My doubts, as it happened, had some validity. The name Central Metric Office proved to be a red herring, since the office’s purposes were narrow. Scotland Yard had something very specific in mind: a system of criminal identification, imported from France, relying on card files of prisoners that were sorted according to an array of bodily measurements. The office in question, though, offered evidence that police devotion to data was quite real, and the office was linked to an impressive network of measurement activities. Probing the episode of the Central Metric Office opened up a new perspective on the history of genetic knowledge, and even on its human meaning.

Most textbook accounts have genetics emerging quite suddenly in 1900. Historians have long treated this moment as pivotal. The year 1900 is when Gregor Mendel’s decades-old hybridization experiments on peas suddenly became famous. Almost immediately, his work was celebrated as the foundation for a science of biological inheritance.

At almost the same time, in 1899, measurements such as those collected by the Central Metric Office drew the attention of anthropologists. A year later they appeared in the first issue of a pioneering statistical journal, Biometrika, with a triumvirate of editors that included eugenic pioneers Francis Galton and Karl Pearson. Their movement to investigate how heredity shaped abilities and “defects” was just then getting off the ground, and they worked to support it with vast repositories of data from schools, universities, prisons, hospitals, and insane asylums. The Mendelian and biometric strains of eugenics thus began to flourish almost simultaneously. However, modern scholarship, taking a more cultural approach, is uncovering a much richer and longer history for the investigation of human heredity.

In fact, as further probing revealed, the biological inheritance of criminality had been widely suspected, often simply assumed, for decades before the London police first spoke of a Central Metric Office. But prison officials had very little access to family data. It was only around 1900 that hereditary information on criminals began to appear in connection with a crisis, as it seemed, of “feeblemindedness.”

What brought about this supposed crisis, paradoxically, was the expansion of schooling. Beginning about 1870, as governments made elementary education universal and even mandatory in much of Europe and North America, they created a category of child known as “feebleminded.” Those who fell behind in school were given this label. They were sometimes sent to special schools, where they were subject to medical and psychological examination. Followers of the Italian criminologist Cesare Lombroso claimed that such children were biologically and morally backward: in short, born criminals. Others denied this, arguing that the defective children were not specifically criminal, but simple and gullible, hence vulnerable to bad influences.

It was, however, the supposed link of criminality to feeblemindedness that sparked systematic data collection on criminal heredity. Felons, arriving in jails or prisons as adults and attended by police officers with no medical training, were unlikely to provide information on the mental health of their families. The opposite was true for schoolchildren under the watch of teachers, doctors, and school officials. The role of heredity in feeblemindedness became a hot topic in the late 19th century, and schools for such children turned into sites for hereditary investigation. It was a huge stimulus to the nascent eugenics movement, which in many respects took off long before 1900, though it was not known as such.

Breeding results on peas and poultry provided a basis for genetic explanations, but did not create these hereditary concerns. Rather, medical-social anxieties contributed to the excitement about breeding and heredity that made biometric as well as Mendelian methods seem thrilling and even fateful. From about 1880, special schools were the most important sources of data on human heredity and of proto-eugenic anxieties.

To get the full picture, however, we need to look even further back to earlier sources for hereditary and eugenic study. Record keeping on inheritance of feeblemindedness was shaped by an enterprise whose first beginnings can be traced back at least to 1789. In January of that year, King George III’s symptoms of madness became alarming enough to precipitate a constitutional crisis in England. Was the king likely to recover, or would it be necessary to appoint his son as regent?

Dr. William Black, a veteran of studies of smallpox inoculation, knew how to proceed with such questions. He found his way to private records on the insane (there were no good public ones) from the royal asylum of Bethlem. Within months, Black published tables of cure rates in relation to several variables, including one on causes of insanity. “Family and hereditary” appeared here as perhaps the most important cause of all.

Black’s statistics were exceptional, but a vast expansion of insane asylums in the early 19th century stimulated new routines of recordkeeping. Causes of insanity were of particular interest. Lay as well as medical witnesses endorsed the key role of hereditary causation right from the start. Although the new public asylums at first reported abundant cures, patient numbers increased with hyper-Malthusian fury. Disappointed by their failure or inability to cure their patients, the doctors (known as “alienists”) focused more and more on the presumed causal role of heredity. If this alarming epidemic could not be checked by medicine, the key might be to persuade young men and women tainted by bad heredity to refrain from marriage.

When King George III’s madness became clear, Dr. William Black searched the records of the royal asylum, Bethlem Hospital, to understand which patients had recovered. Courtesy of the Wellcome Trust/Wikimedia Commons.

This project, eugenic in all but name, was anchored in data collection on patients and their families. A Norwegian alienist, for example, compiled the first family pedigrees of insanity in 1859, and then labored to track the migration of these hereditary factors from generation to generation. Two German doctors compiled data to calculate the increased probability of madness when one or both parents had been diagnosed insane.

When statisticians and geneticists turned their attention to questions of human heredity around 1900, they learned immediately that psychiatrists and school psychologists already possessed not just unmatchable data on the transmission of mental illness and mental weakness, but sophisticated tools to compile and analyze the numbers. All this data work led to modest scientific successes punctuated by embarrassments, as claims for the discovery of a single hereditary factor for mental illness soon appeared scandalous. Data files also facilitated the injustice, as it is now recognized, of forced sterilization—which was legal for a time in much of the United States and abroad—as well as mass killings of asylum patients in Nazi Germany.

