Maggie's Farm

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.

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.

On sale now: (1) Biology and Human Behavior: The Neurological Origins of Individuality, 2nd Edition & (2) Neuroscience of Everyday Life

Dr. Sapolsky is highly entertaining.