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.
Except for some clearly defined, obvious ailments (eg dementia, the schizophrenias, PDD, autism, addiction, melancholia), most diagnoses in the handbook (the DSM, which many of us refer to as "the insurance manual") attempt to define common clumps of symptoms or behaviors without assuming any validity (ie, without any assumption that the clumping refers to any one cause or underlying abnormality) to those clumps.
Many of our "diagnoses" are akin to saying that a patient has a fever. There's a problem of some sort, but you don't know what it is yet, or whether it's serious or not. Lots of them are "life problems." The DSM is, sorry to say, largely pseudo-scientific. That's because we have very little validity to demonstrate.
Since the validity of most of our diagnoses cannot be tested in any way, all people do is to test their reliability (ie how often will two docs make the same diagnosis in a given patient). In a sense, measuring reliability is nothing but a measure of group-think and, in Psychiatry, the reliability of our diagnoses is quite low - in the "poor" range. (This is measured by a "kappa" score of inter-rater reliability.)
Landis and Koch45 have proposed the following as standards for strength of agreement for the kappa coefficient: ≤0=poor, .01–.20=slight, .21–.40=fair, .41–.60=moderate, .61–.80=substantial, and .81–1=almost perfect. Similar formulations exist,46–48 but with slightly different descriptors. The choice of such benchmarks, however, is inevitably arbitrary,29,49 and the effects of prevalence and bias on kappa must be considered when judging its magnitude.
OK, Psychiatry has only a few rare spots of validity, but even its reliability is mostly in the "poor" to "fair" range. The good Psychiatrist here discusses the abysmal reliability of Psychiatric diagnoses.
As Robin Hanson discusses, Psychiatry uses "depressingly low standards" for reliability. Indeed, most of the time Psychiatrists disagree on how to label a given patient because few patients fit the molds, and most sort-of "fit" multiple categories. Furthermore, many diagnoses fade imperceptibly into normal variants: ADD, anxiety, mild depression, pbobias, PTSD, Bipolar 2, and OCD, and personality disorders, for some common examples. (I recently read that 40% of people have some obsessional symptoms at some point in their lives.)
In Psychiatry, you have to be able to tolerate ambiguity. It's not a mechanical profession except for the amateurs. Most if not all people on the sidewalk are at least what we might term "normal-neurotic" in some ways.
As a result, the American Psychiatric Association recommends that the DSM not be applied clinically in the cook book manner in which it is written, but as a guideline to which clinical experience - and understanding the patient in as much depth as possible - inform one's clinical impression. As Dr. Frances says, "It's not a Bible," and should not be applied as if it were.
Indeed it is not. Scientifically, it's mostly a failure but it's a kind of casual dictionary. I do not take it too seriously, and often use diagnostic descriptions which do not appear in the DSM (such as "neurosis"). I can usually find a way to help people anyway, regardless of how I might label them (and often I do not bother to label them at all). Generally, the more clinical experience a doc has under his belt, and the more psychodynamically-oriented he is, the less seriously he takes the diagnostic obsessional nit-picking.
We muddle through, struggle to understand, and still are able to help lots of people in the end. A true diagnosis of a patient goes far beyond anything in the superficial DSM. For example, a real diagnosis must consider the nature and quality of somebody's "object relations," their character strengths and weaknesses, their sublimatory capacities, their defensive structure, their superego functioning, etc. etc. In other words, really knowing what a person is all about.
...the single-mother revolution has left us with the following reality. At the top of the social order is a positive feedback loop, with kids raised in stable, high-investment, and relatively affluent homes going to college, finding similar mates, and raising their own children in stable, high-investment, and relatively affluent homes. At the bottom is a negative feedback loop, with kids raised by single mothers in unstable, low-investment homes finding themselves unable to adapt to today’s economy and going on to create more unstable, single-mother homes.
Not only do we have more poverty, inequality, and immobility; we have the makings of a caste society, with an inherited elite and an entrenched proletariat. That’s not an America that anyone finds very attractive.
