We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Tuesday, June 26. 2012
I lay on the grass, counting tweety-birds, after falling off the top step of a 12-foot ladder while trimming a tree in the front yard, my 12-year old son’s concerned face looking down at me. My father, who could and did do anything he set his mind to, until the day he died in his eighties, also stared down at me. At 64, I had something important to live up to and pass on to my son, so I forced myself to get up, smile, and say, “let’s get back to work” (ibuprofen to secretly follow later).
“NEVER NEVER NEVER GIVE UP reads a plaque behind Dole.” So ends a respectful interview, “Great American”, with 88-year old former Senator Bob Dole by an otherwise snarky toward Republicans young lady from GQ. The young lady can't let go of the diminished physical condition of the man before her, but can't hide the respect and awe at his life. From athelete to crippled veteran to candidate for President to helping today's war wounded, Bob Dole gave all of himself, which stands tall before her.
As it so happens, this morning brought home that message from several other accomplished old men interviewed by my local newspaper, stirring me to talk about other old men and women with whom I spoke or chat with now on the phone. Their politics vary but they all came from impoverished roots here or abroad, are self-made, involved themselves fully in our national life. From my youth to now they share their anecdotes with their younger friend, from my callow days to me now at 64, as I sat or now sit figuratively enthralled at their feet listening. In their twilight years, still, they never never never give up, regardless the challenge, price or risk.
It’s their sense of duty to things greater than themselves, their love of country, which has animated them from youth to old age, a sense of humility before the obligation to pass on a better, stronger, decent world in which the only limitations are those placed on self. From famous labor leaders and former communists or socialists to industrialists to globe-trotting journalists and diplomats to national political figures to best-selling artists, authors and academics, all of their eyes sparkle and inspire as their self-effacing words did and do inspire me.
I met Bob Dole in the early 1970s, at the height of his political power, as he took the time to encourage me. I met the others either at the height of their successes or after. They took time to talk with me, answer my ignorant questions with enlightenment, and kick me in the ass when I dithered or wandered. I could list their names and the lessons they shared with me, but that would fill another several thousand words to even be very brief.
After years of hectoring him to write down some of his encounters with the famous and formative people who he met as an international journalist from the last days of WWII to now, a friend and mentor is now doing so. I hope to help him get it published. He laughed at me for constantly needling him to set his anecdotes down, saying no one cares anymore. I find myself saying similar to younger friends who similarly needle me to write it down. Maybe I will...if I make it to my eighties. You probably had or have similar people in your life. They need to be reminded that someone cares and many more will care if you help their lessons to be remembered by passing it on.
And, amazingly, the Yankees don't want me.
I mean in the musical sense, of course. And, after a thorough, exhaustive 2-minute search through Wikipedia, it appears the precise nature of my affliction is known as 'relative pitch', or, in medical terms, relativepitchitis. That is, I can hear a note being just the teensiest bit off.
My first clue that I was crippled with this life's burden was when a group of us rowdy college students went up to Seattle and visited the World's Fair, which had taken place a few years earlier. Space Needle and all that. There was a machine that would issue a tone for a few seconds, then you tried to match it exactly using a variable dial. I was the only one of five who could do it, and did it three times in a row.
It's been pretty much downhill ever since.
When I walk into a night club with a live band, everyone else is thinking, "Hey, what a great lead guitarist!" Me, I'm thinking, "His high E-string is a little flat! Ouch! Ouch! Ouch!"
Cursed, I tell you.
Which brings me to Barbra Streisand, Celine Dion and Sarah Brightman.
And the brightest new star in the summer sky.
Continue reading "Introducing Jackie Evancho"
Posted by Dr. Mercury in The Culture, "Culture," Pop Culture and Recreation at 09:00 | Comments (65) | Trackbacks (0)
Those two peacocks are the same color
Your lying eyes
“The decline of America began with the replacement of hamburgers and bourbon with quiche and chardonnay.”
