Maggie's Farm

My friend Debbie Cabaniss et al got around to writing this book before I got around to it: Psychodynamic Formulation.

I have written about Psychiatric diagnosis often here, and I re-post my pieces each year. It is a complicated topic, because Psychiatric complaints originate from all sorts of sources and usually multiple sources, and an exhaustive psychodynamic formulation is not always relevant to minor life problems.

When it is relevant, a serious formulation is a difficult thing to do unless one just casually links history to current complaints. That's not a real formulation.

The current fad in Psychiatry is the DSM, which a robot could do. In many situations a DSM "diagnosis" is nothing more than a list of complaints useful only for an insurance claim and has nothing to do with understanding an individual person.

A few weeks ago, we did this: A Maggie's Farm Scientific Survey: Things we often want to avoid doing, but feel better after we do them.

This week, we'll do the sorts of things which are tough to do, require exertion of some sort,  self-discipline, and can be frustrating or exasperating, but in which the process itself contains gratification as well as a (hopefully) somewhat gratifying result. In other words, a mix of intrinsic and delayed gratification.

Here are a few (or maybe most) of mine:

- Practicing piano
- Tennis
- Painting a picture
- Practicing my firearm skills
- Working at my job
- Complex travel planning
- diving deep into prayer
- cooking a perfect and loving meal
- Sailboat racing
- horse jumping
- singing in the church choir
- yard work, planting, pruning, garden design
- reading fairly serious books - life is too short for fluff
- fly fishing - it is fly-fishing week here at Maggie's
- investing my money
- taking a long run on a late April morning with the dog
- raising kids

What are some of the things you find difficult, frustrating, or exertional, but take pleasure in the process too, not just in the completion or the result?

From a physician's report:

I have been so depressed that I have considered killing myself many times. I decided 30 years ago that I could never safely own a firearm because I knew what I would do with it someday. Even so, I have come close to buying a gun. A few years ago, I had extremely severe, treatment-resistant depression—an epoch more than an episode—that lasted several years and steadily worsened despite multiple medicines and weekly visits to my psychiatrist. Eventually, I did go shopping for a pistol. With great difficulty, I chose not to buy it and committed myself to the hospital instead.

Television pitchman Kevin Trudeau is headed to prison.

Prison for being a huckster? Is that right?

Do you have any idea how many medical procedures and medicines which are commonly used today are backed up by dubious science or unproven evidence, or with which placebo effect is dominant? And look at this: your at-home TMS machine! 

And what about nutritional supplements, vitamins, and minerals? The benefits there are minimal to none, most of the time, yet the airwaves are full of sales pitches.

And on internet ads, "Take this miracle pill and..."

What about the organic food and Whole Foods scam on naive and ignorant people? And what about politicians and stockbrokers?

Ineffective things are sold every day, demonstrating the power of wishful-thinking, or magical-thinking, in humans. Hucksterism is an old American, if not worldwide, tradition. Caveat Emptor.

This lady has a lot of complaints about her life, and wants somebody to do something about it: America's Workers: Stressed Out, Overwhelmed, Totally Exhausted.

Perhaps she should quit working and let her hubby support the family the old-fashioned way. If you read between the lines, I think that's what she wants. There's nothing wrong with wanting that.

Dr. Joseph Pierre offers a good explanation of what Psychiatrists do: A mad world - A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

A quote:

The truth is that while psychiatric diagnosis is helpful in understanding what ails a patient and formulating a treatment plan, psychiatrists don’t waste a lot of time fretting over whether a patient can be neatly categorised in DSM, or even whether or not that patient truly has a mental disorder at all. A patient comes in with a complaint of suffering, and the clinician tries to relieve that suffering independent of such exacting distinctions. If anything, such details become most important for insurance billing, where clinicians might err on the side of making a diagnosis to obtain reimbursement for a patient who might not otherwise be able to receive care.

Though many object to psychiatry’s perceived encroachment into normality, we rarely hear such complaints about the rest of medicine. Few lament that nearly all of us, at some point in our lives, seek care from a physician and take all manner of medications, most without need of a prescription, for one physical ailment or another. If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives?

We did inheritances yesterday, so it seems fitting to review gift taxes today.

My impression is that gift taxes are largely dodged in the US today, unless they involve bank transfers of assets, or deeds. It is certainly not unusual for older folks to hand over jewelry, gold coins, artwork, etc. to their kids.

I do not understand why gift taxes exist in the US, but I am confident that readers can provide me with the rationale.

Here are the IRS' FAQs.

Every comment I have read or heard about this terrible incident is ignorant beyond belief.

In fact, all too ignorant and stupid for me to respond to. This time, I have neither the time nor the inclination. It's tragic, unavoidable. There is no perfect safety from either nature or from human nature, and any perfect safety would be a living death.

I am strongly opposed to death taxes of any sort. Those monies have already been taxed, and they belong to your estate which is really just a legal extension of you. You could have spent your assets when alive, but chose to conserve them. Saving is supposed to be a virtue.

(I am also opposed to gift taxes which limit how much one can give to a family member, or anyone else, without a tax penalty, but that's another topic.)