Raising kids as a single parent is something that only extraordinary people can do well.
The obesity epidemic is a convoluted way of saying that the problem with government health care is the people. But that's not the problem. Obesity may not be healthy, but if we ban sodas and force everyone to exercise in the yard before work, the numbers still won't balance. Because the real problem with government health care is government.
When offering a product or service, the most elementary thing to do is calculate the cost of making the product and the price that people are willing to pay for that product. If you can't bring the two together, then you don't have a product. You have a disaster waiting to happen.
Obama promises the progressive agenda — more executive aggrandizement, more marginalization of Congress, more latitude for unaccountable experts to supervise our lives, more regulatory suffocation of society. Romney promises the reverse.
...consider ... that we were born into the freest, strongest, and wealthiest nation that mankind has ever known—and elected as our president a man who promised to “fundamentally transform” it.
Yes, I think that may have been where we made our mistake. We wished to have an orange for a head.
To the extent that these unions shape the Democratic agenda, Democrats aren’t just the party of government; they are the party of inefficient, expensive, unresponsive, bureaucratic government. They are the party of government workers first and foremost, and if there is a clash between the interests of the providers of government services and their consumers (between, for example, unqualified, unmotivated life-tenured public school teachers and kids), the unions come at these issues from the standpoint of protecting workers first, others second.
In terms of the blue social model, they are the party of the bitter clingers: the power of public sector unions among Democrats is a power that inhibits Democrats from putting forward innovative, future-facing ideas (about schools, health care, and so on) and keeps them focused firmly on the defense of the past.
The left’s analysis of its loss in Wisconsin resorts to some classic tropes: it is despair masked as defiance in order to avoid deep introspection...
A rational Liberal, is Prof. Mead. Slick writer too.
Harvard's Michael Sandel is a rock star political/moral philosopher. I've never read him. All I know about him is from this review of his new book, What Money Can't Buy, in The Guardian.
So just a brief thought about the article, not the book. It seems to me as if Sandel has created a straw man of money - or maybe of markets, and wishes people would consider more elevated, more moral views of life.
But don't markets simply reflect what people want, and the decisions and choices people make? Many people seem to want to buy his ideas, which is why his book is making him big bucks in the marketplace of the bookstores.
Sandel makes the illuminating observation that what he calls the "market triumphalism" in western politics over the past 30 years has coincided with a "moral vacancy" at the heart of public discourse, which has been reduced in the media to meaningless shouting matches on cable TV – what might be called the Foxification of debate – and among elected politicians to disagreements so technocratic and timid that citizens despair of politics ever addressing the questions that matter most.
"There is an internal connection between the two, and the internal connection has to do with this flight from judgment in public discourse, or the aspiration to value neutrality in public discourse. And it's connected to the way economics has cast itself as a value-neutral science when, in fact, it should probably be seen – as it once was – as a branch of moral and political philosophy."
"Illuminating observation"? That's new?
It may be true that profs of Economics have attempted to make their area of study as value-neutral as physics, but economics as practiced by the individual person in a free society is as far from value-neutral as can be. After all, there are "markets" in values and morals too and everybody seeks different versions of these products.
Free markets in everything, from ideas, to religion, to dating, to education, to health, to business. That's America to me. Just don't expect me to approve of your choices.
Help me out, gentle readers. What contradictions can you see in Sandel, as seen through the article?
In my post yesterday, Dr. Frances discussed "diagnosis inflation" and "medicalization" of normal life troubles. It would seem obvious that not everybody with a problem has an illness.
However, labeling a problem as an illness does help obtain insurance coverage. That may be the whole point. This topic is discussed briefly here.
While leaning against a wall sweating after my heroic aerobics the other day, at 5:45 AM, I decided to interview a sweet little (but muscular and fit) trainer about some details on the roughly 60 people who show up when the doors open at 5.
