Maggie's Farm

Bombs filled with ball bearings in my Boston Town. It's like a bad dream. What evil and/or insane person or persons did this to our gentle, Liberal town and our world-wide guests?

In the absence of information, it's a Rorshach of peoples' hopes and fears, and on the teevee, talking heads attempt to instill their prejudices to gullible low-info voters according to their preferred narratives. No info? A chance to write something onto their blank slates that might stick to their emotions.

Meanwhile, we have a mass murderer on trial in Philly, a knife-man attacker in a school, and 4 killed in Chicago just last weekend with illegal handguns. We know those details.

Evil exists everywhere and no laws can eliminate evil. Stay strong and calm and carry on. See human history. Our thanks to all of the first responders everywhere, and to all of the good civilians who pitch in when help is needed and run towards trouble instead of away from it.

We will never be free of trouble, but strong men and women will always run to the sound of the guns.

I have been saving two links about Tallis' 2011 book, Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity, until I found time to say something interesting about the ideas. I could not add anything, as it turned out, because Mark Signorelli says it so well in his review.

Tallis, a neurologist (and amateur and impressive philosopher) wrote the book as a critique of biological and evolutionary reductionism. 

Here's a brief review from the WSJ.One quote:

 In his vigorously argued "Aping Mankind," Raymond Tallis takes on what he calls "neuromania" (the belief that we are our physical brains and nothing more) and "Darwinitis" (the insistence that our consciousness can be reduced to evolutionary terms) in a robust defense of the unique nature of human consciousness. Mr. Tallis, a doctor and researcher in clinical neuroscience, believes that most contemporary accounts of human consciousness fail to understand the lived experience of individual minds. Reducing man to simply another animal in a real sense de-humanizes us, with disastrous effects in areas from social policy to the interpretation of art and literature, which the author touches on in engaging asides.

Aping Mankind is negative research. While most popular-science writers attempt to weave compelling stories from the latest neuroscience experiments to explain 'why we are the way we are', Tallis attempts to show why these stories simply cannot be true. If you are skeptical of media--and scientific journal--headlines such as "Researchers discover the location of love in the brain", then you may enjoy Aping Mankind. In this work Tallis exposes the odd proclivity of scholars, from biologists to literary critics, to anthropomorphize pieces of matter while simultaneously dehumanizing human beings. In effect we are systematically transferring our humanity to matter, and this may not be good for our health--just like vitamins.

Returning to Signorelli's impressive review which opens like this:

I can recall very clearly the moment at which the spread of Darwinian ideology became a matter of concern for me. Previously, I had been acquainted with such ideology, and recognized it as but one more strain of fashionable cant, promoted by a set of persons quite obviously unfamiliar with elementary philosophical reasoning. Having attended college in the late twentieth century, I, like many of my generation, simply became accustomed to dwelling in an intellectual atmosphere poisoned by noxious dogmas, whether deconstructionist, multi-cultural, or what have you; Darwinism was evidently just such another doctrine, and so I took no great alarm at its prevalence. That changed one evening when, surfing idly across the internet, I came across the late Denis Dutton’s article on “Aesthetics and Evolutionary Psychology” in the Oxford Handbook of Aesthetics, an article which proposed the advantages of applying evolutionary theory to our inquiries regarding the arts and literature. This was the first time I had encountered Darwinism in such a context, and when I looked into the matter subsequently, I found that Dutton was by no means alone in his project; quite a body of literature had amassed by that point, purporting to offer evolutionary accounts of poetry, dance, and painting, among other things. Now I became alarmed, and greatly so. Literature (understood in the broad sense of learning, or letters) has been everything to me, the source of all my consolation, and all my self-understanding. To see it threatened by this dirty little creed, with its invariable tendency to degrade whatever comes under its purview, was deeply worrying to me. So I began writing against it, with that same defensive urgency that motivates a man to fight for kin and country.

I am a big fan of AA as a help with addiction and as a method for personal growth and maturity.

