Maggie's Farm

Daniel Greenfield asks the question Who Needs The Family?

That's easy for me to answer: I do, and I always did. A person without family, tribe, and community is a person adrift, a lone wolf, a lost soul. Governments have nothing to do with it. He says of socialist schemes:

    The state replaced the family. It told men and women that they no longer needed to make permanent commitments to each or to their parents and children. So long as they paid their taxes, the state would bear the burden of their commitments. And so men and women gave up on each other, parents gave up on their children and children gave up on their parents, the family fell apart and now the state that took its place is also falling apart.

    A building cannot be built on nothing...

At best, the merger of
romantic love and marriage is relatively recent and relatively localized.

We have posted in the past about the history of romance being converted into covenant marriage. Marriage has always been in transition, and, for better or worse, it is in transition now.

As I have said countless times here, I don't know how people can run an orderly, complicated, and productive life without a committed partner, much less create a family with all of the things family entails - finances, traditions, social life, stability, values and religion, disciplines, etc. The very wealthy always could do that, but not otherwise.

I never forget the story of how Thomas Lincoln (Abe's father, a prosperous and prominent Kentucky farmer and real-estate investor at the time) hopped on his wagon and drove to the nearest city, leaving the kids in charge of themselves, to quickly fetch a new wife after Nancy died. I believe he fetched the first widow he could find, Sarah.

Today, he would be arrested for leaving the kids on their own.

Thanks to all for all of the interesting comments on my PTSD post.

Here is an interesting link: How We Were Lied to About Health Care

I have made the case here, in the past, that PTSD is not so much a disease or "disorder," but a normal variant in response to disturbing events. The mental health field, these days, is pathologizing everything and everybody.

I have seen persistent PTSD complaints in all sorts of people, far more civilians than military. Life affects us deeply, and can shatter us, unless we are heavily armored or lacking in emotional response. I have seen them in sudden announcements to divorce, spousal death, deaths of a child, job loss, fatal car crashes, young police officers, and witnesses to the 9-11 jumpers.

We Westerners live in a mostly safe world, insulated from so much of the pain, distress, and horror which were routine in past generations. An ordinary snowfall, or a loss of electric power, is now a really big deal, a tragedy. We are so safe and comfortable that we have lost the tools to cope with tough situations, scenes of horror, and painful memories. These things do, indeed, change us. Comfort and safety have made us innocent, in a way. Police and doctors deal with these things routinely, and develop thick skins, professional distance.

I read this today: Government Can Do More to Treat Veterans with PTSD. The number of returning veterans afflicted with Post Traumatic Stress Disorder has reached crisis proportions.

By government, they mean the VA. "Qualifying" for disability is a terrible idea. Getting into life is the best plan, whether one wants to or not. No matter what happens, it's best to buck up and get on with it.

There is no treatment, no cure, for being human. There is no cure for PTSD complaints other than the old-fashioned "tincture of time." Entrepreneurs out there sell cures which are snake oil. All we Psychiatrists really have to offer these people is care, emotional support, help with substance abuse, and, if they wish, emotion-blunting medicines. There is no magic cure for life's horrors and misfortunes other than alcohol and drugs, and they tend to make things worse in the end.

Some psychoanalysts like Kohut and Kernberg have theoretical ideas about it. Sometimes I think that the word, and whatever idea exists behind the idea, is a sociocultural construct more than anything else.

That is not to say that we are not individuals with our own personality tendencies.

Here's an essay: The Self in Self-Help - We have no idea what a self is. So how can we fix it?

From The Last Psychiatrist, No Self-Respecting Woman Would Go Out Without Make Up.

He covers a lot of ground in his post, including firearms and Goldman Sachs.

As I have often said, there is no useful general definition of happiness. Unhappiness and misery are much more easily defined.

Do all people need a sense of mission or purpose to be "happy" - other than the basic mission of survival and comfort? I very much doubt it. The wonderful psychiatrist Victor Frankl was indeed sustained by his search for meaning in the camps, but that is far from ordinary life and he was far from an ordinary man.

Here's Emily Esfahani Smith's There's More to Life Than Being Happy. I am not sure what I think about that report.

For me, contentment is a good, loyal husband, a good love life, good work, enjoyable if sometimes difficult kids, good friends and good acquaintances, exciting hobbies and sports, integrity and a clean conscience, a dog, a relationship with God, and books to read. Changing the world is a fool's errand for crazy people and narcissists who do not want to focus on the substance of their own brief lives. Can't do without them, though. Part of the fabric.

Mass killings, and serial killings, are in decline. Murder overall, in fact, is in decline except for in some (Blue) cities like Chicago and Detroit which nobody seems to get excited about very much. 

Everybody is seeking scapegoats for mass killing, especially when it's white suburban kids instead of the slow mass murder of inner city black kids, and everybody hops onto the hobby horse they want to ride. Movies and video games, firearms, bomb ingredients, the mentally ill, etc.

The problem is that these mass events are so rare as to be utterly upredictable. We cannot put an armed guard at the door of every classroom. And trust me, you cannot lock up, indefinitely, every paranoid or angry person who has thoughts of killing people. You'd have to lock up half the commenters at Daily Kos. Thoughts about killing, like thoughts of suicide, are very common.