Partly in reaction to these horrors, postwar human and medical geneticists tried to model their science on fruit fly genetics. But doctors, psychologists, and geneticists could not put aside this old faith in genetic causes of schizophrenia, mental disability, even criminality. Geneticists in the 1970s gathered data from prisons in the expectation that much violent crime might be explained by the presence of an extra Y chromosome, and the campaign or the Human Genome Project was included promises to identify the genes for schizophrenia.

The science of human genetics has deep roots in eugenic doctrines and projects that go back more than two centuries. The use of numbers to support ideas arising from fear or bigotry is not limited to benighted days gone by.

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It is in literature, as novels featuring characters on the autism spectrum have become so frequent that they’ve spawned a new genre: “autism lit,” or “aut lit.”

Many of the works put a positive spin on autism. These autistic characters have abilities as well as disabilities; they exist not only as mirrors or catalysts to help others solve their problems, but as active agents with inner lives.

The Curious Incident of the Dog in the Night-Time, first published in 2003, did more than any other book to give life to this genre. Christopher Boone, the narrator, is a 15-year-old autistic savant; that is, he can perform computer-like math in his head. He also has trouble with language and social interactions, the two primary symptoms of autism. Still, he’s shown to have an inner life that includes many opinions, as well as hopes for the future. Perhaps of greatest importance is that he has the ability to pursue his goal of solving the mystery of who killed his neighbor’s dog.

A successful book that breaks new ground will breed many imitations. Back in the late 1970s, Robin Cook’s Coma introduced the medical thriller to the world. And so Curious Incident has been followed by a wide range of novels, including the pseudo-science fiction novel, The Speed of Dark (2005); fiction-that-reads-as-memoir, such as Daniel Isn’t Talking (2006) and Tilt: Every Family Spins On Its Own Axis (2003); young adult novels such as Mindblind (2010); and the light-hearted The Rosie Project (2013) and its sequel, The Rosie Effect (2014).

Of particular interest is M is for Autism (2015), the moving result of a collaboration of young students at Limpsfield Grange, a school for autistic girls. Boys are diagnosed with autism four times more often than girls, and the face of autism is almost always that of a young boy. This novella looks at some of the special issues that young women face, and by doing so it’s an exception in the genre.

Back to our young men, though: Somewhere on the journey from Curious to Rosie a transformation occurred. The smart but anti-social and clueless Christopher Boone morphed into the smart and somewhat clueless but also charming husband and father Don Tillman. Don is a professor of genetics in The Rosie Project and an equally successful professor in New York in the sequel.

On this same literary journey, the perceived limitations of these autistic characters have been turned either into strengths, or into obstacles that, once overcome, become strengths. For example, many of these fictional beings “miss social cues” (a stereotype, but like many stereotypes based in some reality), and therefore don’t dissemble or manipulate the way that neurotypical people do.

Lou Arrendale, the hero of The Speed of Dark, is a thoughtful young man with a superior moral sense. He lives in a not-too-distant future when autism can be cured in infancy. Lou was born just a little too late for that, but now science has invented a way to “fix” autism in adulthood, and Lou has to decide whether he wants to give up the advantages of his condition for the sake of fitting into society’s mold. It’s difficult to imagine a character debating this question 20 years ago, let alone 50.

Mindblind is a contemporary young adult novel; no scientific advances here. But Nathaniel Clark, the hero and narrator, not only drives the action, he ends up being a rock star, at least in his own social circle.

Perhaps the most powerful statement, though, is uttered by the heroine’s therapist in M is for Autism: “You are a wonderful teenage girl. And you have autism. The truth is, you will need some support and guidance with life’s inevitable ups and downs but you can have a glorious, fulfilled life, M, and this is the truth, too.” In other words, even without medical intervention or a touch of wishful thinking, there’s no reason for people on the spectrum to give up on their future.

This positive prediction wouldn’t be made about to Boo Radley, the recluse from To Kill a Mockingbird. Rumors surround Boo: he eats raw squirrels; he drools most of the time. Though these are indeed rumors, from what we do learn about Boo, he may well be autistic. Regarded as a shadowy, sinister figure, Boo ends up saving Scout’s and Jem’s lives, but his “reward” is to have his brave act go unrecognized. We last see him as Scout leads him by the hand back to his lonely existence.

Autism lit is not without controversy: Many readers object to the prevalence of the autistic savant. And in fact, most of these protagonists are gifted: Christopher Boone, for example, is about to sit for his A levels in math, a heady accomplishment in England, where the book takes place. Nathaniel Clark is graduating college (with a double major, he reminds us more than once) at the age of 14.

In reality, savant skills are as rare in the autism spectrum community as they are in the neurotypical one. Those who dislike the novels for this reason cite the 1988 film Rain Man in which Dustin Hoffman plays Raymond Babbit, who can memorize a thick phone book in one night. As novelist and cultural observer Greg Olear wrote, “Thirty years later, the belief persists that autistics can reliably count a pile of toothpicks at a glance. This is a powerful negative stereotype that autistic children (and their parents) must overcome.”

