For difficult patients who need more than outpatient treatment or short-stay stabilization. Over the years, I have found Gould Farm to be very helpful to patients: Gould Farm.

Good, highly-dedicated people work there.

The government offers me a $40,000 check to go on electronic medical records. I won't do it. Who would open up to me if I did?

For the same reason, I keep minimal notes anyway and just enough to refresh my memory. From  The
Electronic-Medical-Records Wreck -Doctors have their own Obamacare nightmare to deal with:

 As I’ve mentioned previously, my own primary-care physician in Colorado Springs quit her regular practice and converted to “concierge care” because of the EMR imposition. Dr. Henry Smith, a Pennsylvania pulmonary doctor, also walked away. “Faced with the implementation costs and skyrocketing overhead in general,” he told me, “I finally threw in the towel and closed my practice.” He said, “As EMRs proliferate, and increased Medicare scrutiny looms, medical documentation is evolving from its original goal of recording what actually was going on with a patient, and what the provider was actually thinking, to sterile boilerplate documents designed to justify the highest billing codes.”

Many docs today are spending more time on computer screens than they are with patients.

If $300,000 buys you a statistical chance of living a few more days with a terminal cancer, would you take it? Would you take it even if Medicare paid for it - which it probably would?

Cancer chemotherapy is a big business: The Cancer Drug Racket:

What is sobering about this booming business is that, as a group of oncologists wrote earlier this year, "most anti-cancer drugs provide minor survival benefits, if at all." They often (but not always) reduce the size of inoperable tumors, but they rarely eradicate the disease. For relatively uncommon malignancies like testicular cancer, some forms of leukemia, and lymphoma, drugs effectively cure the disease; for the common "solid tumor" cancers (lung, breast, colon, prostate, and so on), which account for the vast majority of annual cases, drugs buy some time-precious time, to be sure, but time usually measured in weeks and months rather than years. And even though many of the newer drugs are less toxic, they often still have to be given with older drugs whose side effects include nausea, hair loss, fatigue, and decreasing blood counts. One anti-cancer drug produces a skin rash so severe and disturbing, according to Saltz, that some patients have been asked by employers not to come to work.

I have referred to the DSM as an obsessional disorder. This author approaches it as a dystopian novel, and I do agree with some of his sentiments.

He says, about this "novel," that "A mad person is like a faulty machine."  What he doesn't quite mention is that, in the DSM, essentially everybody has at least one DSM disorder. That satisfies insurance companies, which is the main point in the end.

When government gets involved in things, those things become politicized. Same thing goes for medical care. The death panels are meant to be a buffer against popular clamorings, but they won't work.

When it comes to medical care, nutrition, vitamins, exercise, etc, the loudest quacks and cranks tend to prevail:  The Quackish Cult of Alternative Medicine - Dr. Paul Offit's battle against charlatanism

Is there quackery in non-alternative medicine? Sure, but it is mostly unintentional quackery. Docs tend to cling to the most recent information they have read, but most of it proves, in time, to be in error:  Trouble at the lab - Scientists like to think of science as self-correcting. To an alarming degree, it is no.

Best to go with a conservative physician who has a good dose of skepticism and common sense.

The change in medical care. I refuse to term it "health care," since health needs no care other than one's own reasonably-sensible and attentive but not health-obsessed life, combined with the main factor - luck. From a commenter at Allahpundit:

Perhaps the concept of ‘insurance’ isn’t the right one for health care?

I always liked the comparison that was trying to be made with car insurance…

Yet for there to be an equivalent your car insurance would have to cover:
- maintenance tune-ups, including oil and filter changes
- the cost of repairs for any reason
- a price break per gallon of gas
- an annual detailing
- the cost of tires
- a new muffler annually
- and never, ever raising the cost of your insurance no matter how many accidents you were in, how many tickets you got… anything

Imagine what car insurance would be like if we modeled that on health insurance coverage and you get an idea why health insurance coverage is so high. And why get fuel efficient vehicles if you are getting the gas subsidized? Or bother with the maintenance if you’ll get a brand new engine if you forgot about it? And the cost of such insurance would be… lower than what you have now?

The number of shades of maroon that went into trying to make this entire ‘insurance’ concept work for one’s health is plain nuts. It isn’t ‘insurance’ if you are going to use it constantly… you want something else.

Perhaps a clue.

Health insurance used to be an executive ‘perk’ because it was TOO EXPENSIVE to provide for everyone in the workforce. Businesses got a price break for it to entice people who would not normally come to work to do so during WWII. The war ended. The subsidy via the tax code did not. Strangely enough before this misbegotten idea got infested into the tax code and people’s minds, individuals did not drop over dead in the street and did work out payment schedules WITH hospitals and physicians. Amazingly that worked and there was a strong system of charitable hospitals and care givers to pick up the slack. Then government got involved and screwed it up.