How Bt Corn And Roundup Ready Soy Work - And Why They Should Not Scare You
Viewing Images of High-Calorie Foods Brings On High-Calorie Cravings, Research Finds
What is So Good About Growing Old
Everybody must get stoned
"Economic freedom is the best tool man has ever had in the perpetual struggle against poverty."
"I have written before of my belief that climate has become the first post-modern science."
Via Insty, Government wants more people on food stamps
Road to serfdom
FBI Tracking 100 Suspected Extremists In Military
MITT ROMNEY, A MODERN DAY FITZWILLIAM DARCY?
Decline In Obama's Chicago Clue To His Second Term
Arizona Senate President says Obama is acting like a 'spoiled child
Egypt's Lesson: Incitement is Not a Secondary Issue
Yeshiva University Team Discovers the Arch of Titus Menorah's Original Golden Color
A Hamas victory at the UN Human Rights Council
The pupette went to The Governor's Ball on Saturday. Why not?
Monday, June 25. 2012
..."I'll say this, I don't give a damn about your dreams."
Thunder on the Mountain. How good is this? A masterpiece, in my opinion. The punch of the lyrics and the punch of the tune, plus the way the more recent Bob records sound under-produced. "I got the pork chops, she got the pie, she ain't no angel and neither am I..."
It should be a piece of cake for our literate readers: How's Your Grammar?
I missed one. Shame on me, as a college graduate.
Despite the wishes of the Left, free speech remains foundational in the USA.
What is amazing to me is that there were any votes on the Supremes opposed. Why would anybody in America want to squelch voices and opinions? Unless they have contempt for the peoples' opinions?
It's a sickness, and it has a foothold, but not quite a majority, on the Court. We The People need all points of view, and we have the duty to apply our BS Detectors and biases as best we can. Seems to me that politicians are the biggest purveyors of self-interested BS, but their expensive speech cannot be outlawed.
While putting together my Penn & Teller: Fool Us post, I couldn't help but notice how striking the background music was in the fourth clip. I eventually hunted it down and discovered it was the main theme song to Andrew Lloyd Webber's 1986 remake of The Phantom of the Opera.
Since this is a musical, not a movie, there aren't any videos of the entire song being sung by the original performers, Michael Crawford and Sarah Brightman, but they gave a live performance at the 1988 Tony Awards that featured the last verse of the song, merging into the musical's second-most popular tune, 'Music of the Night'.
Since we here at Maggie's Farm aim to be the best darn-tootin' blog site around, offering the Maggie's Valued Readers™ (that would be you slobs) something that no other site in town has to offer, I've employed the wonders of digital magic to combine the sound track of the first part of the song from a YouTube clip with the clip from the Tonys.
Maestro, take it away.
That crowd certainly got its money's worth.
The lyrics to the theme song are here. I have another clip below the fold.
Continue reading "'Phantom' mini-tribute"
Posted by Dr. Mercury in The Culture, "Culture," Pop Culture and Recreation at 09:01 | Comments (7) | Trackback (1)
Image above: Matisse's 1906 Le Bonheur de Vivre. It's in the new Barnes Museum in Philly.
Is food medicine? Immortality is but a diet away.
Putting Failed States on the Map
Morsi Says “Our Capital Shall Be Jerusalem!”
Romney Is Mr. Normal:
Rex Murphy on Obama: America’s celebrity president
The Obama campaign never sold Obama; it sold the idea of Obama.
Obama/Biden campaign hit bottom with wedding gift appeal
NYT: Democrats shocked to discover that 2,700-page Obamacare bill that no one read or understood could be ruled unconstitutional
How ObamaCare Increases Income Inequality
Hmong pilots saluted in Maplewood
Sunday, June 24. 2012
Special Operations Speaks website has received 750,000 hits in just two weeks. If you know anything about blogging, that's simply incredible sightings. If you know anything about how President Obama's re-election campaign has exposed secret operations, tactics, intel, and allies, in order to make Obama look like something else than a foreign affairs wimp, then please go to the site and sign its petition. Meanwhile, there's lots more coming. Stand by, Obama, incoming.