But there doesn’t seem to be any stopping “autism lit,” exploitative or not. In fact, the fascination with the autism spectrum and fiction has launched yet another literary trend: the “retroactive diagnosis.” Some readers now believe that Mr. Darcy of Pride and Prejudice is on the spectrum; that’s the explanation for his reserve. Some readers suspect that the narrator of Hermann Hesse’s Steppenwolf falls into this category as well. The word “autism” didn’t exist, the theory goes, before World War II, and that’s the explanation for why Austen and Hesse didn’t label their characters themselves.

I’m not ready to jump onto this bandwagon. Calling Mr. Darcy autistic is a way of granting stature to people truly on the spectrum who don’t need your literary charity, thank you very much. But there are worse alternatives. (The retroactive diagnoses might apply to Boo Radley.)

In the world outside victimhood, we remain in the midst of an unexplained epidemic of autism spectrum disorders; some sources say that as many as 1 in 68 children are being diagnosed with the condition. And even with the onslaught of fictional characters on the spectrum, much of the story of autism remains untold.

There’s a saying that has been variously attributed to Temple Grandin, the autistic professor of animal science and advocate for the humane treatment of livestock, as well as to the autism advocate and author Stephen Shore, which has become one of those aphorisms that belong to the world: “If you’ve met one person with autism, you’ve met one person with autism.”

Since each story is different, we can expect the category of autism lit to swell, ideally with more portrayals of people on the spectrum who have jobs, partners, and most of all, purpose.

The post Were Mr. Darcy and Boo Radley Anti-Social Misfits—or Autistic? appeared first on Zócalo Public Square.

I bet having your picture taken by someone with a bulky film camera is not on your list. Yet it might have been, if you lived 100 years ago. For back then “Kodak Fiends” prowled the land and—hold onto your bonnets and bowlers—took pictures of us without our awareness or permission! At the time this was considered a major intrusion into one’s privacy, so much so that they even tried to write laws to prevent such violations.

It may seem strange that merely having your picture taken in public—and we aren’t talking about anything so salacious as upskirt photos—could evoke such psychological distress and paranoia. But is it really that puzzling? How do you feel if someone hacks into your email or social media accounts? It evokes the same unsettling sense of intrusion as Kodak Fiends did a century ago. Perhaps in the near-distant future hacking could become so commonplace that being hacked is just taken for granted, and 100 years from now readers of this column will be mildly amused at our naiveté.

We tend to throw the word “paranoid” around rather loosely, like we do the term “depressed.” Just to be clear, paranoia is a clinical (pathological) condition characterized by excessive undue suspiciousness and the belief in the mal-intent of others. So when you receive an offer from a complete stranger somewhere in Africa who wants to share with you the $350 million they just inherited, and you are suspicious of the offer, you are not paranoid. Just as there is a difference between being “suspicious” and being “paranoid,” so too is there a difference between being “just paranoid” and having “paranoid delusions.” Delusions are those beliefs that we generally feel are improbable or highly fantastic. But the line between reality and delusion can be thin indeed.

Take, for example, Raul Murillo Diaz. According to police, he was fed up with Google’s surveillance and decided to fight back—allegedly by shooting out a window of the company’s building and torching one of the Google camera cars. Ads popped up that seemed to know exactly which websites he had just visited. Ironically, Google denied he was the subject of surveillance, yet it had video footage of his SUV. Don’t those activities constitute surveillance? If you believe that some person(s), government, or other organization is watching you, monitoring you, and digging into your personal life and they actually are, then are you paranoid?

Interestingly, each generations’ paranoid fears appear to be coming true. The fear that Kodak Fiends would steal our privacy has become a reality. There are few places you can go these days without being photographed or caught on security camera. The fear of being watched from on high has also become true, as has the fear that computer chips would be implanted in our brains.

Over the years I’ve had the opportunity to review records of mentally ill patients from different eras. Almost every new scientific discovery or technological advancement has become the stuff of paranoia. The discovery of gasses in the late 18th century became the paranoid delusion of one James Tilly Matthews, who believed that “pneumaticians” operated an air loom beneath the streets of London, influencing those above.

Dirigibles evoked that feeling of being spied on from above, which is exactly what they were doing, only occasionally lobbing an explosive devise of some sort. Blimps were quickly replaced by airplanes, and then jets as paranoid individuals continued to look skyward to see their tormentors. Then satellites were launched. Now paranoid individuals could no longer see their surveillers, but they knew that they were up there, silently spying on them from the recesses of space.

Although it is unlikely that many individuals went through the expense of buying an aircraft to spy on others, the same can’t be said for inexpensive drones. Now you can spy on just about anybody with what amounts to a toy. As the saying goes, even paranoids have enemies (and those enemies probably have drones).

Similarly, the discovery of X-rays led paranoids to fear that others could see through them, which was of course quite literally true. The telegraph gave way to telephones, which stepped aside for cellphones. Each factored into the paranoid’s suspicions. And then there is the now venerable computer chip. Paranoid individuals have long fretted that such chips could be implanted in their brains in order to control them. Ironically, biomedical research is making great strides today in doing just that in order to help a broken brain function adequately.