Government is all about money. Government's expertise is perverse incentives. The Obama-thing, like the previous Hillary-thing, is not technically insurance. It's just pre-paid medical costs, spread across populations and subsidized, or not, by income and with bureaucrats deciding what you can get paid on it.

That's not an entirely insane idea, except that whenever government gets involved with things outside their Constitutional mandate, things turn out wrong and over-controlling by the standards of a free country. Always.

I do not believe that most Americans want every detail of their lives politicized. I think they want to be left alone, but maybe I am old-fashioned.

Child Behaviour: Not In Their Genes?

A blissful marriage is the stuff of teenage fantasy. Real life gets in the way of romance, and our unappealing traits become more evident over time. It's amazing how people put up with us.

The age-old institution remains, for us, a sacramental covenant, a secular contract, and a practical arrangement for building a good, decent, wholesome family life. Especially so in an era in which we, and our kids, all quickly move from home, and the extended family in the neighborhood is a thing of the remote past.

IQ is part of it. If you and a spouse each have average IQs of 100, the marriage should have an IQ of 200. If your judgement is mediocre, you can find a spouse with better judgement. If your social skills are weak, a spouse can help compensate. If your taste in decor stinks, your spouse might do better.

And unless you are very wealthy and can afford plenty of help, four hands can get more done in a few hours than can two.

It all just makes good sense as a life foundation, as something to try to build whatever one wants in life on top of. As much as I may even hate and abuse my spouse at times, my life would be lousy without him. At this point, I could not do it without my companion to rely on 100%. It is a permanent bond, as we vowed in the beginning. We put up with eachother's flaws, and benefit from eachother's strengths. We are loyal to eachother and to our life together, above all else. We even confide in eachother, which can be a bit sexy. Fantasy is fun.

The political Left is ambivalent about marriage. They like the idea of marriage to the State instead of to people, but they like gay marriage. Go figure. Historically, however, marriage did not strictly require monogamy despite the spoken vows in church, and allowed room for adventure. We do not do that because that was not our deal.

Charles Murray has been on this topic for years. Marriage works well for society as a whole, but it probably works well for individuals too. Marriage is increasingly the big sociological divide in American life: Getting and staying married makes you part of a privileged elite.

How America's Marriage Crisis Makes Income Inequality So Much Worse

It's well-known that the Chinese rightly love Western music, and love our "serious" music more than our pop music (not that I believe that any music is really "serious"). It is no surprise that they love ours, because their traditional music is hideous.

Right now in China, it's not so much the violin as it is the piano:

China made 379,746 pianos last year, 77 per cent of global output, almost all of it for domestic sale. Multiply that by ten for second-hand sales and you are still nowhere near the popular estimate that 60 million Chinese children are currently playing the piano, equivalent to the entire population of the United Kingdom sitting down every evening and practising scales for two hours.

I wish that I had had a better piano teacher when I was a kid but that sounds like lame excuse-making. I have no musical talent at all, but I always have wanted to make just a little music for myself instead of pushing a button for it like a king with his court musicians. I wanted to understand what was behind the pieces I was learning to play, and she kept saying "that's for later." Then, eventually, there was no later. I should have been learning scales, and why scales exist. Or maybe not. I have a friend who is taking up piano in middle age, and is having a wonderful time with it. Great delight learning scales and jazz chords.

Every home needs at least one person practicing music, however well or poorly.

Maybe this is like our post about new math. You either have it, or you don't, but there is a gray zone.

Stop calling alcohol “MommyJuice”: How liquor companies target women

I don't think she is blaming the booze business for this. Women have always had their secret Mothers' Little Helpers, of one sort or another, since the beginning of time. Laudanum, alcohol, coca leaf, tobacco, areca nut and betel leaf, you name it - long before TV advertising and Mad Men.

Every human has at least a touch of sadism in them. A touch of other unpleasant things too, such as sociopathy. When these normal traits (eg, have you even felt schadenfreud?) reach some threshold level, we label them.

Let those without sin or sinful thoughts cast the first stone. 

Everyday Sadists Take Pleasure In Others’ Pain

A Psychologist studies crack cocaine use:

 “Eighty to 90 percent of people who use crack and methamphetamine don’t get addicted,” said Dr. Hart, an associate professor of psychology. “And the small number who do become addicted are nothing like the popular caricatures.”

Start by acknowledging that boys are languishing while girls are succeeding:

 Boys in all ethnic groups and social classes are far less likely than their sisters to feel connected to school, to earn good grades, or to have high academic aspirations. A recent working paper from the National Bureau of Economic Research documents a remarkable trend among high-achieving students: In the 1980s, nearly the same number of top male and female high school students said they planned to pursue a postgraduate degree (13 percent of boys and 15 percent of girls). By the 2000s, 27 percent of girls expressed that ambition, compared with 16 percent of boys. During the same period, the gap between girls and boys earning mostly A’s nearly doubled—from three to five percentage points.