It's not the only way, but it might be the best way for those who have trouble with it. Recently, people have recommended two books by Allen Carr:

The Easy Way to Stop Drinking

Allen Carr's Easyway to Stop Smoking

This simple problem, offered by a reader, doesn't (I think) require Bayesian methods:

Suppose some one person stole some money and there are a hundred possible suspects. You use a lie detector, which has a 99% chance of a positive if you are guilty, and a 99% chance of a negative if you are innocent. Someone tests positive. What are the chances the person is guilty?

As with medical tests, this deals with rates of false negatives and false positives. Please explain your answer in the comments.

I found this piece, with this example with some good discussion:

10 out of 1000 women at age forty who participate in routine screening have breast cancer.  800 out of 1000 women with breast cancer will get positive mammographies.  96 out of 1000 women without breast cancer will also get positive mammographies.  If 1000 women in this age group undergo a routine screening, about what fraction of women with positive mammographies will actually have breast cancer?

The answer is 7.8%. That's why needle biopsies are done, but they can be read wrong too. Some error is always unavoidable.

She says doctors themselves generally get such stats wrong. Here's another example:

Here is a simple example, based on Mike Shor's Java applet. Suppose you have been tested positive for a disease; what is the probability that you actually have the disease? It depends on the accuracy and sensitivity of the test, and on the background (prior) probability of the disease...

It's worth reading both brief presentations. The current thinking seems to be that Bayesian is the only reliable approach for data these days, and, if data has not been subject to it, it might not be worth much.

In my field of mental illness, the data is always so squishy to start out with that I am a skeptic about everything I read anyway. I have seen very few reports in Psychiatry which have been subject to Bayesian analysis and are thus probably not worth much. 

My experience is a better teacher which is, I suppose, sort of Bayesian.

It's been far too long since I studied, or used statistics other than to read medical journal articles. Everybody talks about Bayesian Statistics nowadays. They are the new old thing, almost 100 years older than Fisher Statistics (Fisher was an interesting fellow).

In my youth, I learned to be always skeptical about any research results, but I am told that running data through Bayesian methods is a good test of data.

Can somebody explain the concept to me in simple English? I don't intend to use it, just to get the ideas (I can do the math, but I want something conceptual for starters.) Most Liberal Arts students learned basic Stats in college, the p and the t-test, etc., but the Bayesian is new to me.

Reading Buzz Bissinger's confession, My Gucci Addiction, I would have to seriously consider the Bipolar possibility were I his doctor:

In the past few years, I've bought eighty-one leather jackets. Dozens of boots and leather gloves. I've purchased pants that cost $5,000. I own a $22,000 coat. This winter I took a tour of Milan's Fashion Week (all expenses paid by Gucci, in appreciation of my many, many purchases), where I spent tens of thousands more and began to seriously grapple, once and for all, with a compulsion that could cost me more than just my life savings. My name is Buzz Bissinger. I am 58 years old, the best-selling author of 'Friday Night Lights,' father of three, husband. And I am a shopaholic.

Not everybody who does crazy things has a diagnosis, but unless Mr. Bissinger has inherited $100 million, somebody ought to try to stop him before he blows himself up. It does not sound like his wife is likely to do that.

I saw a nice lady for consultation a few years ago. She was distraught, wanted help in rebuilding her life and her emotional strength. Her husband, age 54, had, after an evening of good sex with her, informed her that he had realized that he was gay, and needed to leave her to pursue a gay life style because he did not want to deceive her or betray her.

They cried together and held eachother. She cried for two weeks. After that, she began having panic attacks. He moved out, and the legal aspects of the divorce proceedings had been easy and mutually agreeable.

Six months had gone by and she still felt shattered. The reality of her life had been exploded. I told her that grief takes at least a year.  Mind you, this was a sophisticated urban woman who had once been in the fashion business and who assured me she could readily identify gay guys at a distance. He had always been a loving, sexy, loyal husband with no hyper-macho ways, and no stereotypical gay interests or mannerisms. Good father, too. He worked in finance.

In the six months apart, she told me that he had seemed to transform himself from an ordinary fellow into a flamboyantly gay man who drinks too much, dyes his hair, spends weekends in Provincetown and weeknights in gay bars. He told her it took him 40 years "to find his inner fag." He says he'll love her forever, support her and the kids, but now has found his real self and feels happier than he ever had.