And then there are “targeted individuals,” aka TIs. As the New York Times recently documented, these folks, and there appears to be quite a number of them, believe that they are being stalked by gangs and monitored electronically, often using satellites. They have created a platform to share their plight, but ironically, that platform is electronic. A Google search—which was probably monitored—for “targeted individuals” reveals numerous websites where TIs from around the world post testimonials, support, videos, and advice. At the same time they are warned that just about anyone can be a “handler” (the surveiller or stalker) engaged in electronic stalking and mind control, which they abbreviate to ESMC. If you believe yourself the victim of ESMC, you can buy devices designed to block all sorts of malicious attacks including “psychotronic” attacks. (Sorry folks, couldn’t find a good definition for this one in all of my psychology textbooks and journals. Your imagination will have to suffice). But even TIs are encouraged not to be suspicious of everyone lest psychiatrists label them as paranoid.

So what paranoid horrors lay ahead? Well, self-driving cars are becoming a reality. While I may not have to worry whether the person driving toward me is drunk, now I do have to worry—or be suspicious about—whether that car is going to be hijacked (or perhaps a better term would be hihacked) and driven right at me. The TIs may fear that their cars will be remotely operated by their stalkers. Whatever the new technology, it will become the preoccupation of a new generation of paranoid individuals—and they just might be on to something.

The post Paranoids in the Age of Digital Surveillance appeared first on Zócalo Public Square.

The last question is one that tends to engage the media, and bleed into the minds of the public.

Motive (from the Latin word motivum, meaning “moving cause”) is what moves a person to commit a certain act. In U.S. criminal law, there is no requirement to prove motive to reach a verdict. However, motive may be shown by the prosecution in order to prove that a defendant had a plausible reason to commit the crime. A defendant’s motive may be either rational (i.e., understandable to the average person) or irrational (i.e., it may be caused by mental illness).

The question of motive can be hard to answer—unless one devotes substantial time and effort, using the correct approach and the right expertise. A model example of this is the A&E investigative documentary Columbine—Understanding Why. At the request of the Littleton, Colorado D.A.’s office, forensic psychiatrist Park Dietz and colleagues performed a thorough “psychiatric autopsy” of the two teens responsible for the 1999 tragedy at Columbine High School. Through several interviews and painstaking data gathering, Dietz was able to conclude that the two shooters had multiple motives—power, respect, control, and revenge. Dietz noted that the perpetrators also “did it to gain infamy” and to leave a legacy in order to inspire others.

Common rational motives for criminal acts include greed, anger, jealousy, and the other ignoble human motivations. In contrast, an irrational motive typically involves symptoms of psychosis, such as a paranoid delusion that someone is trying kill you. When you believe your situation amounts to “kill or be killed,” you may lash out to stop your misperceived persecutor. But note that this example nevertheless represents a motive—albeit one that might be described as “rationality within irrationality.” While it flows from a psychotic delusion, there is, in fact, a logic to the motive of the actor.

While motive can depend upon a seemingly endless combination of bio-psycho-social factors, even in the most heinous and difficult to fathom crimes, there is motive. The popular myth that the perpetrator of a mass shooting “just snapped” has been debunked.

Prior to Charles Whitman’s 1966 mass shooting from atop the University of Texas tower, many cases of mass murder involved a depressed and angry man who killed his family and then himself. Such cases did not capture much media attention. Why? They were regarded as “family business” and were “too close for comfort,” according to Park Dietz. In contrast, mass shootings beginning in the 1990s have been covered intensely by the media and appear to be a different type of violence, at least in the eyes of the public. Compared to depressed and despairing familicide-suicides, these “modern” cases are likely distant enough from the average person’s experience to capture the public’s attention with morbid fascination over prolonged periods of time.

The news media often heavily influences public perception of mass murders, offering simplified explanations that assume the perpetrator is either “mad” or “bad.” Such simplistic explanations are easier for the media to report and for the public to accept. Psychiatric illness, while present in some mass murderers and mass shooters, is far from the most significant or consistent finding when individual cases are analyzed in great detail. No research has reliably established that most mass murderers and shooters are psychotic or suffering from a serious mental illness. However, many have been found to have been preoccupied with feelings of social persecution and fantasies of revenge for some type of perceived injustice. Studies of mass murderers have found that it is not uncommon for them to leave some type of final communication. Indeed, the study of mass murderers’ final communications has led to a greater understanding of their psychology and motivations.

From a public health perspective, a better understanding of mass murderers’ motives is the only rational way to prevent these tragedies and to dispel harmful myths that could lead to ill-informed crackdowns on those suffering from mental illness. This is not only an ineffective way of solving the problem, it is quite misguided. Only a small fraction of persons with serious mental illness are violent. Even if we were to assume a causal association between serious mental illness and violent crime, the overall contribution of this population to violent crimes in society is only about 3 to 5 percent. Thus, focusing broadly on persons with mental illness as a “risky” population is similar to what we observed after September 11, when anyone of Middle Eastern ancestry was viewed with heightened suspicion. But, concluding that a mass murderer’s motives are “senseless” and therefore unworthy of study is also too broad a determination, one that risks preventing future tragedies.

