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.
If the Supreme Court could decide that a “living constitution” reflected the failures of laissez-faire capitalism in the 1930s, which is what we’re told it did, then why can’t it decide that a living constitution must recognize the failures of big government in the 21st Century?
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).
A whole pisspot full of computers are going to lose their Internet connection this July 9th. Let's find out if yours will be one of them.
It's actually kind of a bizarre story. Your computer connects to the Internet using DNS numbers. Some bad guys in Estonia ran a fake advertising scheme and infected a shitload of computers around the world with a DNS hijacking program which changed the computer's DNS numbers. It would still connect with the Internet just fine, albeit occasionally the user might find some new browser window open advertising this or that, which is how the bad guys made their money.
Enter the authorities, who catch the bad guys but then are faced with a problem. If they had just confiscated their servers, every infected machine on the planet would have immediately lost its Internet connection — and without the owners having the slightest idea why.
Rather than risk global anarchy, the FBI substituted the servers with some rental servers to give people time to clean up their computers, but time is running out and the servers are going to be unplugged this July 9th. There's already been one court-ordered 'stay' of 3 months, and it doesn't look like there's going to be another.
The reason anti-virus programs don't catch the little rascal is because it's not actually a virus; it's not even a program, just a web file. The second someone clicked on the original fraudulent ad, the damage was done. No file was ever downloaded so there wasn't anything for the anti-virus program to analyze and stop.
If so, head here for some fix-it tools, and please let us know in the comments which tool you used and on what operating system.
Mac users: If you use a browser with a Windows emulation program, check the FBI file for how to access your DNS numbers so you can compare them to the above list. If you're not running emulation, don't worry about it.
Router users: Check the router section in the FBI file. The router has its own DNS numbers that need to be manually checked against the list.
I suppose I should note the historical impact of the event. While there have been innumerable viruses, worms and trojans over the years that were expected to ignite on a certain date, creating Gawd knows what kind of havoc, almost none of them ever panned out. This time, however, we're being given a specific date and it's a damn good guess it'll actually happen.
Most voters don't know what the heck is going on, and don't care very much. We often forget this although in ordinary life we encounter such ignorance every day. Friend Sissy recently objected to my pointing this out, but I will stand by my first-hand impression.
Our readers seem to be highly-informed and engaged about policy, but pols know that such voters do not matter much.
Ilya discusses informed and uninformed (and uninterested) citizenry in his usual charming and amusing way, below:
My post at The New Criterionis up, “Judaic Studies and Western Civilization”. Judaic Studies in one form or another for centuries was a core subject in college curriculum, in order to best understand the West's Judeo-Christian civilization. Now, Judaic Studies has faded from centrality, as has much of the focus on Western civilization. That focus in Judaic Studies is what is needed to reinvigorate student interest and to keep Judaic Studies from degenerating into the sort of PCism and irrelevancy of other studies departments.
While visiting The New Criterion and enjoying its always interesting literacy, I encourage you to click its Donation page.
For those who refuse to click over to read my piece at The New Criterion, it is also below the fold.
For every person who says “I’m unhappy” there must now be a thousand who say “I’m depressed.” The change in semantics is important: the person who says he is unhappy knows that there is something wrong with his life that he should try to alter if he can; whereas the person who says “I’m depressed” is ill, and it is therefore the responsibility of someone else — the doctor — to make him better.
For the sorts of Psychiatrists who find it valuable to probe below the surface, there are many sorts of depression and many causes. Even grief can sometimes lead to a debilitating depression.
In my private office, the most common "cause" of agonizing, if not always debilitating, depression is narcissistic injury. These patients often can benefit enormously by psychotherapy alone, and can end up far healthier and stronger than before.
Since unions are non-profits, I have never understood how they can legally engage in partisan political efforts at all. But what do I know?
Forbes says:
The most far-reaching effect of the decision may be the court’s requirement of an opt-in system for public-sector unions when they impose a special assessment or dues increase. The court seems to be carving out a special case for public-sector unions, perhaps because of the political power they have to elect politicians who will serve their interests and diminish the political power of employees who disagree with them.
The simple truth why there are so many national security leaks is that the prime actors -- government officials, Congress, the media -- want them or are unwilling to stop them.
The current spate of serious leaks is not the first time this has occurred. There were major leaks during the Bush administration damaging to the post-9/11 ramping up of anti-terror activities, with no punishment of the offenders. By comparison, the leak of Valerie Plame’s not-so-secret CIA employment became the subject of a Special Prosecutor, and abuse of that process. These two examples revealed that prosecution and follow-up on leaks depended on whose political position was furthered and whose political ox was gored rather than the actual damage to national security.