I thought to myself "That was a real gay marriage." I also wondered whether he was Bipolar, but it didn't matter because it was over and her challenge was to write what I term "a new chapter."

I had seen this a number of times before, in mid-life men and in women too. I can't say I understand it. Nobody really does, but I do understand the grief. Agonizing. I also understand the horror of wondering whether much of one's life has been fraudulently-lived in a fake reality.

In my line of work, I encounter plenty of people who live in fake realities of their own construction, but it's not ordinarily about sexual matters. It's usually about other things. I carry the burden of a thousand stories in my soul, but don't feel sorry for me. It's a privilege, and I get paid to carry them.

(nb: real details of this story are totally altered and combined - fake but true)

If marriage is primarily a legal contract, then why can't two elderly sisters marry? It might very well be to their advantage, and they may love eachother deeply. Or does marriage have to involve sex? If so, who from the government is going to check to make sure that sex is happening? God knows, the world is full of sexless marriages.

And, yes, what about polygamy? Why not? It's not Christian but it is Old Testament Jewish and it is modern (quietly) Mormon - and Islam. How many wives did David have? I read that Solomon had 200 wives and 800 concubines, or maybe the other way around. I do not know when the Israelites gave up polygamy.

The whole topic becomes more and more absurd and confusing as cultural traditions are undermined. Gays can get married while the heterosexual people are now up to 50% childbirth out of wedlock. Crazy world. It's called cultural change.

Then I noticed this: Kagan ’09: ‘There Is No Constitutional Right To Same-Sex Marriage’. That statement signifies to me that she is an unwise person. The Constitution does not set up government to dole out rights to the people, but rather to protect the mostly-unlimited rights of a free people. But I am repeating myself.

Freedom and privacy require no "penumbra." Back to the US Constitution, the American social contract:

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  This list of rights should not be read to limit in any way any other rights of the people.

  
  


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  The powers not specifically granted to the federal government by the Constitution, nor prohibited by the Constitution to the states, are reserved to the states respectively, or to the people.

  
  

Two confused thoughts:

1. Marriage. Everybody is writing about the gay marriage topic. How is marriage defined? Is the Supreme Court being asked to be a dictionary? To revise the dictionary? That's above their pay grade.

2. Is there a "right" to gay marriage? Isn't that the wrong question? The Federal government was never assigned the power to determine such personal things in a country in which the presumption of local and, most importantly, individual liberty is the centerpiece. We do not have, or need, delimited rights. Government has delimited powers (supposedly). I guess the issue had to become a federal case because marriage is not so much about a relationship, but, maybe unfortunately, about a legal status with many legal implications.

Obamacare isn’t forever, but what’s next is worse

Charles Krauthammer, MD, gets it. He always did. Our money- and power-greedy government has always drooled over the idea of control of medical care because so much emotion and money is involved. Votes, power, control.

Believe me, personal care does not lie in the future. At that point, I will give up. I will give up charity care too, if there is any of it left. I did not enter Medicine to be an employee or a peon. If that is what the people want, they can have it.

For me, it's a calling but I will not do it as a government peon.

If psychotherapists "screw up" their children any more than anybody else, I haven't seen the data. (My own kids, BTW, are perfect.) Biggest issue with parenting these days? Trying to be friends with the young. They can be pals when they grow up and achieve independence but, until then, make your own friends.

It's a perennial topic, however. If therapist-types do, I think it comes from being over-attentive, over-protective, overly-empathic, and not respecting kids' resilience and adaptability.  How Therapists Screw Up their Children.

It's important for therapist-types to put their work hat on before work, and to take it off after work.

This on parenting is related: Please Do Not Adjust Your Child

Unlike, it seems, some or many of the young women in Medicine today (50%), I never had any interest in being anybody's employee.

The Doctor Won't See You Now. He's Clocked Out. ObamaCare is pushing physicians into becoming hospital employees. The results aren't encouraging.

My freedom in practice is to see people anytime I want or can, to work whatever hours I want to, to follow no imposed treatment protocols, to set my own fees and to provide as much charity as I wish, and to help anybody I chose to.

Nobody tells me what to do or how to do it. Maybe I'm a dinosaur. I'll see patients on a Saturday or Sunday if need be.