Well, it's about women but it might as well be about men. In a sense, everybody wants it all, but everbody's "all" is different. Furthermore, there is this annoying thing called reality which always gets in the way of wishes.
As Insty points out, this is a middle, or upper-middle class, demand/expectation: The Soapbox: Let’s Stop With This “Having It All” Crap
Peter Robinson interviews Dennis Prager. I enjoy Prager, partly because he doesn't talk over my head.
Parts 1 and 2 were re-posted over the past two days.
I mentioned in an earlier post that a person's ability to adjust reasonably well to adult life does not necessarily depend on their DSM diagnosis (if they have one), but instead on their personality traits. Most of the personality traits we observe in people have to do with what we call "ego functions."
For just a few examples, what is their physical, mental and emotional stamina and endurance? What is their stress-tolerance, and how easily are they overwhelmed? How good are they at assigning themselves tasks and completing them? Are they reasonably honest, or connivers? What are their relationships like, and what sorts of relationships do they like to have? Are they socially appropriate? How sound does their judgement seem to be? How do they do with maintaining boundaries? How smart are they? How flexible is their thinking? How do they do with delaying gratification? Are they reliable or erratic? How self-regulating are they, or do they depend on external structures to function well? How often do they make excuses or blame? What do they want out of life? What motivates them? Do they have wholesome outlets? Are they emotionally mature? How do they view themselves, and how consistent is that with the reality?
Furthermore, what traits are out of line and give the person trouble managing life?
As I mentioned before, it is foolish to hold any standard of human perfection: I call that Psycho-utopianism. Let's just say that we are interested in a person's profile.
For the final post on the topic pf Psychiatric Diagnostics, let's take a closer look at Leo Bellak's list of ego functions, from Dr. Blatner's site which I linked last week. (It's not the best list. I wrote up a better one years ago, but cannot find it.)
When we try to assess these things, we know that we are looking at surface manifestations, not at what is going on in depth. Like geologists gazing at a landscape, we speculate about what is underground based on what we see above ground, and then test our speculations with test drilling.
Modern Psychiatrists and Psychoanalysts often tend to focus on the "Object Relations" item, believing that, developmentally, the integration of mental relationships effects the stability and integration of the adult person (and that aberrations can be improved with Psychotherapy). I am a friendly skeptic about that, and more inclined towards the genetic basis of personality traits (which by no means implies that they are immutable).
OK, I am going to avoid depth psychology here because my purpose with these posts was to give a sense of the sorts of things shrinks think about when they evaluate somebody and not about Psychotherapy or Psychoanalysis. As for the medical students who will not specialize in Psychiatry, these sorts of methodical ways of thinking about people are quite practical, not especially theoretical, and, I believe, useful to everybody in their dealings with others.
Photo is Anna Freud, the more-or-less founder of Ego Psychology.
I took Chemistry from a Nobel winner chemist in a classroom of 250 eager students, many of them hopeful pre-meds. He clearly had been assigned to one undergrad class, but he didn't seem to resent it.
He had fun talking to a class of undergrads, but he talked about whatever he wanted to, whatever was on his mind. He liked to talk about how the planet was running out of oil so there would be no substrate left for medicines and organic chemicals. He said everything you need to know is in the textbook and, if you are confused, try to grab a TA.
Well, the impatient TAs had zero interest in that chore. As a result, many of us formed study groups which were great fun. I wanted to learn Chem so as not to be an ignorant person, and later took Organic for the same reason, despite being a History major. The Chem exams were a bitch. The five in my study group all got As, back before grade inflation. Science grades were curved. The reason our group did so well was partly because one of our study approaches was to create difficult problems for eachother. We'd meet at night in an empty classroom and do everything on the blackboard (remember them?).
In the Weekly Standard, Obama’s Victory Plan - The economy won’t necessarily do him in.