Furthermore, mass killers like Timothy McVeigh and serial killers like Ted Bundy were not even mentally ill in any usual sense. Evil, not ill. Not to mention Nidal Hasan, the Fort Hood killer. A military Psychiatrist, no less (and a presumed Jihadist). Or the 9-11 killers.

Terrible events are black swans and probably not preventable. Dangerous people rarely seek help with their problems anyway, and criminals ignore laws. Nobody who is hell-bent on mass killing is likely to tell anyone.

From the NYT yesterday,  Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say.

Here is Top 10 Myths About Mass Shootings

I posted about epigenetics a few weeks ago: Epigenetics in Metazoans.

Here's a good example from pigs: Why Cloned Animals Aren't Identical.

I entirely agree with 1 Boring Old Man.

Here's another: DSM5 Dead on Arrival!

As I have mentioned here before, I don't know how it is possible to run a complex household effectively without two or more adults in it. We know that marriage has seen a marked decline in the lower socioeconomic strata, thus contributing to a vicious circle of poverty, malfunction and dependency. From what I have read, marriage is still going strong in the middle and upper-middle strata. I suspect that is because middle class people desire a coherent, orderly, busy life which is enriching to everybody in the family - and one reason why divorce is so traumatic: it's not just about money, it's about structure.

From Exodus from Marriage:

“The scale of marital breakdown in the West since 1960 has no historical precedent and seems unique,” the distinguished historian Lawrence Stone said a few years ago. “At no time in history, with the possible exception of Imperial Rome, has the institution of marriage been more problematic than it is today.”

You know you are reaching true adulthood when you read articles about The Kids These Days and end up grimacing. We have posted about the hooking-up culture in the past, about "friends with benefits," and about how the youth are mating randomly and promiscuously like rabbits in the woods and yet are spared the reputational problem which would have occurred when I was 20.

The example from The New York Times is about girls: The End of Courtship?

Voyeurism is fun, but tacky. From what I see in life, which is quite a lot, it seems to me that these stories are the exception rather than the rule. From what I see, the average middle-class American girl avoids casual sexual encounters and wants to be treated respectfully if not lovingly. There is a bell curve, and the left tail of the curve is sociopathic.

So much for the girls. For the 20's guys, there is no doubt that it has gotten very easy to get lucky in the bars these days, if that is how one chooses to live. The modern trends of feminism are great for the guys: they get much more sex and sexual variety without committment, and the women make their own money. Unless you feel that relationships are a serious matter and that using others is a form of low life, that is.

Elizabeth Wurtzel wrote a much-commented-about essay (about herself, of course, in whom she seems excessively interested) last week, Elizabeth Wurtzel Confronts Her One-Night Stand of a Life.

There are some grim aspects to her report from the front lines of the follow-your-impulses approach to life, but, in the end, I have to comment that I think it's just great that, in America, there is the freedom and opportunity to construct a life any way one chooses.

As long as I do not have to end up supporting it, that is. Despite all of her opportunities, I fear we all may end up supporting her in her old age, if she achieves it. True bohemians are supposed to die young-ish, of TB, cirrhosis, drug overdose, AIDS, broken heart, or other such romantic maladies:

I have written about the illusion of a state of Happiness in the past here. In doing so, I have always pointed out that it's a term without a meaningful definition. However, it has always seemed to me that happiness implies, for some, an imaginary infantile state in which all wants and needs are met rather than the state of stress, difficulty, and challenge which many of us seek.

For a simple example, I have a friend who never feels "happier" than when struggling for hours in a fruitless effort to master a Chopin piano piece.

Transient joys and delights certainly occur, as can periods of contentment with their implication of acceptance of, or resignation to, the limits of reality.

Leszek Kołakowski poses the question Is God Happy? (h/t Althouse) as a way to reflecting about the human capacity for happiness. He says:

Happiness is something we can imagine but not experience. If we imagine that hell and purgatory are no longer in operation and that all human beings, every single one without exception, have been saved by God and are now enjoying celestial bliss, lacking nothing, perfectly satisfied, without pain or death, then we can imagine that their happiness is real and that the sorrows and suffering of the past have been forgotten. Such a condition can be imagined, but it has never been seen. It has never been seen.

Kolakowski clearly adopts the definition of happiness to which I alluded earlier, ie, the serene absence of any disturbing thoughts or feelings. Sounds more like a mindless beach vacation to me than something anybody would aspire to for more than a few days. Sounds like heroin.

Regarding the question re God's happiness, it's an absurd question. God is not human.

Readers know my interest in the workings of the human conscience and the structures of human morals. The (our) devils are relentless in pursuit of the low-life, the dark side.

Hawkins at Pajamas: Here ... are a few signposts that will alert you to stop, pause, and take stock to make sure you’re not on that gentle slope.

How's that for a catchy end-of-holiday-season header? (Metazoans is the new name for the Animalia Kingdom - those creatures with differentiated tissues like sponges, earthworms, and people.)

I have been attempting to familiarize myself a little with the rapidly-expanding science of Epigenetics lately. When I took pre-med Genetics, it was a marginal topic. Now that the fundamental workings of DNA are fairly well understood, epigenetics has become a hot field ("epi" because it's the things - heritable things - that effect cell-differentiation, growth and development, etc. on top of the basic DNA template, but are affected by the environment). Shades of Lamarck.