A quote from the article:

Once they work for hospitals, physicians change their behavior in two principal ways. Often they see fewer patients and perform fewer timely procedures. Continuity of care also declines, since a physician's responsibilities end when his shift is over. This means reduced incentives for doctors to cover weekend calls, see patients in the ER, squeeze in an office visit, or take phone calls rather than turfing them to nurses. It also means physicians no longer take the time to give detailed sign-offs as they pass care of patients to other doctors who cover for them on nights, weekends and days off.

Most hospitals exacerbate these strains by measuring the productivity of the physician practices they purchase in "Relative Value Units." This is a formula that Medicare already uses to set doctor-payment rates. RVUs are supposed to measure how much time and physical effort a doctor requires to perform different clinical endeavors.

A quote:

Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"

The people interviewed practice the same way I, and plenty of my colleagues, practice. No insurance, and thus no back office staff and low overhead. No boss, practice exactly the way I want to as I decide with my patients.

Amateur addicts always have an excuse, but those who are honest with themselves will admit that it just makes them feel good and that they have addictive tendencies.

There's a Reason That Addicts Say Yes to Drugs.

Emerson College's Insurer Will Cover Transgender Student's Transition Surgery.

These people who seem to believe they are the spawn of aliens, animals inside a human body, boys who believe they are girls, and all the other sorts of silly fantasy lives that people put on display today, are people with only the slightest grip on reality.

I would never claim that we shrinks and psychoanalysts have the power to change such unfortunate fantasies/delusions, but seeing other physicians collude with such fantasies disturbs me more than a little bit.

Many rightly criticize Psychiatry for over-pathologizing human variation, but normalizing total weirdness is another matter. Strange is strange, and nobody should be afraid to say so in fear of the Thought Police.

He has a new book out, about what he learned from the Harvard lifetime study. He is delightful. The podcast is here.

Why we have our best ideas in the shower: The science of creativity.

I always figured that it's because there were no distractions, same as driving alone with the radio off (which I recommend).

Do the nanny-staters and busybodies want stores to sell food that people don't want to eat?

Here's an amusing response to that widely-linked NYT piece:  Sweet savage food marketing at the New York Times

Moss' hystrionic NYT article complained about food that panders to the human taste appeal of salty and sweet foods. Well, guess what - the human sense of taste is limited to sweet, salty, and bitter (and sour). So why didn't Moss complain about the pickles with the burger too? Or is sour OK with him?

Unsurprisingly, the appeal of fatty food is not taste, but textural and olfactory. However, as I have preached here many times, fatty food is good stuff and is required for health, vigor, and mental functioning.

Just skip those carbs if you wish to stay slim.

I entirely agree with the comment:

Wakes and funerals already exist to serve the immediate needs for mourning and recognition of the loss. Participation in normalizing rituals is probably far more helpful than therapy in the immediate aftermath of a such a loss.

We all agree that human monogamy is not "natural" in any animal sense. It's a stretch.  If marriage matters to you, and you've been married over a year or ten, this could a pretty useful talk, and takes the topic further and more intelligently than the supermarket magazines ever will.

Just one of the secrets seems to be experiencing one's spouse in different situations and seeing them being effective or impressive in different ways - socially, professionally, intellectually, adventurously, morally, humorously, physically, talent-gifted, etc. We can never know everything about another person and it is much easier to become familiar with a spouse's flaws than with their varied strengths, many of which may be hidden from us.

For one example, when on occasion I have barged into my husband when he is deep in prayer, I do see him with new eyes. For another, when I see him regaling people with wacky stories at a party.

The secrets to desire in a long-term relationship:

As the man says, "their definitions expel me and, in fact, most mental health professionals."

I like to claim that the DSM is an Obsessional Disorder.

We learned about an interesting center for evaluation and training for kids with autism, mental retardation, and developmental disorders: The May Institute.

Walter Mead linked to Brill's article in Time, Bitter Pill: Why Medical Bills Are Killing Us:

A quote:

I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem...

Tort reform is an easy place to start. I think 90% of CAT scans are defensive, and are billed at anywhere between $600 and $3000.

Second might be an acceptance of the inevitability of death. No, I do not mean death panels. I just mean acceptance. Death is not an enemy.