I am taking Sundays off from my morning links this summer.
Too many farm chores and I need to be getting to the gym early, then church. Just scroll down and catch up with us.
Saturday, June 23. 2012
Part 1 was re-posted yesterday
(This series is a peek - a few samples - into what goes on in Third-year Psychiatry in Medical School. Very few of the students will select Psychiatry as a specialty, but all do clinical rotations through Surgery, Pediatrics, Internal Medicine, Psychiatry, OB-GYN, etc. - and further elective rotations in the 4th Year. I focused on Surgery and Orthopedic Surgery in my 4th Year. The Surgeons did their best to win me over, and almost did.)
In one of the teaching sessions, we watch a video of a half-hour intake interview of a patient in the Internal Medicine clinic, done by a third-year medical student. At the end of it, I ask "Let's list everything we now know, or might speculate about knowing, about this patient."
We go through the medical history, the patient's demeanor (what's their style? Dramatic? Passive? Grouchy? Warm? Arrogant? Sneaky? etc), physical appearance, dress, posture, eye-contact, tone of voice, nature of his interaction with the interviewer, apparent intelligence, knowledge about health issues, work history, family, special concerns, and so forth.
The students who have been science nurds and wizards are often astonished by how much information can be collected from a simple half-hour medical - non-psychiatric interview. I write it all down on the whiteboard, some as facts and some with a ?.
It usually fills the entire board, especially if I write large enough.
In Psychiatry, we have no high tech diagnostic tools - just our eyes and ears.
Moving to Psychiatry, let's assume that we are meeting with a patient in the Psychiatric consulting room - a new patient who does not require any sort of acute crisis intervention or triage. What do we want to know about this new patient right away, after they tell us why they are here?
First things first. We want to know about their general health. That is from their story, and via eyeball. (Over the years, I have diagnosed hypothyroidism, brain tumors, Lyme disease, MS, GI cancers, Parkinson's Disease, early Dementia, etc. in people who have come to me for Psychiatric help).
Then the obvious things. Their life story, their family history, their current life situation. We assume we are never getting the whole story, but we need a provisional frame for the picture. In the process of asking our questions and following up topics of interest, there are a number of other things we get from initial interviews, using our bag of tricks and our sensitive ears, which are solid data.
For some examples:
- We determine how self-observing they are, their capacity for "insight"
(These are the sorts of observations that make some folks uncomfortable with shrinks in social settings. People are often not aware that when we shrinks are out of the office, we probably think about these things less than the average person. For us, it's work.)
The point is that the Psychiatric interview is just a variant of the medical interview, but one which usually takes more than a half hour. Sometimes, much more. With healthy patients with neurotic problems, sometimes it can take me 5 or 6 one-hour meetings just to come up with a provisional case formulation and treatment plan (if needed). With very ill patients, 3 minutes can be enough to make a triage plan (eg Agitated guy fighting with security guards and cops yelling that they are CIA trying to implant more transmitters in his brain. Easy. Get the guards to hold him down and give him IM Haldol and Ativan with a little Cogentin...and wait a while.)
What's our goal? Our goal is a thorough Psychiatric Diagnosis and a Case Formulation. In medical school, in Psychiatric Residency, and in an Analytic Institute you have to write these up as lengthy formal presentations, but at my stage you just kinda do it in your head and store it in your head, except in special circumstances.
As rank amateurs, medical students cannot be expected to do either of these in an expert way, but we require that they produce a couple of these on some of the patients they are following.
For Diagnosis, I ask the students to use Dr. Blatner's The Real Psychiatric Diagnosis (just one page) as an outline.
For Case Formulation, I ask them to use his The Art of Case Formulation.
I like Dr. Blatner's brief outlines because the focus is on portraying and understanding a patient, not just slapping a superficial label on them.
Part 3 tomorrow.
Photo: Harvard Prof Dr. George Vaillant, author of Adaptation to Life - another of the books the students read during my course.