This gap in education engagement has dire economic consequences for boys.

As I have said before, all boys have some ADD. The best male students have some OCD to compensate.

Does "neuro-everything" make the concept of Mind obsolete? Mindless - The new neuro-skeptics.

The really curious thing about minds and brains is that the truth about them lies not somewhere in the middle but simultaneously on both extremes. We know already that the wet bits of the brain change the moods of the mind: that’s why a lot of champagne gets sold on Valentine’s Day. On the other hand, if the mind were not a high-level symbol-managing device, flower sales would not rise on Valentine’s Day, too. Philosophy may someday dissolve into psychology and psychology into neurology, but since the lesson of neuro is that thoughts change brains as much as brains thoughts, the reduction may not reduce much that matters. As Montaigne wrote, we are always double in ourselves. Or, as they say on the Enterprise, it takes all kinds to run a starship.

The constant fuss about prescribed pain meds is puzzling to me. To Cut Abuse, F.D.A. Is Altering Painkiller Label Rules. I believe that pain relief is one of the best things doctors have to offer the suffering, so I believe in generous opioid use when needed.

Here's what I have learned, over time:

- Abusers of precribed narcotics are a trivial social problem
- Habit-forming opioids can make a lot of people functional
- The biggest social problems with narcotics are their illegality
- Addiction is a psycho-social-spiritual challenge for the individual

What are you views?

Bradley Manning Is Not a Woman - Pronouns and delusions do not trump biology.

I have been slow to get to this over-worked story, but It's an excellent article about the surgical approach to identity confusion. I suspect that the vast majority of American Psychiatrists would agree with the author's point of view.

Michael Jackson thought he was Elizabeth Taylor, but he was not.

 Re-posted from earlier this year -

On the top of Maggie's Farm, we seem to reject being subject to the efforts of do-gooders. Is the road to hell paved with good intentions? Do-gooders always seem to either want my money, or want to control me.

This morning, we linked James Taranto's brief discussion of a remarkable paper in the Proceedings of the National Academy of Sciences, titled Concepts and Implications of Altruism Bias and Pathological Altruism.

In just eight dense pages, Prof. Oakley covers a lot of ground and goes far beyond the Law of Unintended Consequences. She touches on psychology, science, medicine, philosophy, and politics. It's a remarkable paper which indeed pulls enough threads together to represent a potential paradigm shift. One quote:

The bottom line is that the heartfelt, emotional basis of our good intentions can mislead us about what is truly helpful for others. Altruistic intentions must be run through the sieve of rational analysis; all too often, the best long-term action to help others, at both personal and public scales, is not immediately or intuitively obvious, not what temporarily makes us feel good, and not what is being promoted by other individuals, with their own potentially self-serving interests.

Indeed, truly altruistic actions may some-times appear cruel or harmful, the equivalent of saying no to the student who demands a higher grade or to the addict who needs another hit. However, the social consequences of appearing cruel in a culture that places high value on kindness, empathy, and altruism can lead us to misplaced "helpful" behavior and result in self-deception regarding the consequences of our actions.

From Dr. Sally Satel, James Q. Wilson and the Defense of Moral Judgment:

One purpose of The Moral Sense was, as Wilson put it, “to help people recover the confidence with which they once spoke about virtue and morality.” The other goal was to trace the origins of human morality. Summoning an array of anthropological evidence, Wilson elaborated on the idea that our moral sense is innate, acquired not through learning but through evolution. These sentiments do not spring to life fully formed; instead, they are cultivated within family and society. Adam Smith and Thomas Jefferson had advanced the idea of inborn moral affinity but Wilson enlarged upon it, proposing that the moral sense rested upon four foundational pillars: sympathy, fairness, self-control, and duty.

Having a good-sized hippocampus helps a lot in life, but can it be too large and effective?

Marilu Henner remembers everything.

The History and
Psychology of Clowns Being Scary. You aren’t alone in your fear of makeup-clad entertainers; people
have been frightened by clowns for centuries.

It tells a bit about Grimaldi, the great clown. I have noticed that it's not just kids. Dogs are afraid of clowns too.

We all know that loneliness sucks. Often, not having enough alone time sucks too. Sociality takes effort and thought, and can be draining at times. At it best, it is effortless, delightful, supportive, and life-enriching.

I count myself lucky in having so many pals, friends, and good acquaintances. I do not know why life evolved that way, but I guess God gave me a fairly appealing personality. I figure that I was raised properly, have pleasant manners, know how to dress and to make cheery dinner table conversation, have a decent sense of humor about life and an abundance of interests and controversial opinions.