Comparatively, little study has focused on sociocultural motives. Sociocultural factors may provide critical data for prevention efforts that extend beyond individual factors such as mental illness or efforts to “profile” offenders. The investigation of social and cultural factors seems reasonable, if not obvious, when attention is paid to the words perpetrators leave behind. For example, the Sandy Hook Elementary School shooter posted online in late 2011: “[You know what I hate] … Culture. I’ve been pissed out of my mind all night thinking about it.” Elliot Rodger, the Isla Vista, California, shooter, posted a manuscript online in 2014 stating, “Humanity is a cruel and brutal species.”

P.E. Mullen keenly observed that perpetrators of mass shootings acknowledged being influenced by previous mass murderers who received significant media exposure, which may be one important factor contributing to the breeding of these tragic events in Western society. Extensive and sensationalistic media attention beginning in the 1990s may have further perpetuated what Mullen describes as a “script,” resulting in a perverse glamorization of the act, particularly in the eyes of subsequent perpetrators. The study of individual cases of mass shootings that have occurred since the ‘90s suggest that perpetrators often felt socially rejected and perceived society as continually denouncing them as unnecessary, ineffectual, and pathetic. Instead of bearing the burden of perceived humiliation, they plan a surprise attack to prove their hidden “value.”

By becoming a lone protestor against an “unjust” reality, the perpetrator creates and assumes a victim role in which he can win—even by losing. Western society in particular has had a long-standing fascination with the tragic anti-hero or outlaw, the Bonnies and Clydes of American history. Their short, violent lives have become the stuff of legend. The very public and dramatic nature of mass murder seems to speak to a need for wide recognition. For the perpetrator, such a tragic revenge establishes a connection with spectators who will not soon forget what they have seen. Thus, a further extension of Mullen’s western cultural script may be characterized as the Script of the Tragic Anti-Hero, which details motive in the following “acts:”

1. The perception of a ruined social identity
2. The experience of persecution and social alienation
3. The formulation of plans to reclaim the identity via tragic revenge
4. The need for the tragic revenge to be dramatic in nature
5. The public enactment of tragic revenge
6. The aftermath of media coverage and propagation

Rodger’s final written communication appears to follow this script precisely. His communications reflect a pattern of alienation and malignant envy, culminating in a violent bid for fame and validation: “Humanity has rejected me … Exacting my retribution is my way of proving my true worth to the world.”

As supremely selfish and unacceptable as this is, it represents motive laid bare.

The post With Mass Murderers the Tragedy May Be Heinous, But It’s Rarely Senseless appeared first on Zócalo Public Square.

At 16, I was too much of a goody-two-shoes to consider underage drinking, but I equated lipstick with a poise I didn’t yet have. I saw myself as oafish, an embarrassing, unladylike teenager with much to learn. So, I tried to become a woman worthy of mass-produced rhinestone notebooks. I wore lipstick every day, and I started starving myself.

“Do you remember when you decided to do it?” I’ve been asked this question a handful of times, as though I sat down and charted a five year plan for destroying myself from the inside. No, I don’t remember the first time I thought seriously about anorexia. I know I was 14 or 15 when I first became dissatisfied with my body. That’s when I started logging my calories—just to maintain a healthy weight, I reasoned, and then just to lose a couple pounds. I stopped writing my caloric intake down once I’d memorized hundreds of calorie counts, and never went over 300 calories in a day anyway.

I remember taking glucose tablets to school so my blood sugar would stay up and keep me awake. At the bell, I would run to my next class of the day so I could nap through the remainder of the four minute passing period. I slept through lunch. In the school bathroom, it was everything I could do not to shatter the mirrors. Disgust at myself turned into an uncontrollable rage. Even after all I did, I was still so huge, so hideous. How?

The psychological discomfort of anorexia is so extreme, it sounds impossible. It feels ridiculous to even talk about, even though it produces sensations of true horror. I cannot emphasize enough how terrifying it is to spend hours looking in the mirror, searching for a sign—any sign—that you are inside the body you see.

Hayes wearing one of her creative looks.

When you spend enough time staring at yourself, your body seems foreign, removed. This is a tenet of abject body theory. When you focus on a single flaw, it becomes detached, a malignant “other” that seeks to destroy you. For anorexics, that abjection applies to the entire body. I went years without seeing myself in the mirror. I saw a monster, facial features I’d analyzed until they seemed cadaverous, layers of fat and muscle and skin that were no longer human, but grotesque. I didn’t see myself, and it didn’t feel fair to be trapped inside a body I thought was oversized to the point of being freakish and terrifying.

Even when I was starving, unable to stay standing or awake for more than a few hours at a time, I still saw myself as repulsive, engorged, and hulking. This is laughable; at 5’7” and 125 pounds, I was hardly a behemoth. But I was a head taller than all of my girlfriends, most of whom weighed 100 pounds soaking wet and were on laser-focused diet plans of their own.

There was also the matter of my personality, which is the one part of me that is undeniably oversized. I have always been a performer in some capacity, and that disposition doesn’t lend itself to feelings of delicacy. “Larger than life,” I’ve been called, and what a choice of words. I knew the moment I opened my mouth my veneer of normalcy would crack. So I set about crafting a façade as close to typical as possible.

