What I learned from reading The Last Psychiatrist

The Last Psychiatrist is the name of a pseudonymous blog, which used to publish cultural critiques as well as the author’s thoughts on psychiatry and medical science in general. I used to visit it regularly and even though I didn’t understand 10% of what was written, I still feel that I got something useful out of it. The website has been inactive for years and experiences frequent downtimes. In case it disappears forever (the Internet does forget, after all), I will use this article to collect some excerpts as well my thoughts on them. Most of what follows is completely speculative.

The author of The Last Psychiatrist, who liked to call himself ‘Alone’ might actually have been a real psychiatrist living somewhere in the United States. He frequently posted stuff I disagree with, incoherent ramblings and alcohol-fueled rants, but there were also frequently nuggets of wisdom to be found in between. The name of the blog does not suggest that the author is the last psychiatrist to ever live, instead he sees himself as the psychiatrist to Friedrich Nietzsche’s Last Man. Evidently, he draws a lot from the German thinker, who also provided the tagline of the site (“Worüber man nicht sprechen kann, darüber muss man schweigen.” – “What you can’t talk about, you must be quiet on.”).

What is the main theme of the blog? As Alone himself writes:

This is important. It is the thesis of this blog: nothing matters more than your will. Even if wine and beer are themselves of no consequence to one’s health, the lifestyle that follows with the conscious choice to drink either one Is of consequence. Every choice you make influences your identity, and not the other way around; the sooner you accept this, the sooner you can become the person you want to be. You get to pick who you are. Go pick. From "Just How Many Drinks a Day Is Bad"

This was posted in an article commenting on health recommendations concerning alcohol which is typical as much of his life advice seems to be embedded in articles discussing seemingly random topics. Still, the central theme is clear. Action is the only thing that matters, words are meaningless. If you want to be a musician, play music. If you want to be an athlete, hit the gym. If you want to be a writer, write, however badly. If you want to be a good person, do good things. Whatever it is, do it. Sitting at home and fantasizing about what you could do is just a mechanism that your brain uses as a defense against change. If you don’t try, you can’t fail. This point is driven home in "The Near Death Of A Salesman" (in my opinion one of his most readable essays).

He was in really good shape, except for the belly. At home he could eat right, exercise, go to church, raise two sons and a daughter, but three out of seven days he was in a car or in a hotel. Real life was on hold. So the cheesesteaks, the corn chips, and the sodas belonged to a different reality, and when the doctor asked, "do you have a good diet?" he answered yes and he wasn't lying.

He didn't take any medications, the only thing he took was Lipitor and a blood pressure pill, that's it. He had some Percocets for his back pain from a fall nine years ago, he got Xanax off the internet, he took one or two of those a day, but it was just to help him relax when he was traveling, he didn't really have a disorder so it didn't count. Also Ambien. He also had some Plavic or Plavix or something, but he didn't really need it, he only took it because his doctor didn't want him to get any more clots, but he hadn't had any clots for three years. So.

Drinking was part of that other reality, too. He had a couple of drinks at business lunches, one or two before dinner, then some wine, a few more before bed; and yes, ok, he drank when he was at home too, a bottle of wine with dinner and a few vodkas with Letterman, but he was never sloppy, always in control. He was sure his 12 year old son didn't know. When the doc asked, "how much do you drink?" he truthfully responded wine with dinner.

The rest was not planned, he never thought, "I got to get some martinis into me." So it didn't count.

This is a man who lies to himself, who does not take any responsibility. He doesn’t imagine himself as the kind of person who eats unhealthily or is an alcoholic, because this is not who wants to be. Reality does not matter. The story takes a turn for the worst.

He sat down. Of course it was a stroke. He had known it all along, but he hadn't wanted to admit it.

A stroke. Oh my God, now what? He hadn't died, but he knew the weakness would be permanent, and every moment he didn't get treatment was risk of more weakness, more infirmity.

All those things he had dreamed about, all the things he had wanted to to-- a radio show, golf pro, the novel, losing weight, going back to school to become a lawyer-- all those things would never happen.

He wouldn't be able to finally read The Federalist Papers with his son, wouldn't be able to learn trigonometry to help him with his homework; he wouldn't be able to wake up at 5am every day with his eldest son and help him train.

The stroke had taken all that away from him. All he'd be able to do now as live day to day.

I wont’ spoil the ending, it really is a good story.

The crux is of course that he would never done any of these things. If he would, he had already started. Words are meaningless.

Identity

From “The Abusive Boyfriend”:

*He doesn't hit you, he's not that kind of abusive.

And he's not mean, or controlling, not like that. No, not really.

But he's careful to make sure you don't notice that a certain movie is on tonight, and he's deftly avoided ballroom dancing lessons with you. And he walks you the other way if he spots one of your friends, or any billboard with Gabriel Aubry on it.

He's not jealous, he just doesn't want you... distracted.