For those who were born socially awkward or unskilled, life can be especially difficult. Socializing agreeably requires some training, example, and experience, and perhaps a little talent for it. Most of all, it requires remembering that it's not about YOU.

Every human feels rejected, unwanted, or like an outsider sometimes. That is normal. Some people give up on making connections, and that is a shame. We all need people around who can just open the front door without knocking and walk in, knowing that they are welcome for a coffee or a beer or a glass of Scotch. We all need people who are willing to take a chance to seek us out, too, for connection. That is a blessing.

Here's the article: The Lethality of Loneliness.

Social isolation can lead to sorts of inbred craziness and impaired social reality-testing. Chicken or egg? Who can tell?

Reposted -

Like some other readers, I found Charles Murray's presentation fascinating.

I have been thinking about it. As I commented then, sociologists tend not to discuss psychology. A good rule of thumb is that a person's character traits - personality traits - determine a lot about their adaptation to life and to reality - their success in making goals, and pursuing their goals, for themselves.

It doesn't matter where character traits come from: genetics, examples, or wherever. What matters is the balance between the useful ones and the detrimental ones.

Furthermore, some character traits, like obsessionalism, are good for some things (eg being a pilot or surgeon) but detrimental for others (eg being a jazz musician, or displaying emotion in relationships). For another example, the capacity for controlled violence (useful for cops and soldiers and, in fact many other jobs too including my own, at times). People are even beginning to talk about the usefulness of Asperger's traits.

Each of us is our own stew of traits and strengths and weaknesses. Mature adults do not blame the world or others for their difficulties, but look at themselves, try to identify their shortcomings, and try to improve them if they chose to.

I do not view social class or income as a measure of life success or life adaptation. In my professional world, we use other, less superficial measures such as quality and stability of relationships, breadth of interests, responsibility and reliability, self-control, active engagement in life, and so on.

However, as Murray implies, social class can be a very rough measure of human adaptation for people with material ambitions: people in the upper middle class tend to be more adaptable and able socially and intellectually, and those in the lower class tend to either have more adaptive problems, or to cause more problems for others (which includes governmental or charitable dependency, crime, disorder, etc).

Before I run out of space, I want to say a word about social capital, as I constructed my own practical understanding of it. In my simple-minded way, applying one's social capital means participating in and contributing to one's community, whatever that may be. Being a constructive part of it, beyond the bare minimum of holding down a job or raising a family.

Whether it's as simple as introducing people to each other, throwing holiday parties, getting a stop sign on a corner, helping a kid find a job, volunteering at church, raising money to sustain the local chamber group, running a Boy Scout troop, attending town meetings, joining clubs, starting a softball team, or coaching soccer, we all have ways to contribute to our social network, our neighborhoods, and to our communities. I do know how corny all that sounds, but I believe it is very important.

Our social capital is truly the kind of capital which we must either spend or waste before we die. People who do not jump in and spend theirs before they die are selfish, mean, and un-American, in my book.

The Old Man discusses his journey as a Psychiatrist amongst the most severely ill. The TED video at the end is remarkable.

The comments are interesting, too.

Our commenter Buddy offered this thought a while ago on They keep changing the name of it:

"the thing is, tho, that the moral or ethical question of entering consequentially into a stranger's life is not the same question as whether or not one is lonely."

His excellent phrase "entering consequentially into a stranger's life" got me thinking. As a psychotherapeutically-oriented shrink, most of my work is to "enter consequentially into strangers' lives," and that is a privilege and sometimes a frightening position which I am paid to do as a professional person.

Most adults are cautious, aren't we? - about who we permit into our lives, and to what extent. We may make exceptions with relatives, clergy, or people with white coats, but, generally, our interpersonal lives consist of concentric circles, admitting few to our inner sanctum.

The reason for that is, of course, because confiding in someone, being emotionally intimate with someone, cannot be inconsequential for normal people. Relationships affect us and affect our lives, so they are a serious matter and potentially dangerous.

Loneliness is painful. Lonely people, sad to say, and substance-abusers may be less discriminating about whom to let in. Fact is, though, closeness is always somewhat risky for both people involved because we humans get attached and thus vulnerable.

Buddy's comment, however, was on the topic of Sugar Daddies and mistresses, sort-of about the idea of sexual intimacy rather than personal or emotional intimacy. There is the hooking up culture of course. A college student recently told me that if he strikes out and doesn't get laid by a different girl each night of Spring Break in Nassau, he will feel like a loser. But I do not mean to be discussing purely recreational or athletic alcohol-infused sexual adventures.

What I am wondering about is whether it is possible for a Sugar Daddy and the gal, over time, not to form an affectionate attachment despite the basic free-market win-win foundation of the relationship. Or even regular co-workers.

Perhaps some people are more capable of inconsequential intimacy or exploitative intimacy than others. Not perhaps. Definitely.