I went to my friends and asked for their help, and they taught me how to wear makeup. Not to experiment with makeup, mind you, but how to use makeup to mask my flaws. Those flaws were not, as I assumed at first, the occasional pimple or patch of dead skin. My eyes, my nose, the curve of my cheeks—these were my flaws, ones I’d had all my life. So I began to use makeup to reflect attention away from the parts of me that still protruded, puffed, and swelled. I would rarely leave the house without foundation, contouring, eyeliner, mascara—a facsimile of my friends’ faces, if I couldn’t copy their bodies.

In college, I started to “recover” from anorexia in the physical sense. That is, I had to choose between eating and failing out of school. I took on an ambitious course load and a number of extracurricular activities, and I reluctantly began eating again. But my relationship with my body was more fraught than ever. My body’s metabolism wasn’t accustomed to regular meals, so I overachieved again, zooming past the Freshman 15. In less than three months, I gained 40 pounds, and I was miserable. I experimented with new makeup techniques to mask my weight gain. I invested in more cosmetics instead of the frustrating process of shopping for clothes.

And then, as it always does, my creative nature took hold.

As I emerged from the mental fog of starvation, I became restless. I sought out more to do in the city. On stages, I told jokes and recited poems. On my face, I went wild with texture and color. It started with a tube of purple lipstick that became my go-to color; then I tried a red eyeshadow that startled me by being flattering. I found solace in green, glittery lipsticks that made my lips look like a fairytale frog prince. Some days, I would leave the house with a neon pink monochrome face—eyebrows and all—to match my outfit.

The art of changing my face distracted me from the pain I’d felt. In fact, I liked when I looked “ugly.” People took notice of my outlandish makeup palettes, and then took notice of everything else I was doing. I also discovered that other people wanted to wear fun and silly makeup looks too, and suddenly I was making friends and teaching them how to make their black lipstick stay on all day and how to replicate eyeshadow looks from ‘70s fashion magazines.

I proved to myself that I didn’t need to be delicate and dainty to be seen as worthy. I could make a radical transformation in my appearance, and at the end of the day I could take it all off. Maybe I didn’t love the face and body under the makeup, but no matter what I layered atop it, it was always there. Even on the days I didn’t recognize myself in the mirror.

My mind and body are at a ceasefire. There are days when I still want to shatter mirrors, when my reflection seems insidious. But most mornings, I wake up and greet myself with a smile. I have some degree of control over what people see when they look at me. Even better, I know who I am underneath everything I show the world, and that can’t change.

The post The Art of Being “Ugly” appeared first on Zócalo Public Square.

On October 22, 2014, Michael Zehaf-Bibeau fatally wounded a soldier on Parliament Hill in Ottawa before being shot by the police. A Muslim convert and a drug addict, he didn’t have any psychiatric record, but his mother confirmed he was mentally deranged. Two days later, Zane Thompson, a Muslim convert, described as a “recluse” with mental problems, attacked four policemen in New York City with a hatchet, a “terrorist act” according to the NYPD commissioner. On December 15, 2014, Man Haron Monis, a self-proclaimed Iranian sheikh, who was suspected of murdering his wife and had been charged with 40 sexual offenses dating back a decade, took hostages in a café in Sydney during 16 hours, before being shot dead by the police–two hostages died in the raid. Australian Prime Minister Tony Abbott said the gunman had “a long story of violent crime, infatuation with extremism, and mental instability.”

This may sound like a modern epidemic, but, as I know from my experience studying French history, connecting terror and madness is a very old story.

In 19th-century France, psychiatrists and politicians were particularly quick to accept the analogy between revolutionary terror and madness, leading psychoanalyst Sigmund Freud to say later that the French were a “people of psychical epidemics, of historical mass convulsion.” Psychiatrists coined new diseases such as “political monomania,” “revolutionary neurosis,” “paranoia reformatoria,” and even “morbus democraticus” (democratic disease). Theorists and writers concurred. Addressing readers potentially nostalgic of revolutionary spirit, the diplomat and historian Chateaubriand wrote that the Reign of Terror (1793-1794), a policy of political repression, “was not the invention of a few giants; it was quite simply a mental illness, a plague.”

But what does systematically combining political violence and madness mean? Not much, since it takes two complex terms and, by combining them, offers a simple explanation.

Scientists can fall into the same tempting trap. Théroigne de Méricourt, a feminist supposedly leading a group of armed Amazons during the Revolution, ended her life in a lunatic asylum, where she was diagnosed with dementia due to her political convictions. This clinical demonstration was full of factual errors and approximations, and based on plagiarism of a sort, as a sick condition was portrayed as the result of sick ideology. Of course, Théroigne may have been insane. But was her madness necessarily related to her beliefs or did the doctor’s opposing political (royalist) beliefs orient the diagnosis?

Charenton, where Jacob Dupont, a famous thinker in 19th-century France who advocated atheism, was institutionalized.

Beside politics, religion (and the acceptable “limits” of its practice) often interferes in diagnosis. On Feb. 14, 1810, Jacob Dupont, a famous thinker who had advocated atheism, was institutionalized at Charenton, a lunatic asylum founded in the 17th century. Dupont’s medical file reads:

Former Doctrinaire [i.e., former member of the Confraternity of Christian Doctrine], former representative in the Legislative Assembly and the Convention; withdrew to a small village near Loches, where he lived for eight years with a sister who died six months ago. Metaphysical and revolutionary reveries, notorious advocacy of atheism in the Convention; publicly gave a course on that subject on Place Louis XVI seven years ago. Many writings full of the same madness. No violence, no delusions on other subjects.