He has no problem admitting that other men are attractive ("I'm no Tom Cruise"), but never the men that you yourself find attractive.

He's never mean or disrespectful to your friends when you're out together (he goes reluctantly, but for you), but later he reminds you of how you're better than they are, and when they do things "like that" it's silly/wrong/beneath you. He never says you can't go out with them, but there's always a coincidental reason for you not to. "Oh..... well..................... I had a special night planned for just the two of us..."

[…]

No. He's afraid things will get worse or they will get better. He is afraid of change, any change, not just because the relationship may change but because if it changes then he would have to change. Into what? How? With what resources? With what net? Once change has happened, doesn't that mean other possibilities were obliterated? It is his possibilities he is trying to beat down with your sclerosed dreams.

All that matters is keeping the relationship intact. Even if you both end up miserable, better misery and stability with him than the tachycardia of something else, something unknown, something he can't control or defend against.

Do you know this guy? You think you do.

This is what you need to know: the boyfriend I'm describing isn't Tom, the hipster who's number one on your speed dial. And no, I'm not directing this at you, man-boy, I'm not saying you are doing this to your woman, though you may be. At any moment there is only one person in the room no matter how many people are in the room, and that one person, you, is lugging around the same man you've lived with for years. The abusive boyfriend I'm describing is your unconscious, and Tom has nothing on him, though Tom has, through the hypertrophied intuition of damaged men, figured out how it all works.

The unconscious doesn't care about happiness, or sadness, or gifts, or bullets. It has one single goal, protect the ego, protect status quo. Do not change and you will not die. It will allow you to go to college across the country to escape your parents, but turn up the volume of their pre-recorded soundbites when you get there. It will trick you into thinking you're making a huge life change, moving to this new city or marrying that great guy, even as everyone else around you can see what you can't, that Boulder is exactly like Oakland and he is just like the last guys. And all the missed opportunities-- maybe I shouldn't, and isn't that high? and he probably already has a girlfriend, and I can't change careers at 44, and 3 months for the first 3/4 and going on ten years for the last fourth, and do I really deserve this?-- all of that is maintenance of the status quo, the ego.*

A large part of Alone’s writing is concerned with the theory that the Ego is just your brain’s defense mechanism to prevent you from changing yourself. We build an identity and then cling to it. Thinking “I am just not the type of person who could ever complete a marathon” just means you are locking yourself inside an imaginary prison.

Narcissism

From “The Second Story of Echo and Narcissus”, perhaps the essay where Alone articulates his ideas most succinctly (which is not very succinctly at all):

The story you know is that Narcissus was so beautiful that everyone wanted to be with him, but he rejected them all: no, no, no, no, no, not good enough. One rejected lover was furious and begged Nemesis, the goddess of vengeance, for retribution. "If Narcissus ever falls in love, don't let the love be returned!" Nemesis heard the prayer and caused Narcissus to fall in love with himself: he was lead to a pool of water, and when he looked into it, he fell in love with what he saw. And what he saw wasn't real, so of course it couldn't love him back. But Narcissus sat patiently, forever, hoping that one day that beautiful person in the bottom of the pool was going to come out and love him. You should take note of this first, easy lesson: if no one ever seems right for you, and then the one person who does seem right doesn't want you, then the problem isn't the person, the problem is you.

When Laius and Jocasta were told that Oedipus would eventually destroy them, they pinned his ankles and abandoned him in the woods, ensuring that he'd someday have cause to do it. And so when Narcissus's parents heard the requirements for their child's long life they would have done everything possible to ensure that he didn't know himself. No one knows what Liriope and Cephisus did, but whatever they did, it worked: he didn't even recognize his own reflection. That's a man who doesn't know himself. That's a man who never had to look at himself from the outside. How do you make a child know himself? You surround him with mirrors. "This is what everyone else sees when you do what you do. This is who everyone thinks you are." You cause him to be tested: this is the kind of person you are, you are good at this but not that. This other person is better than you at this, but not better than you at that. These are the limits by which you are defined. Narcissus was never allowed to meet real danger, glory, struggle, honor, success, failure; only artificial versions manipulated by his parents. He was never allowed to ask, "am I a coward? Am I a fool?" To ensure his boring longevity his parents wouldn't have wanted a definite answer in either direction. He was allowed to live in a world of speculation, of fantasy, of "someday" and "what if". He never had to hear "too bad", "too little" and "too late." When you want a child to become something-- you first teach him how to master his impulses, how to live with frustration. But when a temptation arose Narcissus's parents either let him have it or hid it from him so he wouldn't be tempted, so they wouldn't have to tell him no. They didn't teach him how to resist temptation, how to deal with lack. And they most certainly didn't teach him how NOT to want what he couldn't have. They didn't teach him how to want.

Narcissism is on of the central themes of the blog. However, for Alone that means something different then how it is commonly portrayed.