Epigenetics is interesting partly because it's one of the ways that a metazoan species can be affected by environmental influences during growth and development. Molecular tools for shaping the final product. The complexity of metazoans (as contrasted with fungi, bacteria, and protozoans, for example) requires complex epigenetic processes. Heritable things which switch on or switch off gene expression.

Here's the simplest short piece I could find: What Is Epigenetics? Easy to follow if you ever took intro Bio.

The wiki entry is actually a good intro, but tough sledding unless you had a decent college education or are a bio reader.

Over the next few decades, we can expect interesting new discoveries about how epigenetic processes affect human psychology.

I have spared our readers all of the more technical and experimental things I've been reading. If I can interest one person in the topic, great.

I've been preaching this since long before Gary Taubes' books came out. That's because I have a colleague who studies the physiology of insulin. From what I know, Taubes is right. A quote re Dietary Incorrectness at Powerline:

Taubes disputes the connection between dietary fat and high cholesterol. He challenges the thesis that dietary fat is detrimental to our health. He rejects a balanced diet. He advocates a high-fat diet. He opposes dieting. He doesn’t object to exercise, but he asserts that it makes you hungry. It’s almost funny. He is the dietary equivalent of politically incorrect.

Taubes is a serious science reporter, not a crank. As I say here ad nauseum, and as Taubes explains, if you want to get trim, quit the carbs. None. That includes fruit, which isn't any good for you anyway. It's just sugar. As the man says, after 14 days off all carbs they will not appeal to you so much anymore. (There is an addiction-like quality to carbs.) And if you want to be fit, youthful, sexy, intelligent, and vigorous, then exercise or do physical work too. If you want to lower your triglycerides, get better genes or take Lipitor.

It's not complicated. It's a free country, food is cheap and exercise is free. Do what you want to achieve the goals you desire. Don't tell me it's hard to do, because everything in life is hard to do except eating, surfing the net, and watching TV.

They feel they must for PR, grandstanding, or as a power grab, but it won't matter in the end. From my readings about the Newtown nightmare, the killer was a distinctly odd, fairly bright but low-functioning kid, maybe autism spectrum or childhood schizophrenia spectrum, schizoid, or something like that. A harmless oddball. Some colleagues of mine have suspected a psychotic break, but I doubt it. Wired a bit wrong from the beginning I suspect, but this is not uncommon at all. Everybody has a loose wire and it's a matter of degree.

As the over-stressed parents of such kids learn, there are no cures for these problems. Often, no effective treatments either other than zombifying them with antipsychotic medicines. Sometimes a residential placement with lots of support can be useful but not curative in any way - and would need to be voluntarily undertaken. The killer's family had plenty of money, access to all of the resources that a wealthy family in wealthy and treatment-rich Connecticut and his devoted mother could provide, but nothing much could be done because there was little to do.

Not only is help limited in power, the humbling fact is that mental health professionals are essentially unable to predict either violent, homicidal or suicidal behavior except in the most acute situations. We try, often over-react, but these are black swan events which are unpredictable by definition. We cannot lock up every unusual, isolated kid who enjoys war games any more than we can lock up every angst-ridden teen with thoughts of suicide. And if we could, for how long? Kellerman writes about deinstitutionalization but that's not what this is about. Angry and unhappy people are everywhere.

Furthermore, many if not most people who could use a hand from mental health professionals have little interest in pursuing that. Interestingly, the ACLU recently blocked a Connecticut law which would have made outpatient treatment mandatory for some patients. Not that mandatory "treatment" can do much good. That's why people needing help slip through the cracks: they don't want it.

The sanest, least hysterical essay I have read on the topic is from Megan McArdle: There's Little We Can Do to Prevent Another Massacre. One quote from her excellent piece:

Unlike many libertarians, I am fine with a ban on automatic weapons. But no need to hop over to Change.org to start a petition to ban them; machine guns have been illegal in the United States since 1934, and since the 1980s, it has been illegal to manufacture and sell any automatic weapon. Apparently unbeknownst to Twitter, we have also already made it illegal for the mentally ill to buy or have guns, and have background checks aimed at prevented just that.

But beyond the strange calls to make serial killers pray more and outlaw things that are already illegal, the most interesting thing is how generic they were. As soon as Newtown happened, people reached into a mental basket already full of "ways to stop school shootings" and pulled out a few of their favorite items. They did not stop to find out whether those causes had actually obtained in this case.

It's the age-old "something must be done," but, as Megan points out, bad cases make bad law. The only consoling fact is that mass murder has been declining in the US since 1929. Guns have little to do with it. People determined to wreak havoc can do it in many sorts of ways, from making bombs to driving cars or airplanes into buildings, and do so across the world. The US has no monopoly on killing sprees, contra Michael Moore. If one looks around the world, it can seem as if civil behavior, as Americans understand it, is the abnormal.

Gun laws? Bomb laws? Other criminal laws? Evil-doers ignore and bypass laws while honest people end up having their freedoms limited by them. Naturally, when dramatic events happen in the world - 9/11, crash of housing bubble, mass murders, storms, etc., the pols and "advocates" and rent-seekers jump avidly onto their favorite hobby-horses and ride them for all it's worth for their own reasons. People want to assign blame on anything, it seems, other than, in this case, the seemingly demonic perpetrator.

As cold as it may sound today, crushing tragedy is part of the human condition and has always been. No "mental health system" or politician or policy will change that unless we all decide to live in a prison camp. We do believe in being armed, though, to minimize the odds of becoming a victim. That's why we have lightning rods on our roof, too.