Here it is spelled out: Atheism is madness. The assertion itself is not surprising in a society that shared Louis Sébastien Mercier’s opinion that atheism was “the sum total of all the monstrosities of the human mind” and “a destructive mania … that is very close to dementia.” This time, however, the judgment served as a diagnosis penned by a physician who, even though he was using the term “madness” in a colloquial sense, admitted that Dupont had “no delusions on other subjects.”

This point is crucial, because it proves, in black and white, that religious beliefs constituted a sufficient basis for confinement. If the doctor, Antoine-Athanase Royer-Collard, had known that Dupont had been forced to resign his seat in the Convention 1794 due to his mental state, and was arrested the following year for raping a blind old woman, he would have felt even more justified in his diagnosis. Though Royer-Collard had only looked at Dupont’s openly declared atheism to make his decision, the background information would have underscored how it was only part of a larger pathology.

What do we learn from history? That a plausible conflation of terms, if not carefully scrutinized and documented, often turns out to be a very harmful confusion.

If we go back to our contemporary examples, it appears that the three men (at least according to what newspapers tell us) share some common traits: Islam, violence, and hypothetical madness. In other words: religion, political extremism, and medical condition. The three men are considered lone-wolf jihadists, who live “on the fringe of the fringe,” as the Sydney hostage-taker’s attorney characterized his client.

Isolated, frustrated, unable to join any terrorist organization, these so-called jihadists are first and foremost social misfits, galvanized by causes that get daily media attention. No anti-terrorist laws could ever apply to them, unless you could put the entire population of the world under continuous surveillance. Recent studies from Indiana State University and University College London have demonstrated that 32-40 percent of lone-wolf attackers suffered from mental problems, while, actually, “group-based terrorists are psychologically quite normal.”

What can we take away from this? We must be more careful about differentiating solo attackers from organized political forces–just as we must be more careful about using the word “madness.” In other words, let’s restore the full meaning of complicated concepts. And let’s remind ourselves that terrorism is a real threat of political thought, that religion is not fanaticism, and that madness is a very serious social issue that deserves more attention in countries that have failed to create effective mental health policies.

The post Are All Terrorists Crazy? appeared first on Zócalo Public Square.

Today, I’m back on the streets of Modesto, as CEO of the nonprofit Peer Recovery Art Project. Through our downtown gallery, events, and outreach programs, our collaborative empowers mental health consumers—people who have had challenges with mental health—to take part in the arts in various ways. By creating art, putting on arts events, and using art projects to enhance public spaces, they improve their own health and connect to the community.

Our goal is to demolish old attitudes about the roles that mental health consumers can play in the places they live. We are fighting against stigma, and tradition, that say we must isolate mental health consumers. Today, while many mental health groups talk about the importance of people in recovery belonging, they end up talking mostly about caseloads, funding cuts, crisis, and paperwork. Our approach is different; we jump right into community.

We do this by combining two missions into one: supporting people in recovery, and revitalizing public spaces, especially the downtown core of Modesto’s business district. People in recovery do the work of revitalizing these spaces, and through their work pose the question: “Who is responsible for taking care of our community?” Our answer: “Everybody, including us.”

The Peer Recovery Art Project was born from a class I facilitated called Peer-to-Peer, a nationwide education program for people with mental health challenges developed through the National Alliance on Mental Illness (NAMI). After the class ended, a few of us wanted to continue to support one another as well as others, but we didn’t want to be limited to traditional mental health settings, such as clinical offices or the group rooms of public mental health departments. One idea I offered was to participate in community-based projects that were open to all, with no labeling of certain people as mentally ill.

We started informally in 2007 by participating in the Modesto Blues, a major music festival, and in a community walk that raised funds for NAMI. It was hard to find money at first. I was amazed by the amount of funding spent on “art therapists” inside institutions—and how little was spent in the local community to find creative outlets for people who otherwise could wind up in jails or hospitals. But we eventually raised the money we needed, thanks to a number of local individuals and businesses and a big assist from Wells Fargo.

We’re driven by the idea that music and art, because they are so widely appreciated, are the best way for people to integrate into a community. I think that’s because art and music are accessible and familiar, and so they inspire feelings of security rather than fear. We also know that art stimulates the imagination and thinking of all people; those who create come to see themselves differently. For people who are mental health consumers and for people who aren’t, art becomes a way of expressing hard-to-express things, and developing relationships. Art in this way counters isolation.

Over the years, we evolved from an informal “street team” into an art collaborative in which some of the contributing artists may have experience as mental health consumers. Sometimes their art reflects that experience; sometimes it doesn’t. Either way, we seek to nurture and respect their work, in part by publishing a monthly newsletter. The artists do all the work of creating, connecting, putting on events, and selling their work. Our Arts for Freedom Art Gallery offers “open door” access to all and a place for local artists wishing to show their work. We tell anyone pursuing their own artistic journey that we are here to serve them—and the community. We’ve grown from 50 artists to close to 400 artists, and another 400 people have participated by volunteering.