From "The Other Ego Epidemic":

[Alone lists online articles where narcissism is discussed in connection with grandiosity.]
_"Looks like you were right, even the popular press is catching on to the increase in narcissism--"

Belay that. These magazines are your enemy. Do you think they exist to improve you?These articles aren't saying narcissism is on the rise, they are saying grandiosity is on the rise. They are conflating the two. Even psychiatrists get this wrong, they are not the same.

Leave aside for now what is the distinction. Look instead at the result: by focusing on the grandiosity, it leaves you, the reader, with an out. "Look at these grandiose idiots. That's not me." By virtue of the fact that you aren't famous, important, grandiose, you must therefore not be a narcissist. It creates a self-satisfied sense of importance because you're not like them. That's narcissism. These articles actually reinforce your narcissism. They are the wrong kind of friend you've picked to assure you: "that stuck up bitch, what does she know, you're too good for her anyway."

If you're reading it, it's for you.

“If you’re reading it, it’s for you.” might be The Last Psychiatrist’s most used sentence. Whenever you find yourself at 2 in the morning aimlessly surfing the internet and reading outrage-inducing articles thinking “How can the author be this stupid, who is reading stuff like this?”. Well, you are. News websites only publish articles because people read them, the reason why they do is irrelevant.

What do you do if you think you might be a narcissists? Alone has some advice in “Can Narcissism Be Cured?”

"But I want to change, I want to get better."
Narcissism says: I, me. Never you, them. No one ever asks me, ever, "I think I'm a narcissist, and I'm worried I'm hurting my family." No one ever asks me, "I think I'm too controlling, I'm trying to subtly manipulate my girlfriend not to notice other people's qualities." No one ever, ever, ever asks me, "I am often consumed by irrational rage, I am unable to feel guilt, only shame, and when I amcaught, found out, exposed, I try to break down those around me so they feel worse than I do, so they are too miserable to look down on me."If that was what they asked, I would tell them them change is within grasp.
[...]
"So all is lost?" Describe yourself: your traits, qualities, both good and bad. Do not use the word "am." Practice this.

I am not sure if I am a narcissist according to Alone’s definition, but this advice has helped me come to terms with my own insignificance.

On Dating

From How To Destroy A Marriage

Contempt.

*This statement is 100% accurate: cheating on your spouse is less detrimental to your marriage than rolling your eyes, looking away, and saying, "oh my God, you're so annoying."

I'm not saying you can get away with cheating. But contempt in the marital interaction is the most important predictor of marriage failure; and, probably, those marriages should be dissolved as soon as possible anyway. No good will come of them.

[…]

No time to yourself.

Self help guides get this wrong. They say that to preserve sanity, you need some time for yourself; they say new moms need some "adult conversation." That is counterproductive.

You rush through dinner, through clean up, through idle conversation ; you're checking off your "responsibilities" so that you can get a moment to yourself. The result is you are not there, you're passing through, emotionally, until you can get to what you think you want to get to.

Life is what happens while you're trying to get to the computer.

A lot of people are going to disagree with me, and they are wrong. First, understand that your family is all there is. There is no break, there is nothing else, there is no "adult conversation." It is possible you may never golf again. The kids aren't the distraction-- everything else is the distraction. If golf is a pleasant diversion that doesn't cause you to rush through family life in order to get to it, then it's ok. Otherwise, it's out. Otherwise you will be rushing through family life to get to course. And you will miss out on the family, and will still not get any real relief from golfing.

Once you have accepted this, you can then proceed to step 2: decide on two or three "distractions" you really like, and put them into your routine, with dedication and commitment. If you are truly committed to them, your spouse will understand (and they'll have their own.) But if you pick, say, going to the gym MWF, but you yourself aren't dedicated, it will appear to your spouse that you use it as an escape only when things get tough. (Because that's what it will be.)*

I notice this sometimes when I am eating dinner with my family and feel an urge to get away as fast as possible and randomly surf the internet.

From Don’t Settle For The Man You Want

You want something uplifting, so here you go: you can never have a good relationship with anyone when your focus is the relationship. There's a human being there who existed well before you got to them, and they weren't built for you or your needs or your parents or your future dreams as an actor. If you want to be happy with someone then your body and mind have to instinctively adapt to their happiness. If you're not ready for this kind of sacrifice, then you're simply not ready.

When you find yourself hating someone (who did not directly hurt you) with blinding rage, know for certain that it is not the person you hate at all, but rather something about the that threatens your identity. Find that thing. This single piece of advice can turn your life around, I guarantee it.

Reading The Last Psychiatrist has been a bit of transformational experience for me. It is easy to think of myself as a good person just because that’s the person that I want to be and like to imagine myself as. But am I actually good? Do I make altruistic choices even if they come at my own detriment? Thinking about these questions made me realize, that while I am not actively bad, I am not actively good either.