Genius Israeli scientists have produced a medical marijuana without THC.
I'm sure this will be a big hit.
Maggie's Farm readers are frequent guests of Bird Dog on his visits to the arts in Manhattan. I was shocked, really, actually shocked, when Bird Dog told me he'd never been to Brooklyn. By itself, Brooklyn is the 4th largest city in the United States. About 10% of Americans' families trace their families to originally being Brooklynites. Many of America's most famous celebrities hailed from Brooklyn, ranging from the early Dutch settlers who also bought Manhattan for trinkets and Thomas Paine, John Greeleaf Whittier and Walt Whitman, Mae West and W.C. Fields, George Gershwin and Aaron Copeland, John Steinbeck and Joseph Heller, Woody Allen and Barbara Streisand (my sister was at Erasmus Hall High School with her, Erasmus having the highest number of Westinghouse and National Merit Scholars in the nation), Lena Horne and W.E.B. DuBois, Gil Hodges and Sandy Koufax, to .........the list goes on and on. It contains top flight colleges. Prospect Park rivals Central Park. Its restaurants and arts are world class. There are far more beautiful brownstones than anywhere else. And, then, to top it off, its beaches have been New York's summer playgrounds and winter strolls for generations. One of those beach communities, next to Coney Island, is Brighton Beach. My grandmother and, later, my mother, in their old age lived in Brighton Beach highrises looking over the Atlantic and if you craned your neck you could see the Statue of Liberty. Here's a terrific photo homage to the Brooklyn that I grew up in. The video below is about Brighton Beach today, a thriving enclave for Russian emigres. They settled there because most were Jewish and the area was Jewish.
Bird Dog, doggit, you've got to get thee to Brooklyn, often. Manhattan midtown is where people not from New York City hang out, missing the real New York City.
The beautiful Friesian horse
You overweight folks are damaging the planet
Should people be taxed by the pound? By the UN, of course?
Alert! World on the verge of chocolate crisis
What sorts of people are in super-max prisons?
Microsoft Surface Could Totally Change the Tablet and PC Markets
Checking the APA's Findings on Homosexual Parenting
Back to the City - Young millennials prefer urban living, says Alan Ehrenhalt.
Cities are much more fun for young single people
Tinsel Town has hijacked Obama’s campaign
They bought it, they own it
Europeans hate to work
Europe’s Self-Inflicted Decline: French Taxing, Italian Regulating, Greek Mooching, and IMF Economic Illiteracy
Obama Wants Your Birthday Money & Wedding Gifts
You Lefties know the answer.
Napolitano: Can the President Rewrite Federal Law?
California high speed rail is dead
Obama widens Latino voting gap
Doctor Claims Euthanasia Significant Part of British Health System
Obama’s lies and the media’s betrayal
What’s Happening in Iraq After the U.S. Withdrawal? An interview with Aymenn Jawad al-Tamimi, an Anglo-Iraqi political analyst
Sorry, Washington Post, Romney didn’t get rich moving U.S. jobs overseas
Friday, June 22. 2012
Ed. note: We will post each of the 3 parts daily.
These posts are bits from a short series of presentations which I give to medical students during their required Third Year Psychiatry rotations. Which is to say, it is more or less directed to the general public but oriented towards general-physicians-to-be.
(Very few of these medical students will choose Psychiatry as a career, given all of their choices. More of them will chose Radiology than Psychiatry - wherein they will have plenty of fun and much to learn but never even have to talk to a patient at all - or Dermatology, wherein they will never have to be on call for the hospital. However, most will select Internal Medicine for their internships, which itself is a path to other specialties. FYI, all American-trained Psychiatrists do internships which include Internal Medicine or Pediatrics, plus Neurology, and get Board certification from the American Board of Psychiatry and Neurology.)
My presentation is not about making specific diagnoses (that comes from other Profs) - it's about the preliminaries: how all Docs can think about their patients, if they want to, and how shrinks think about their patients.