In the meantime, we all mentally re-live the nightmare in our minds and wish it to be undone, to go away, to not be real, to be impossible.

Latest update: Killer's mom was attempting to get him committed to hospital

I am pleased that we posted on Father Rohr this morning. I have no interest in posting on the topic of dramatic mass murders on this site, because I have already said all I have to say about it already on previous postings.

Dramatic or undramatic, evil is pervasive. There is not a single human heart without some. We read about guns, mental illness, government policy, a bad culture, inattentive parents and others, etc. These are all distractions. The relevant topic is human evil in all of its forms. We do not like to think about that.

Believe it or not, I saw a headline saying "Gun kills 26 in Connecticut."

A planet without humans would be a planet without good and evil. The utopian narrative goes something like this: "If everybody is properly served, controlled, treated, drugged,  provided for, etc etc, horrible things might be eliminated from the world." That thought is truly crazy and is the reason we have trademarked the term "psycho-utopianism" on this website.

A simple jump rope is possibly the best cardio exercise device one can own. It is also the cheapest and most portable.

Jumping rope will burn also 11 calories per minute (more than anything else) while offering almost total body fitness. If you have the fitness and endurance to jump rope for half an hour, you can burn off one candy bar or one donut but few people could go that long even if they wanted to. At a very fast pace, maybe a donut in less than half an hour. However, nobody I've seen can go that long.

At my gym, it's mainly men who jump. Amazon has all sorts of jump ropes. Many people like the beaded ones and the weighted ones.

Done properly on the toes, it's a low-impact exercise. Most people seem to jump in 30-second to three- or six- minute stints. It is demanding for people over 25.

 Here's 3 Benefits of Jump Rope Fitness

10-Minute Jump Rope Cardio Workout

Jumping rope for boxers

If you google jump rope exercise you will find hundreds of articles about technique and the benefits.

Dr. Helen discusses the recovering adult teenager Tucker Max: American Immaturity: How We Grow Up After We Grow Old.

Her post reads a bit like an old fogey complaining about "these kids today," but she is talking about adult-aged kids, not real teenagers. Some of the comments are interesting. I am convinced that difficult realities and challenges are what creates adults.

From A Nation of Singles - The most politically potent demographic trend is not the one everyone talked about after the election:

23.8 percent of men, and 19 percent of women, between the ages of 35 and 44 have never been married. Tick back a cohort to the people between 20 and 34​—​the prime-childbearing years​—​and the numbers are even more startling: 67 percent of men and 57 percent of women in that group have never been married. When you total it all up, over half of the voting-age population in America​—​and 40 percent of the people who actually showed up to vote this time around​—​are single.

What does this group look like? Geographically, they tend to live in cities. As urban density increases, marriage rates (and childbearing rates) fall in nearly a straight line. Carville and Greenberg put together a Venn diagram which is highly instructive. Of the 111 million single eligible voters, 53 million are women and 58 million are men. Only 5.7 million of these women are Hispanic and 9.7 million are African American. Nearly three-quarters of all single women are white. In other words, the cohort looks a lot like the Julia character the Obama campaign rolled out to show how the president’s policies care for that plucky gal from the moment she enrolls in Head Start right through her retirement. You may recall that because of President Obama, Julia goes to college, gets free birth control, has a baby anyway, sends her lone kid to public school, and then​—​at age 42​—​starts her own business (as a web designer!). What she does not do is get married.

Is this a general cultural phenomenon, or class-related? I understand that Julia feels married to the government, but don't most people feel the need for a loyal human partner and helpmeet anyway? Marriage may be fraught with challenges, but I cannot even imagine trying to run my complex life single-handedly. Even four hands often do not seem like enough. Speaking just practically, romance and friendship aside.

People in positions of responsibility are supposed to be able to identify cranks and quacks.  

However, fake science and hyped science have been around forever. If you look hard enough, you can find an expert who will say anything. Sadly, despite all evidence, the fearmongering about vaccines and autism just won't die.

Here.

I learned a lot about ADD and ADHD at a recent conference. I am slowly coming around to thinking that it's something worth looking for and paying attention to. There are a number of complicated issues surrounding the diagnosis which I will not get into now.

The author of the piece about the famous long-term study of Harvard students from college to old age says that George Vaillant has demonstrated little more than that an ability to adapt predicts an ability to adapt. From Their Right Stuff -The evolution of the Harvard guinea pigs:

As with orthodox Freudianism, there is a hedonistic bias to the ideal of maturity that the study proclaims. To blossom is to shed “rigid” attitudes. There is nothing more contemptible than an “inhibition.” Perhaps you think that, in a free society, in-hibitions are good since they spare us from having to submit to others’ pro-hibitions. But if that is how you think, you will find this book’s system of values un-intelligible. Vaillant sees evidence of one Episcopal minister’s maturation in the way “he had put aside absolute convictions about faith, morality, and authority in favor of a new appreciation of their relativity and mutability.” If this book has a hero, it is a meathead named Boatwright, who says, “I don’t give a damn if I’m remembered for anything. I’ve enjoyed my life and had a hell of a good time.”

I am sorry to say that the socio-cultural bias is a darn shame. My profession is half-good at defining problems, but terrible at defining relative health. Everybody has at least one problem, and having problems is normal.