She told me that it is not the same people every day, but it tends to break down like this:
- around 1/3 are Moms who do an early work-out before going home to make breakfast for their kids (while Dad is still home and the kids are sleeping). She said this early-bird approach is increasingly popular with Moms around here, where men typically leave for work at 6 or 6:30. - most of the rest of the folks, 50-50 men and gals - are there before work, with their dress clothes with them on hangers
Plus
- about 7-10 muscular hunks doing weight training - mostly guys but always a couple of gals - and usually an "anorectic or two" on the treadmills
The truth is that union ranks are collapsing as former members are now choosing to opt out. The AFT chapter in Wisconsin lost 6000 members, and AFSCME, the key union of state workers, saw its membership rolls drop from a high of 62,818 to 28,745. If those workers really saw a benefit in union membership and they believed in its principles, they would have stayed members even if dues collection was now voluntary. But these former union members chose to desert the ranks, preferring to keep the extra thousand dollars or so they would have given to the union and to put it in their own pockets.
Since the death of Mao, the People’s Republic of China has almost never hesitated to sign and ratify pacts, conventions, and treaties—and at the same time violate them.
The point remains: Sovereignty belongs to nations, and the European Union is not a nation. The solution to Europe’s economic crisis will belong to nations, not to the union of nations. The euro is not a national currency. As such, it is bound to be challenged. Greece is likely to present the first challenge. Others will follow. The nation states of Europe were never going to sacrifice themselves for the euro or the EU. What we see in Europe today is an old truth playing out. Power most effectively resides in the nation-state, not in the bloodless creation internationalist dreamers.
Dr. Francis, who had been an editor of the DSM 3 and Editor of the 4, and was a teacher of mine back in the day, discusses some of the current diagnostic craziness related to the DSM 5 (h/t to 1 Boring Old Man).
His talk also contains some good general comments about Psychiatric medical practice, for those who might be curious about it. Sensible fellow, and articulate without teleprompter.
I will post some more items about diagnosis this week for the two or three readers who find the topic interesting.
Despite the cultural storms and waves, it it is the daunting job of royalty (or at least of Brit royalty who are currently, sort-of of German origin despite being Brit in culture and manner) to make the best stand for the core values of duty and service.
I have never met the Queen, but I have always liked the cut of her jib.
The Queen of Duty - In an era of irresponsibility, Elizabeth Regina always does what is expected of her.
Minding The Campus blog, from the Manhattan Institute, is one of the preeminent venues for discussing issues in higher education. Today, my third annual shock at what is presented as required reading for incoming students at my alma mater and at many other colleges appears at Minding The Campus: Working Hard to Convince Freshmen They Are Victims.
I encourage you to click the link and go to the Minding The Campus website to read it, because you will find a site worthy of a daily visit.
Look around you. The late-20th-century Western lifestyle isn’t going to be around much longer. In a few years’ time, our children will look at old TV commercials showing retirees dancing, golfing, cruising away their sixties and seventies, and wonder what alternative universe that came from. In turn, their children will be amazed to discover that in the early 21st century the Western world thought it entirely normal that vast swathes of the citizenry should while away their youth enjoying what, a mere hundred years earlier, would have been the leisurely varsity of the younger son of a Mitteleuropean Grand Duke.
If converted to cash, means-tested welfare spending is more than sufficient to bring the income of every lower-income American to 200 percent of the federal poverty level, roughly $44,000 per year for a family of four. (This calculation combines potential welfare aid with non-welfare income currently received by the poor.)
He said, ‘Look, what do you care who does the work?’” Liebau recalled Obama saying in reference to her management of the law review. “’It is the same amount of work for you to hand out the work no matter who it goes to, so why fight it? Do what’s easiest for you. Give the work to the people who will do the work, and just don’t worry about the people who don’t want to pull their weight.’”
Liebau wasn’t impressed.
“I guess I was young and naïve: I was like, ‘Ah but that wouldn’t be fair,’” she said.