I do understand that the greedy government wants any money it can get, from any source, and I also understand that estate planning for the wealthy employs thousands of attorneys and accountants who might otherwise have little to do.

What's wrong with the idea that, over time and over generations, there would be the freedom for families to accumulate assets for the benefit of their present and future kin? The more, the better. Financial independence to some degree can be either a blessing or a curse, but, contra Teddy Roosevelt, that's not government's proper concern. I have seen family businesses, farms, and family vacation places destroyed by estate taxes, and it seems wrong to me.

Here are my poll questions - assuming you and spouse have died:

1. Do you want to leave any assets to your kids, grandkids, relatives, friends, or do you want to die broke?

2. What % of your estate would you wish to give to charities?

3. If you have one prosperous kid and two middle class or poor kids, would you write your will differently for them?

Most likely. However, it's a hot area of genetics nowadays: End the Hype over Epigenetics & Lamarckian Evolution

A place for kids to play and hang out which isn't bubble-wrapped.

It's not really the nanny state, it's tort lawyers driving the nonsense. We did wild and crazy things when I was a kid, including BB gun battles and stone-throwing battles. We made bonfires in the woods, and swam in the reservoir in our underwear. We stole our parents' cigarettes and smoked them in the woods. Of course, that was not on school property. I was a tomboy.

We broke our arms and our legs, got banged up, and got lost. Good adventures, good training for life. I got to the point where getting lost was a fun challenge.

Isn't all sex recreational in some sense of the word? Eating is recreational too, in part, and they are both fun. Well, unless these things are dutiful chores which they can be, sometimes, for some people.

What's wrong with recreational sex (eg FB's, friends with benefits, dorm trios - meaning studly guy plus 2 playful and adventurous gal roomies, one-nighters, etc) among the uncommitted? And isn't lots of marital sex really recreational, in some sense, anyway? If not "casual" - see "kitchen table sex."

It's a serious question. In the old days, people married in their teens so that an extended period of sexual ache, longing, and loneliness was more or less taken care of. Of course, we all have our morals, scruples, religions, ethics, and considerations for the feelings of others to take into account. That's the issue, isn't it?

Frequent sexual and romantic thoughts and desires are, for better or worse, a routine part of being human. People can fall into love, lust, or desire readily. (They can fall out of those things too, fairly readily.) I am constantly reminded in my work about how prevalent, but far from universal, recreational sex is among the young, and among older singles. (No, I am not one who views sex as sacramental but more as an animal aspect of humanity with an overlay, so to speak, of a hundred other meanings. In my youth, I think I was too sentimental, religious, soulful, respectful - and controlled - to ever have been a party girl. Some regrets? Not saying. My fantasies are exciting, but private.)

A book by Psychiatrist Stephen Grosz: The Examined Life: How We Lose and Find Ourselves.

It's about peoples' life stories. Highly readable by the non-professional.

Science is never settled, is it? Our approach is to always be skeptical of everything.

This is interesting: A Challenge to the Supremacy of DNA as the Genetic Material

Good posture makes people look better. It makes you look younger and inspires confidence, and it feels good.

Good posture is a habit, and so is poor posture. The military is effective at training good posture. Typical causes of poor posture are psychological, lack of training, aging, and physical weakness.

If you want to improve your posture, just imagine your Mom reminding to to sit up, or stand up, straight, all day long. Then you can work on your abdominal and back muscles, which are what make standing upright possible. Here you go: Exercises for Better Posture.

Life training matters, and can only come from home. Moms say "Stand up straight, look people in the eye, have a firm handshake and a pleasant but reserved demeanor. Nobody wants to know your natural self." 

No pain, no gain? This is about gratifications and pleasures earned in the completion of things one has the impulse to avoid which require possibly unpleasant exertion, effort or discipline in contrast to easy, unearned gratifications.

The capacity to delay gratification is considered a measure of maturity and life-competence, but we all struggle with something ever day. The enemies are "I don't feel like it" or "I feel like it." In other words, self-indulgence. The enemy is us.

The earned gratifications of accomplishment tend to feel better afterwards; unearned gratifications (eg food, booze and drugs, shopping, trips and vacations, watching TV, romantic affairs, surfing the web, etc, etc.) tend to feel good while doing but often worse after because they are easy pleasures or cheap thrills which have costs which are often out of proportion to meaningful gains.

I'll confess some of my personal routine challenges, some trivial and some not:

- Getting to church - hate to dress and drag us there on Sunday morning, but always glad we went
- The gym and/or painful ("Feel the burn") exercising. No pain, no gain.
- house cleaning (I don't mind doing laundry though - thank God for electricity)
- Paperwork, paying bills, and tax prep
- Facing/doing scary or confrontational things - eg "difficult conversations"
- Dieting
- Calling Mom when I have nothing to talk about
- throwing a dinner party or cocktail party
- Studying things you need to know but aren't interested in
- giving up wine for Lent
- going to the doctor or dentist
- boat cleaning
- social events where you don't know anybody - but then you meet interesting people
- meeting with estate planners, revising the will
- getting a kid through college
- attending professional meetings
- weddings (boring except for the families) and wakes/funerals (difficult to face, for me)

What's on your list of things you feel like avoiding, but feel good after you do them?