Everybody struggles with problems. As CS Lewis reminded us, bear that in mind whenever you meet somebody. Therefore be kind (but always be alert to predators).

Is "fairness" just a nicey-nice word for nursery school teachers? From Asma,  In Defense of Favoritism:

The old folk wisdom that group closeness comes from opposition to others is not borne out by recent data. Nor is the old developmental story that we all start out as egoistic Hobbesians, who slowly learn to care for others. Affective neuroscience research on early-childhood bonding suggests that, as mammals, we probably start out as emotionally glued microcommunities (family and tribe) before we become autonomous ego-driven creatures. Favoritism, not egoism, is probably the primal value system.

In short, favoritism or bias toward your group is not intrinsically racist, sexist, or closed-minded. Privileging your tribe does not render you negative or bigoted toward those outside your tribe. And to top it off, we're now beginning to understand the flexible nature of our ingroup favoritism—it doesn't have to be carved along bloodlines, or race lines, or ethnic lines. Psychological experiments reveal a whole range of criteria for ingroup bias. For example, test subjects have been shown to award higher payoffs to arbitrary ingroups, like people who just happen to share the same birthday as the test subject. And ingroup bias can be demonstrably strong when subjects share allegiance to the same sports teams, and so on.

and

If our high-minded notions of retributive justice have roots in the lower emotions of revenge, then why should we be surprised if fairness has roots in envy? I have no illusions and feel entirely comfortable with the idea that fairness has origins in baser emotions like envy. But most egalitarians will find this repugnant, and damaging to their saintly and selfless version of fairness.

A good, provocative essay about human nature and our need for tribal affinities.

Call it Psychopathy or Sociopathy or just "bad people," people with predatorial instincts are all around us. Overwhelming most are non-violent, but what Dr X points out is that psychopathy is a matter of degree.

Most people who worry about being bad or evil, are not especially so. Sociopathic people rarely recognize their inner bad, and often think highly of themselves. Significant degrees of sociopathy can be found in people in all walks of life, not just in penitentiaries (in which few penitents are to be found). I knew a brilliant, charismatic Psychologist with abundant psychopathic traits who probably helped more people than I ever will with his charm, warmth, and wisdom. He had enough self-awareness to keep himself out of serious trouble but he had some close calls.

Dr X pointed out this piece at Smithsonian: The Pros to Being a Psychopath - In a new book, Oxford research psychologist Kevin Dutton argues that psychopaths are poised to perform well under pressure. Not sure I agree, but an interesting topic.

Modern males forge deep bonds with core friends.

Yes they do, and they should. There is nothing modern about it, though.

Winter sports are the best ones (shooting, hunting, Paddle, skiing, Squash, indoor tennis), but you have to be in shape. The Official Maggie's Farm Fitness Program (no TM) is neither for big muscle building nor a rigorous fitness regime to regain a neglected physique but is cheap, time-saving, and highly-effective for those in decent shape who want to tighten up for the black diamonds (but ask your physician whether it is appropriate for you before suing Maggie's Farm or me):

1. Want to lose flab? Go on a no-carb, or almost-no-carb, high meat diet. Carbs are the devil, the delicious fat on the meat is not. Salad is for rabbits, anorectics, or for fun. Fruits are pure carbs. A few kinds of vegetables are low in carbs and tasty, but not necessary except to fill the tummy. Little to no nutrition in them. If you are a food-worrier, take a multivit to relieve your anxiety.

2. Aerobics: 30-40 minutes/day (running, treadmill, spinning, erg, swimming, or especially elliptical), pushing it as tolerated

3. Lower body: Several sets of lunges and squats as tolerated.

4. Abs: Several sets of bicycle crunches, as tolerated.

5. Upper: Push up sets and free-weight (not heavy) military press sets

6. Back, etc: Sets of The Plank, pushing sets as tolerated.

This is fun, only takes an hour/day, and gets your head ready for a good day of mental work. To save time, you can alternate days, aerobics on one day and the rest on the next day. That's enough to tune up an already-fit body.

I wonder what our readers do to keep themselves from going to pot in an America in which fewer and fewer people do real labor.

In The New Yorker, a Boston physician studies The Cheesecake Factory in an effort to decide whether Big Medicine can be more efficient and effective than the usual: Big Med. It begins:

It was Saturday night, and I was at the local Cheesecake Factory with my two teen-age daughters and three of their friends. You may know the chain: a hundred and sixty restaurants with a catalogue-like menu that, when I did a count, listed three hundred and eight dinner items (including the forty-nine on the “Skinnylicious” menu), plus a hundred and twenty-four choices of beverage. It’s a linen-napkin-and-tablecloth sort of place, but with something for everyone. There’s wine and wasabi-crusted ahi tuna, but there’s also buffalo wings and Bud Light. The kids ordered mostly comfort food—pot stickers, mini crab cakes, teriyaki chicken, Hawaiian pizza, pasta carbonara. I got a beet salad with goat cheese, white-bean hummus and warm flatbread, and the miso salmon.

The place is huge, but it’s invariably packed, and you can see why...

I'm no fan of Big Med - I practice Cottage Med and I prefer to do it my own way. However, it's a fascinating article and actually makes me want to try a meal at The Cheesecake Factory too. I had thought of it as a kind of cheesy place, but I love wasabi-crusted tuna as long as it is just seared.

