered discomforts. Of course, text messages differ in importance: An unanswered text to a potential lover becomes exponentially intolerable and often paralyzing. Some develop a psychiatric problem living in constant fear of “the silent treatment” and often experience lack of an answer as one.  The immediacy of communication, especially of the aptly named instant messaging, confuses the senses into believing the texters are having an actual dialogue. In any type of conversation getting no acknowledgment and response, is stressful and often rage provoking. The drift from written communications like letters and faxes to written conversation has not created a similar change in how we perceive it. We use instant messaging – a type of written communication – with the inner rules of conversations: our feelings and perceptions are mismatched. Many develop “instant messaging tension” which a similar, phone conversation would never provoke.

Another consequence of texting is “anxious re-reading” and “over sharing”. We do not have to struggle to remember what was said since our text “conversations” are available for rereading. Those who suffer at baseline from anxious ruminations tend to develop anxious rereading which is equally painful. Worse, we often combine anxious re-reading with oversharing; another digital phenomenon. In oversharing, many who would have never dreamt to secretly record and share phone conversations, see no issue with sharing their text conversations with others. Interestingly, the more personal the exchange the more likely it is to be shared with others. The anxious re-reader overshares the intimate conversation attempting to gain insight for hidden meaning. The question “what did he/she mean by that?” can occupy 3 girlfriends for an entire evening even if there is nothing unusual about the text, and nothing unusual was meant. While in itself not a psychiatric problem, text re-reading and oversharing offers a totally new way for distraction.  We get distracted by texts when we sleep, we get distracted while we drive, work, eat, watch television, and are often “engaged” in and endless group “chat”.  Most texts provide unimportant information, and many can wait.  But the immediacy and accessibility of texts, anytime and anywhere, is astonishing. Only fifteen years have passed from never having texted in history to the development of a compulsion to read a new text, respond immediately and wait for an answer in ever multiplying loops.  I cannot think of anything similar that went from nothing to permeating any personal space or time, in merely 10 years.  What does it do to our psyche?

Psychiatrists have always relied on Human nature as a basic point of reference.  It is therefore quite unsettling to observe human nature rapidly mutating in front of our eyes.    Many inventions deemed essential for the moment, have dwindled in popularity and all but disappeared.  But the new format of communication is not going away.  Because it addresses an essential, unmet need of humanity: It enhances our conscious, word -based communication, at the expense of nonverbal and subconscious transmission of information. This triumph of word based communication is apparently so satisfying that we are willing to give up all vestiges of freed attention that could have been dedicated to merely sitting and thinking.

The brain performs most of its activities close to the speed of light as it transmits and receives information without our conscious awareness.   Conscious thinking is not fast enough to decide instantly what should be screened out and what should be focused on. Hence our attention span shifts slower to enable us to decide what information is worthy of attending to. Communicating via text is akin to being surrounded by many people all talk to us at the same time about different issues, while being unaware of the others.  The unfettered immediacy of text communication interferes with our ability to triage information and decide what is important and what is not.  Several aspects of communication have to be sacrificed for that immediacy: the most important being the absence of emotional modulation.  Our communication evolved from the dense, multi sensorial expression we shared with our primate cousins. The development of verbal language offered accurate communication in large groups, without losing the nonverbal nuances. Texting as conversation is dry and cryptic, word-based communication. This self-imposed simplicity and emotional poverty over our communications leads to the ever-increasing banality of contemporary discourse.  But the really interesting question is how does it affect the way we interact with our own self.  Would you adhere to the nonverbal abstract and emotionally nuanced way you communicate with yourself?  Or would the new, increasingly concrete communication modality, take over your inner world?

Contemporary psychiatry has to be Avant-garde.  Literally ahead of the times as new inventions challenge our instincts and senses at a breakneck pace.  The voyeurism of Instagram, the urgency of dating apps, the giddiness of snapchat and the bonhomie of Facebook – all those have existed in more crude forms. They are all built around our ancient instincts:  curiosity, community, and desire to mate.  But the mind has never had something like texting (or other instant messaging modes).  Blogs and tweets and talkbacks, have democratized the public space, and created new venue for people to broadcast their opinions and thoughts.  But texting has never been here before.  We never had this ability to communicate with anyone in the world, whenever and wherever they are, predicated on brief, word based transmissions, where “emoticons” serve as the affecting melody.   The rate and universal enthusiasm by which we made texting into an ever-present, essential and addictive aspect of our lives indicates some primal power at play, catapulting us to unchartered terrain.  The promise of “wearables” – the applewatch3 can fully replace the mobile phone – portends further diminution of self-reflection.  We are going to wear our communication device 24/7 offering uninterrupted entry to our attention.  And to think that mobile telephone in its current permutation is less than 15 years old. Exposed to this constant external attention grabber, what attention would be left for communication with our own self? How can our internal needs (already mostly ignored, suppressed and denied), compete with the avalanche of bite size information? Avant-garde psychiatry is like the sierra club. Fighting to preserve what is becoming extinct by raising awareness to the consequences of those extinctions

As is aptly demonstrated by the current American regime, a brave new world in which communication devolves to the “nuance” equivalent of grunts, but the technology is nuclear, is not that safe for the future.

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