There are laws on the books, federal agencies with the responsibility, and contracts signed that can be used to find and bring leakers to justice. Justifiably, national security professionals and front-line Special Operations forces have protested the lack of enforcement. Self-servingly, media has demanded even more impunity via a federal shield law. Partisanly, Congress has abdicated its oversight role. Avoidingly, Presidents have mouthed platitudes or claimed innocence.
The abdication of responsibility by those responsible or who should be deeply concerned about national security during the Bush administration has been taken to blatant new depths by the Obama administration’s re-election campaign.
The obvious truth is that these and other leaks are rarely the result of independent investigative reporting. Rather, someone in power secretly goes to the media with the damaging details, either to obstruct policy or to garner support for their own political ends.
Former US Attorney General Michael Mukasey writes...
This is from back when F&F was ordered by Obama in 2009 (thanks, reader):
Thus, a lousy and aggressive, if reckless, border plan, OK'ed by Obama and Holder, that resulted tragically. A fatal SNAFU, resulting in American deaths and many Mexican deaths. Why not just say so? Admit a well-intentioned but ultimately tragic error. That is termed "manning-up." There is nothing much to conceal here that I can see.
Unless there are tons of unfortunate emails about the PR approach to the mess that would be embarassing to the Administration. Stupid, unnessary cover-up? Stupid, stupid, stupid. Or am I missing something?
This is stupid stuff. The Admin's covert leaks to the media are the bigger scandal. This is a sideshow, despite these terrible and unnecessary deaths. Nobody died in Watergate.
In the case of universities, the anti-elitism strategy has been to insist that the degree experience become a near-universal benefit. At the same time, the belief has to be maintained that the whole thing is still in some way a major achievement, a reason for enhanced self-esteem. (This, of course, generates the familiar prizes-for-all inconsistency.)
The nagging doubt remains: as long as it is not literally for everyone, and as long as there are some institutions which are more exclusive than others, there is something about universities which is at odds with the prevailing ethos of perfect, Facebookish horizontality.
It is this ambiguity which seems to keep the what-are-universities-for programme busy, and makes boggling about the question so appealing. Nothing is said which contravenes the basic pseudo-egalitarian ideology, but a certain frisson is generated by juxtaposing mutually inconsistent requirements...
"The deficit spending the Greek government wants to do is almost-entirely suppressive or neutral to GDP - it is spending by government, for government, on government. The population is shrinking, their internal revenue picture is already dreadful and only getting worse (because they have the worst ratio of producers to consumers of tax funding in the civilized world, and getting worser) and the only way any government of Greece can survive and keep the mayhem in the streets down to acceptable levels is to restore the drunken-sailor approach to public spending that got them into trouble in the first place. This means 14 monthly pension checks a year, retirement at 50 for workers in hazardous trades like hairdressing, and all the other 1,001 ways they managed to bankrupt themselves already."
The MSM pundits always wail about "ungovernable" when their pets fail at their jobs. I remember when NYC was said to be ungovernable when Dinkins was mayor. It was amusing and gratifying to see how governable, prosperous, and civilized NYC became when Giuliani was elected.
What is a "college education" in America, these days? Seems to me that there is no such unitary thing, and that it can mean almost anything. As I have mentioned here in the past, I have interviewed college grads who could not do calculus or even explain basic statistics, read a foreign language, or write a grammatical, well-structured formal essay. These basic skills can be achieved in high school, by those who want to learn stuff.
Or easily achieved in the library or on the internet. Not everybody is driven to learn things.
There's a debate going on these days about the notion of "college for all," and Robert Samuelson has been scoring points.
College for All, of course, entails extensive remediation for kids who are not prepared for, or capable of, "higher ed" as we older folks think of it. It also entails lowering expectations and standards. I don't blame the schools - I mostly blame the students. There is no such thing as "getting an education," because all learning is ultimately self-education. Without drive, curiosity, discipline, determination, and IQ nothing valuable will happen.
The education industry, naturally, markets itself and wants to fill all of their seats with warm, paying bodies even if they are not capable of serious high-school level achievement. Here's a summary of the current debate on college-level remediation.
A History of Women’s Bathing Suits
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.
A whole pisspot full of computers are going to lose their Internet connection this July 9th. Let's find out if yours will be one of them.
Sex in the park
Impact of Student Debt on Future Housing Demand