Dr. Robert Michels discusses the future of Psychiatry in an interview. A quote:

Psychiatry begins at the end of the 18th century with the medicalization of a group of people who were seen as strange by the rest of the citizens in the world. And that medicalization led to many things. One is it lead to their humane treatment. Previously, it wasn’t uncommon to see people that today we consider psychiatry patients, who’d be chained in institutions to keep them away from society.

It led to an attempt to study what was the nature of their problems, to describe them. It led to people talking to them instead of jeering at them or reviling them.

And it led to the development of more knowledge about the cause, the course and what factors might influence their disturbances. So it led to treatments. Within a 100 years those treatments were beginning to be…quite effective. We learned that some of them suffered from diseases we could cure.

At the turn of the century before this one…in nineteen hundred … a third of the patients in mental hospitals in this country suffered from the complications of infectious diseases. We largely cure those now so you don’t see them these days. We have some new infectious diseases. But we’ve pretty much cured the old ones that causes psychiatric problems...

I heard on the radio that residents of Bridgeport, CT were pelting utility workers with sticks and eggs (where did they get those eggs?) to "express" their disgruntlement about having no power two days after a powerful Nor'easter his their town. (It was a Nor'easter at that point, more or less, or a hybrid but not a genuine hurricane.)

It was necessary to assign police to escort the utility repairmen, who had come there from all over the country and from Canada to repair their lines.

My rhetorical question is this: Where do people get it into their heads that bad things, and bad consequences, should never happen and, if they do, that there is someone to blame? It seems like the height of immaturity to me. Who taught people that this is what life is like?

Men and Women Can't Be "Just Friends"? The age-old question is addressed in a sloppy study in Scientific American.

Humans aren't Bonobos, but in human connections there is always some sex in the air. The popularity of "friends with benefits" relationships among the youth, and now middle-aged singles - makes that clear. Lots of other things are in the air too, like competitiveness, childish emotional wishes, familial-type feelings, feelings of tribal affiliation. loneliness, delight or amusement in another's company, shared intellectual or recreational fun, exploitative aspirations, etc., etc.

My profound and earth-shaking point here is simply that human interactions and connections partake of all aspects of being ... human.

There's one thing I know for sure: Put a guy and a gal who are pals in a comfy place away from home, add alcohol, stir, and anything can happen. Alcohol numbs the prefrontal cortex.

Interviews with Nobel laureate Kandel are always stimulating. 'I See Psychoanalysis, Art and Biology Coming Together':

I see psychoanalysis, art and biology ultimately coming together, just like cognitive psychology and neuroscience have merged recently. You have specifically selected examples, which I use not to illustrate how science can enhance insight into art. Rather I use them to show how artists had insights into the mind that Freud did not have and that enriched and corrected what Freud taught us. This is what concerns me in the first third of the book. It is in the second and third parts of the book that I outline a biological approach to how we respond to a work of art...

It's a big mystery. It is difficult to find any evidence for anything "before" time and space existed, before "matter" existed.

For my practical purposes, in the beginning was logos - the Word.

Which brings me to my topic of thought and communication as poetry and metaphor. I just completed one of Prof. Robert Sapolsky's Great Courses, Being Human: Life Lessons from the Frontiers of Neuroscience. It's only 2 DVDs, but it is an inspiring introduction.

In one section of his presentation, he mentions James Geary's I Is an Other: The Secret Life of Metaphor and How It Shapes the Way We See the World. The WSJ reviewer said this about the book:

“Geary . . . succeeds in making the case that metaphor is the meat of language and not a sauce.”

From a Platonic point of view, it's not just the meat of language, it's the meat of thought. Sapolsky says that most communication is the residue of poetry.

Keller seems to have written his glowing essay about the Liverpool Protocol, How to Die, without talking to any practicing American doctors. He is writing as an advocate of Obamacare, and speaks as if American doctors won't let people die while the English people will.

If he had spoken with American doctors, he would know that most American internists do something very similar with patients whose condition is hopeless, and do so routinely. Daily. Everybody dies. American hospitals have plenty of patients with "DNR" (Do Not Resusitate) orders on their charts, and hospice units and hospice centers are common in the US.

I see two exceptions, occasionally. One is when the family or patient is adamant about "Do anything and everything." These tend to be people who don't know much. The second is with some terminal cancer patients. I have seen terminal cancer patients, with widespead metastatic disease in the ICU, dying while the latest cancer chemotherapy is still being pumped into their veins. It's pitiful.

Generally, doctors know when to give up and do not view death as an enemy. Unfortunately, Bill Keller seems to be addressing a straw man.

Keller should read this: Why Doctors Die Differently - Careers in medicine have taught them the limits of treatment and the need to plan for the end. Doctors know when they're a goner, and when their patients are too. Most docs do not offer false hope, and do wrong when they do.

Dr. Dalrymple has a post: Why Psychiatric Disorders Are Not the Same as Physical Diseases.

They sure aren't. That's why we don't term them "diseases." But it's more complicated than that. Psychiatrists address most complaints which concern the mind.