It's partly meant to be a corrective to the often-stated idea that the DSM is any gold standard of diagnosis, and it is meant to encourage young docs to think about their patients' lives, not just about their diagnoses - whether psychiatric or otherwise. And if I can interest them in the sorts of things shrinks think about, and gain some appreciation for what shrinks do, so much the better.
My presentation is based on the idea that, in the end, the job we shrinks get paid to do is to figure out what interferes with a person's ability to make a reasonably mature and effective adjustment to life if they wish to do so, and to try to reduce pathological mental pain, impairment, and anguish (but not healthy pain, worry, and anguish, like guilt, regret, sadness, realistic anxiety, or grief).
It's not to try to make people "normal," because "normal" doesn't really apply. People are wonderfully different, each with his own unique fingerprint of strengths, weaknesses, neuroses, interests, abilities, ego strength profile (about which more later), etc. In fact, unusual characters are a fine addition to the fabric of life.
I usually end my first session with a case example, for example, of a 42 year-old patient with hypertension coming in for a routine follow-up with his internist or GP. He has been prescribed 20 mg of Coreg/day for a month, and his systolic BP is 170 (had been 180 at his last visit).
I do my rapid-fire Socratic shtick. I ask them "So, Doctor, what do you want to know about this guy?"
"Is he compliant with the meds?" somebody wonders.
"Compliant!" I say. "What is he, your servant?" "Isn't the right question whether he is concerned enough about it to take the pills every day? Whether he can afford the meds? Does he need your free samples? Whether his life is too disorganized to do it? Whether it's the right medicine or the right dose? Or whether he even cares?"
We go on like this for around ten or fifteen minutes, and end up constructing a picture of a middle-management sales guy who is recently unemployed, divorced with two kids, mildly depressed, worried about money and alimony and child support, living in a small rented condo with rental furniture on take-out junk food and Chinese food, with some tendency for denial because he feels overwhelmed, with some deterioration in his self-care since his divorce made worse by the lack of structure and discipline in his unemployed life. His BP is the least of his concerns, but he does want to maintain a good relationship with the Doc, who he views as a friend and as a caring emotional support.
You rapidly move past the notion of A Case of Hypertension to the uniquely human and individual. It's good fun for all of us, and a good break for them from the fascinating but mechanistic details of caring for the renal functions of unconscious gomers in the ICU. It's about the art of doctoring, not medical science. You cannot do medicine "by the book," because each patient is his own book.
Then I tell them that they have just made a first step towards Real Psychiatric Diagnosis - and the real practice of clinical, office medicine as opposed to our equally wonderful technological medicine. It's about wondering "Who is this person who is asking me for help?" and not just about "What ails them?" After all, hypertension is painless, and doesn't really "ail him" at all. If you want to help this guy, all of this information about him might be useful to you.
In conclusion, I warn them that the same thing applies to Psychiatric diagnostics. Some people with Schizophrenia - a dread and incurable disease - have more satisfactory lives than some addicts - a sort-of fully curable problem. People are complicated, and so, often, are their lives.
Then I command the students to read MacKinnon and Michels' The Psychiatric Interview as their first of several readings for my series. A Psychiatric interview isn't much different from any other medical consultation with a new Internist or Family Doc, really - except no physical exam other than that of the well-informed medical eyeball (which can detect a lot).
Yes, I will interrogate them on their readings just as the Surgical Profs do with their text on the examination of the abdomen, or Neurologist Profs do with the diagnosis of stupor and coma (or, as we termed it in medical school, the Diagnosis of Stupor, Coma, and Death. Funnily enough, the diagnosis of death isn't always so easy).
Parts 2 and 3, and maybe 4, later. Why am I posting this? To help me collect my thoughts and to improve my presentations.
Photo is Dr. Emil Kraepelin, father of modern Psychiatric diagnosis who, among many other things, distinguished Manic-Depression from Dementia Praecox (Schizophrenia).