Like any art collaborative, we have showings. We host the Art Show Wine Tasting area at the McHenry Village Shopping Center each year to give an opportunity for artists to connect to art lovers. We show art and have our musicians play at the Day of Hope, an annual gathering in Stanislaus County for mental health consumers, family members, educators, and service providers. We bring art classes and live music to local schools. We help our artists with framing and with the set-up for our shows. We promote our artists on Facebook and manage sales inside our community gallery. James Devlin, a painter and Afghan war veteran who came to us as a volunteer and later became an employee, has now shown his art throughout the state.

Among our tools for bringing new artists to Peer Recovery is a step van—a 1974 International Grumman Olson (similar to what FedEx drivers use)—that we purchased with no idea how we would be able to afford to operate and insure it. But we knew we needed to be mobile, to bring people into our collaborative who are isolated or live in different parts of the county. So we painted a mural on the outside (showing a series of four faces, which depict a blending of cultures) and set up our “Traveling Art Gallery” on the inside. The van goes all around Stanislaus County, often parking outside events.

We continue to grow in our reach and our ambition. We’ve started a new speakers’ bureau through which our members give talks about the arts and ending the stigma of mental illness. We also have a new international arts exhibition, which travels around the area; it debuted in April at Maxx Value Foods on Modesto’s west side.

The only requirement for participation in Peer Recovery is geographic. Our program is open to anyone from Stanislaus County who wants to participate without regard to race, ethnicity, age, gender, or sexual orientation. We have many community partners who do outreach or contract with us to provide arts in some form. The Stanislaus County Office of Education uses our gallery as a summer youth work experience destination. Downtown Modesto business owners recruit staff from our volunteer pool and request specialty support services for events.

I have bad days like anyone else, but I find that this work—and the possibility that we can do even more—inspires me. In the near future, we want to develop new programming to improve people’s social skills and help them work with the public in retail settings. We’re also trying to figure out creative ways of using peer-to-peer mentoring to advance the careers of our artists. Beverly Fabrics here in Modesto just offered to discount and provide art supplies for our projects. Project YES (Youth Employment Services) and the county office of education have agreed to bring our International Arts Exhibition to young people on their campuses. There’s no end to how deeply arts can connect you to the community.

The post Can Art Heal Our Minds—and Our Communities? appeared first on Zócalo Public Square.

That’s fine in principle, but, in my experience, clear-cut threats are rare, while vague threats are common. And with the latter, it’s much less clear what a doctor should—or even can—do.

Consider the case of a mentally ill patient who might appear capable of violence but who doesn’t make an explicit threat. As a physician, I am in most cases legally prohibited from releasing information about this patient.

Many of us might want a mentally ill person who seems at heightened risk of violent behavior to be prevented from buying a gun, perhaps by having that person entered into a database of people who would be blocked from access to a gun, but currently, no such protection exists.

A few days after the recent shooting at Los Angeles International Airport of three people, including a TSA agent who died, I had the chance to speak with one of Southern California’s most experienced law enforcement officials, Long Beach Police Chief Jim McDonnell. He told me that a growing percentage of Americans, including 74 percent of National Rifle Association members, favor background checks for gun purchases. McDonnell said that in many of recent mass shootings with a single gunman—such as the cases of Jared Lee Loughner, James Holmes, and Adam Lanza—prior behavior on the part of the shooter suggested severe mental instability.

But when I asked Chief McDonnell about who people should call if they think that somebody who’s mentally ill is likely to be violent, his answer was, “I think that would be us.” In other words, police would show up to interview the person and decide if he or she could be detained. If no detention resulted, police would create an “incident card” in order to alert officers in case the person is at the center of any future incident. That’s helpful to policing, but it doesn’t have any effect in limiting the purchase of firearms.

Police are constrained because, in California, as in most states, there are very strict criteria for detaining a mentally ill person, embodied in section 5150 of the legal code. The person must be a danger to himself (or herself) or an immediate threat to someone else, or he must be unable to provide food, clothing, or shelter for himself. Making things harder is that the mentally ill exhibit great fluctuations in behavior. Sometimes they may appear to be dangerous, but at other times they may not, so a lot depends on when the authorities happen to encounter the person. Bizarre behavior does not qualify for the 5150 designation.

From what I’ve read, most of the recent mass shooters offered warning signs about their potential for violence, but none met the standards that would allow a policeman to take action. Even if I as a doctor were to report my misgivings about a person to the police, they would follow the exact same procedure as they would with a report from anyone else.

Earlier in my career, I spent several years working as an emergency specialist. In that capacity, I had the legal authority to certify a person for detention under section 5150. But I never used it for people who were just “potentially” violent, nor, as far as I could see, did my emergency department colleagues. In a hospital or emergency room, the actions and statements of a severely mentally disturbed person—short of credible, explicit threats—would not create the sort of red flag that those outside the medical or policing professions might think it would.

Perhaps, from now on, it should.

In the wake of so many shootings, healthcare providers should be thinking about how we might do more to prevent those who are severely mentally ill from obtaining firearms. To be sure, we must protect the rights of those who are mentally ill—most of whom are never violent—especially since they already suffer under many other burdens. But, still, the law will have to change. Otherwise it’s hard to see how we can place an effective barrier between the mentally disturbed and lethal weapons.

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