Some are caused by wiring abnormalities in the brain (eg autism, PDD, probably schizophrenia), some by brain damage (eg strokes, Alzheimers, hydrocephalus, trauma). Many complaints seem to combine brain vulnerabilities of some sort with the mind and personality of the person (eg OCD, Bipolar spectrum problems, severe depressions, etc etc). However, most often in outpatient settings we deal with complaints which appear to be "all in the mind" or mostly so (eg neuroses, personality problems, relationship problems, character flaws and weaknesses, fears and phobias, addictions - first in the mind, then engraved in the brain -, emotional immaturity, major life dilemmas, milder and reactive forms of depression, etc etc).

Dalrymple's post is about Dr. Oliver Sachs' determination not to label his symptom as a neurotic one. There is much comfort in believing that one's complaint is "physical" or, as we often term it, "organic."

In fact, many Psychiatrists today seek to over-medicalize Psychiatric complaints. Did your beloved spouse of 60 years just die? Oh, you have Depression, a chemical imbalance requiring 40 mg of Paxil daily.

Our trademark term "Psycho-utopianism" refers to the idea that we would all be thoroughly happy and fulfilled in life were we only given the right drugs or psychotherapy. Reality would be undone, and Eden restored.

Thus there can be a sort of conspiracy between patients and Psychiatrists (perhaps aided and abetted by the structure of the DSM and the drug companies) to view all or most complaints and symptoms as external or alien to the mind, so to speak, instead of, often, embedded in it or part of it. Part of oneself, that is.

During one of my residency inpatient rotations, we were to sit with hospitalized schizophrenics, addicts, and Borderlines for 4 hours/week. We were instructed not to attempt any "therapy" or to try to fix anything, but just to use the time to try to comprehend where they were coming from, what was going on in them, and how they were interacting with us. This was a remarkable experience in more ways than I have time or space to write.

The neuroscience craze of the 1990s grossly overpromised future clinical usefulness. My advice to the neuroscientists is to be as humble as Eric Kandel because Oliver Sach's hysterical paralysis will never be located in brain matter just as my love for tennis never will.

Related: Was it really me? - Neuroscience is changing the meaning of criminal guilt. That might make us more, not less, responsible for our actions

Also related: Googlizing Neuroscience

I touched on some of these topics recently in Psychiatry’s Legitimacy Crisis

At American Thinker, The Verdict on 'Doctors' Obama and Romney:

The parasite called bureaucracy is the big winner in the Obama scheme. Before the ACA, the regulatory bureaucracy consumed 40% of all Healthcare dollars. With six whole new agencies, thousands of new regulators, and 2,700+ pages of incomprehensible, often contradictory rules, tapeworm "B" will likely consume half of all the money the U.S. spends on patient Healthcare, leaving fewer dollars for health care (the service).

The article is at Ricochet. The comments are good.

For young docs these days, it's about paying off $200,000 in loans (not to mention 3-4 years after that as an intern and resident on a pittance), the incredible burdens of paperwork and new regulations, conflicts between wanting to be independent and the security temptations of getting a salary.

The big change in the past 20 years is women becoming 50% of medical school students. When I went to med school, it was around 25%. Many of the women, I have observed, are happy working limited hours, do not mind being salaried, and do not welcome the burdens and risks of private practice, taking full personal responsibility for patients, being on call, etc. They want to have babies, with work as a sideline. It's a big change from the independent cowboy medical practice of the past. Those cowboys were my role models.

Without wanting to sound sexist, I do have to observe that women are more comfortable following the rules than men are.

The neurosciences were the sexy new frontier in the 1990s, but popular writers often offered the impression that any basic science of the central nervous system might have clear implications for understanding the workings of the mind.

From the article of the above title:

The idea that a neurological explanation could exhaust the meaning of experience was already being mocked as “medical materialism” by the psychologist William James a century ago. And today’s ubiquitous rhetorical confidence about how the brain works papers over a still-enormous scientific uncertainty. Paul Fletcher, professor of health neuroscience at the University of Cambridge, says that he gets “exasperated” by much popular coverage of neuroimaging research, which assumes that “activity in a brain region is the answer to some profound question about psychological processes. This is very hard to justify given how little we currently know about what different regions of the brain actually do.” Too often, he tells me in an email correspondence, a popular writer will “opt for some sort of neuro-flapdoodle in which a highly simplistic and questionable point is accompanied by a suitably grand-sounding neural term and thus acquires a weightiness that it really doesn’t deserve. In my view, this is no different to some mountebank selling quacksalve by talking about the physics of water molecules’ memories, or a beautician talking about action liposomes.”

Use the Force: How Magicians Can Control Your Decisions - Our choices are often not as independent as we would like to believe.

It is certainly true that we frequently deceive ourselves about the rationality and the intent of our choices. As easily as we may deceive ourselves, we are easily deceived too. The article explains some of the tricks magicians use to "force" our "free choices."

In Psychiatry today there is much discussion, debate, and confusion about diagnosing the varieties of serious mood or attitudinal instability (ie instability which is life-disrupting in some significant way).

It's not your grandfather's Bipolar Disorder anymore. The numbers of people labelled as "Bipolar spectrum" has increased dramatically, for better or worse, in recent years. It may be "diagnosis creep," or it might be better understanding. A complicating factor is the overlap between Bipolar Spectrum problems and Borderline Personality, discussed here, where flips in attitudes towards relationships (eg idealization and devaluation) can be prominent in both (along with volatility, grandiosity, hypersensitivity, rage and paranoia).