“And what surprised me is apparently that didn’t bother Barack at all. It was just kind of like — take the easy way out. Why bother yourself with all these silly notions about justice and fairness? Do what works. Revealing? I don’t know. Good advice? I didn’t particularly think so.”
In 1911, the poet-philosopher T. E. Hulme observed that “there must be one word in the language spelt in capital letters. For a long time, and still for sane people, the word was God. Then one became bored with the letter ‘G,’ and went on to ‘R,’ and for a hundred years it was Reason, and now all the best people take off their hats and lower their voices when they speak of Life.” I think Hulme was on to something, both in his observation about the inveterate habit of reverence and the choice that sanity dictates. I wonder, though, whether we as a culture haven’t shifted our attention from “L” for “Life” to “E” for “Egalitarianism” or “P” for “Political Correctness.”
It is noteworthy, in any event, to what extent certain key words live in a state of existential diminishment. Consider the word “Gentleman.” It was not so long ago that it named a critical moral-social-cultural aspiration. What happened to the phenomenon it named? Or think of the word “respectable.” It too has become what the philosopher David Stove called a “smile word,” that is, a word that names a forgotten or neglected or out-of-fashion social virtue that we might remember but no longer publicly practice. The word still exists, but the reality has been ironized out of serious discussion. It is hard to use straight. Just as it would be difficult to call someone “respectable” today without silently adding a dollop of irony, so it is with the word “gentleman.”
Read it all. There is all sorts of good stuff in it.
Greetings from West Columbia, South Carolina from Captain Tom.
Lake Murray is a very interesting fishery. 50,000 acres of water and all kinds of micro-ecologies from amazing pan fish through it's premier striper fishery. 20/25 lb catfish are common and bream, shell cracker, crappie and your garden variety sunfish are in abundance in dinner plate sizes. The striper fishery is incredible - again, larger specimens of this fish are not uncommon in the 30 lb range with the average specimens running in the 15/20 lb class.
Lake Murray was built in the late '20s by impounding the Saluda River and its basin at Dreher Shoals a little Northwest of Columbia, SC. At one time, it was the largest earthen dam ever constructed. Water from the dam was used to power hydroelectric turbines for a large part of South Carolina and these turbines are still in use today.
Lake Murray also has an interesting military history. The Army Air Force during WWII used the lake's islands as bombing and strafing target practice. Five bombers were lost in the lake, four were recovered at the time for salvage, but the fifth, a somewhat rare B-25C, was lost until it was found in 2003. A salvage effort was launched in late 2004, the plane raised and it is now located at a restoration facility in Montgomery, Alabama.
Lake Murray is also famous for its Purple Martin Sanctuary located on Bomb Island (approximately in the middle of the lake). As odd as it may seem, this is a major tourist attraction for the area as thousands of Purple Martins leave in the morning and return in the evening to roost over night. A lot of boaters make an evening of picnics on the water watching the evening return of the Purple Martins to Bomb Island. If you Google up Purple Martins and Bomb Island, you will see some images and an incredible radar image taken of this daily routine. I don't have my pictures of this event - took the wrong laptop with me.
Ed. Note: You can read all about the remarkable anadromous and adaptable Striper here.
A steering committee led by Joyce Moy, director of CUNY’s Asian Research Institute, ran faculty focus groups based on “identity.” The groups included “African-American/black, Asian, White/Jewish, Lesbian/Gay/Bisexual/Transgender, Hispanic/Latino, Individuals with disabilities, and Italian-American.”
CUNY targets Italian-Americans for affirmative action in response to lawsuits alleging bias….
“White,” said a Jewish professor at Kingsborough Community College, “is in every way a detriment to be categorized because of the push to hire minorities.”
Good grief. And still, it seems exclusionary to me to omit "White Native Americans" from the special treatment list.
“163 CEOs of Fortune 500 companies are former Marines, more of them having enlisted than having served as commissioned officers. When you consider that less than one percent of Americans served in the military in the last decade, understanding the causes of that ratio challenges you to think.”
Royals 