For years, I have been explaining here that dietary fats are not a meaningful factor in heart disease (arterial disease). Your cholesterol level most likely doesn't matter either unless you have familial hyperlipidemia or diabetes. I believe those outliers skewed earlier studies.)

Here's more evidence: Study Questions Fat and Heart Disease Link.

The article also says this:

The smaller, more artery-clogging particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, Dr. Chowdhury said. “It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said. “If anything is driving your low-density lipoproteins in a more adverse way, it’s carbohydrates.”

Once again, it's the carbs that are the problem. Best thing is to deal with that carb addiction.

Dr. Dalrymple: The Difference Between Firmness and Cruelty

Deny the dark side of human nature at your own risk. Those who deny it in others tend to be those who deny it in themselves.

I have written many times here about food fetishists. I am not referring to people with diagnosed eating disorders, just to people with neurotic concerns about "healthy food" and the silly wealthy people who go to Whole Foods.

"Healthy food" cannot be defined, because humans evolved as opportunistic omnivores. We can and will thrive on anything and everything we can stuff into our gaping pie holes. Americans and Europeans are the most over-nourished people on earth, as is most of the Western-influenced prosperous world.  

Here's this looniness: Food Fetish on Campus - Colleges and universities are embracing "food studies" primarily as another way of pushing leftist beliefs.

"Food Studies"? Yes, with a minor in beer and pizza after classes. Unless you need to lose fat, have a pepperoni pizza and a beer, then some ice cream, find some other more productive interests to think about, and you'll do just fine in life. I regret informing you, as a physician, that "You are not what you eat." It's just too bad that life is not that easy.

In the Western world, too much nutrition is the biggest concern. It's now termed a "First World Problem" - How little of what will I eat for supper?

Forever Young? 20 of the Hottest Women Over 60 Years Old. 65 is the old 45. All it takes is some care, some flair, some estrogen, some exertion, and a little cash for teeth, hair, and skin.

Re the below by Peter Arno, Are you? And is he the young man you married?

Dalrymple begins:

 In my career as a doctor in prison, I met a few swindlers in my time and on the whole I liked them. They had charm and intelligence, which perhaps is unsurprising. It isn’t easy to imagine a charmless swindler, after all; it is almost a sine qua non of the trade. Whether their charm preceded their swindling or they developed it in order to practice their swindling is hard to say, though the former is more likely. Be that as it may, their charm was their stock-in-trade and human gullibility the market in which they sold their wares.

Wave by Sonali Deraniyagala

The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics by Daniel James Brown 

High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society by Dr. Carl Hart. Amazon comment below:

 High Price is the harrowing and inspiring memoir of neuroscientist Carl Hart, a man who grew up in one of Miami’s toughest neighborhoods and, determined to make a difference as an adult, tirelessly applies his scientific training to help save real lives.

Young Carl didn't see the value of school, studying just enough to keep him on the basketball team. Today, he is a cutting-edge neuroscientist—Columbia University’s first tenured African American professor in the sciences—whose landmark, controversial research is redefining our understanding of addiction.

In this provocative and eye-opening memoir, Dr. Carl Hart recalls his journey of self-discovery, how he escaped a life of crime and drugs and avoided becoming one of the crack addicts he now studies. Interweaving past and present, Hart goes beyond the hype as he examines the relationship between drugs and pleasure, choice, and motivation, both in the brain and in society. His findings shed new light on common ideas about race, poverty, and drugs, and explain why current policies are failing.

A new study: High suicide rates for soldiers in, out of war

A while ago, Junk Science put in a well-deserved plug for Dr. Paul McHugh and Dr. Sally Satel in his piece, in which he notes that the majority of military suicides have never been near combat.

I could discuss the topic of suicide and suicidality for days. Suicide is not one thing. It is endlessly complex, and definitely not always accompanied by clinical depression or other mental illness. Shame, guilt, loss, or anger are often prominent components, along with personality disorders, Bipolar, psychosis, and other things.

PTSD? Readers know that I tend to think that it is not a "disorder" but a normal variant. The people who put the DSM together can't tell the difference.

Here's the article by Elise Cooper to which he was reacting: Suicide in the Armed Forces: Not a Disgrace

"What it comes down to is that the mystery of joy does not pose a problem for me. I treat it as a constant rather than a fleeting experience."

Taki is a blessed human being; one of the fortunate ones for whom life itself is a blessing and who can spread it to others.

Psychiatric Times retracts essay on “satanic ritual abuse”

Psychiatry has seen its share of damagingly-erroneous fads over the years: multiple personality, satanism, "recovered memories." It's important to learn from such fads and errors, not to hide them in embarrassment.

Every branch of medicine, and of science in general, experiences erroneous fads and false enthusiasms. Only a few years ago, the climate scientists were going nuts about global cooling, and soon, perhaps, they will do so again.

The only cure is chronic skepticism.