All of this mess can be treated. I have become a fan of Lamictal for mood instability and attitude shifts which do not rise to the level of full-blown Manic-Depression but which are well-outside the normal moods and shifts of daily life. Lamictal plus confrontational psychotherapy, and maybe an antidepressant.

Here's Hornbacher's book, Madness: A Bipolar Life

I often wonder what such peoples' lives (mostly women) were like before modern treatments. Not too good, I suspect, in the absence of a loyal spouse.

‘Feminist Progress Right Now Largely Depends on the Existence of the Hookup Culture.’  A quote:

...to a surprising degree, it is women—not men—who are perpetuating the culture, especially in school, cannily manipulating it to make space for their success, always keeping their own ends in mind. For college girls these days, an overly serious suitor fills the same role an accidental pregnancy did in the 19th century: a danger to be avoided at all costs, lest it get in the way of a promising future.

I doubt that it is widely true that young women have become the sexual exploiters and predators, but I know it is true to some extent. 

I wonder what our readers have observed.

Dr. Henry Marsh on brain surgery (h/t Vanderleun). A quote:

I woke early on the morning of the operation and lay in bed thinking about the young mother I had operated on the previous week. I had operated on a tumour deep in the right side of her brain and somehow – I do not know how since the operation had seemed to proceed uneventfully – I had caused a major stroke, so that she awoke from the operation paralysed down the left side of her body. I had probably tried to take too much of the tumour out. I had probably strayed too deeply into her brain. I must have been too self-confident. I had been insufficiently fearful. I longed for this next operation, the operation on the pineal tumour, to go well – that there should be a happy ending, that everybody would live happily ever after, Neurosurgeons look with awe and excitement at brain scans showing pineal tumours, like mountaineers looking up at a great peak that they hope to climb. and that I could feel at peace with myself once again.

It's a wonder how many physicians are natural writers. Dr. Marsh is one.

A good book for single girls and ladies who think having a good husband might be a good idea for a good life: Getting to 'I Do': The Secret to Doing Relationships Right!

There is plenty of motherly and grandmotherly wisdom in that book. Men used to talk about "settling down." Women need to learn how to make that happen unless their desire is to live forever like Hollywood starlets.

Here's a quote from the Amazon comments:

"Getting to I Do" catalogued various relationship scenarios, where the authors pointed out what worked and what didn't. I have to be honest, being a self-supportive "modern woman", I at first thought that the simplistic illustrations of male/female dynamics were really old-fashioned and that I might as well just talk it out with my grandmother. But, the book went way beyond just designating roles. For me it helped me to embrace the woman I was and to understand the relationship dynamic I wanted to have.

The book is terrific. I read it and applied it to my next relationship-someone I fell in love with and wanted to marry. I went through the "phases" as stated in the book and when it got down to the "negotiation" phase, my boyfriend wanted to move to France, with me. Great! But, not with an engagement. Turns out he was not ready to be married. It was a very painful to think about being without him. To have my dreams of being married to him dissolve. Fortunaltely, I had learned that I would be putting myself through so much more pain and anguish if I had up-rooted my life without any commitment other than being a great boyfriend. So, I let him go.

Some of both, like most things in life. The Science of Poker:

There are many people who hate math but are great poker players, but there are hardly any players who lack the people reading abilities and still manage to be good poker players,” said Vonk. “Mathematical knowledge can to a large extent be replaced by intuition and experience. After a player has played a million hands of poker, even if he does not know the math at all, he will have a decent feeling about when it is profitable to draw to a flush and when it is not.”

That said, knowing the math means you can acquire this kind of knowledge much more quickly, and those skills can give an edge in very rare situations that don’t often occur in a poker game. “To be a great player, you need both!”

This is just the conclusion of Robert Pinsky's long poem (1975) Essays on Psychiatrists (h/t, Ars Psychiatrica).  Full version here.

Essaying to distinguish these men and women,
Who try to give medicine for misery,
From the rest of us, I find I have failed

To discover what essential statement could be made
About psychiatrists that would not apply
To all human beings, or what statement

About all human beings would not apply
Equally to psychiatrists. They, too,
Consult psychiatrists. They try tentatively

To understand, to find healing speech. They work
For truth and for money. They are contingent...
They talk and talk...they are, in the words

Of a lute-player I met once who despised them,
"Into machines"...all true of all, so that it seems
That "psychiatrist" is a synonym for "human being."

Even in their prosperity which is perhaps
Like their contingency merely more vivid than that
Of lutanists, opticians, poets--all into

Truth, into music, into yearning, suffering,
Into elegant machines and luxuries, with caroling
And kisses, with soft rich cloth and polished

Substances, with cash, tennis and fine electronics,
Liberty of lush and reverend places--goods
And money in their contingency and spiritual

Grace evoke the way we are all psychiatrists
All fumbling at so many millions of miles
Per minute and so many dollars per hour

Through the exploding or collapsing spaces
Between stars, saying what we can.

With the RNC done with, my shrink take is this: Big man with small ego vs. Small man with Inflated ego. The corner office vs. Hollywood; serious stuff vs. fainting teens; competence vs. tingles; real jobs vs. styrofoam pillars; freedom vs. Euroland.

Admittedly, I am biased. I have never understood why so many in my field fall into the Leftist, statist side of politics rather than into the Libertarian. It makes no sense to me because our job is to have faith in individual people rather than seeing helpless, dependent masses.