We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Except for some clearly defined, obvious ailments (eg dementia, the schizophrenias, PDD, autism, addiction, melancholia), most diagnoses in the handbook (the DSM, which many of us refer to as "the insurance manual") attempt to define common clumps of symptoms or behaviors without assuming any validity (ie, without any assumption that the clumping refers to any one cause or underlying abnormality) to those clumps.
Many of our "diagnoses" are akin to saying that a patient has a fever. There's a problem of some sort, but you don't know what it is yet, or whether it's serious or not. Lots of them are "life problems." The DSM is, sorry to say, largely pseudo-scientific. That's because we have very little validity to demonstrate.
Since the validity of most of our diagnoses cannot be tested in any way, all people do is to test their reliability (ie how often will two docs make the same diagnosis in a given patient). In a sense, measuring reliability is nothing but a measure of group-think and, in Psychiatry, the reliability of our diagnoses is quite low - in the "poor" range. (This is measured by a "kappa" score of inter-rater reliability.)
Landis and Koch45 have proposed the following as standards for strength of agreement for the kappa coefficient: ≤0=poor, .01–.20=slight, .21–.40=fair, .41–.60=moderate, .61–.80=substantial, and .81–1=almost perfect. Similar formulations exist,46–48 but with slightly different descriptors. The choice of such benchmarks, however, is inevitably arbitrary,29,49 and the effects of prevalence and bias on kappa must be considered when judging its magnitude.
OK, Psychiatry has only a few rare spots of validity, but even its reliability is mostly in the "poor" to "fair" range. The good Psychiatrist here discusses the abysmal reliability of Psychiatric diagnoses.
As Robin Hanson discusses, Psychiatry uses "depressingly low standards" for reliability. Indeed, most of the time Psychiatrists disagree on how to label a given patient because few patients fit the molds, and most sort-of "fit" multiple categories. Furthermore, many diagnoses fade imperceptibly into normal variants: ADD, anxiety, mild depression, pbobias, PTSD, Bipolar 2, and OCD, and personality disorders, for some common examples. (I recently read that 40% of people have some obsessional symptoms at some point in their lives.)
In Psychiatry, you have to be able to tolerate ambiguity. It's not a mechanical profession except for the amateurs. Most if not all people on the sidewalk are at least what we might term "normal-neurotic" in some ways.
As a result, the American Psychiatric Association recommends that the DSM not be applied clinically in the cook book manner in which it is written, but as a guideline to which clinical experience - and understanding the patient in as much depth as possible - inform one's clinical impression. As Dr. Frances says, "It's not a Bible," and should not be applied as if it were.
Indeed it is not. Scientifically, it's mostly a failure but it's a kind of casual dictionary. I do not take it too seriously, and often use diagnostic descriptions which do not appear in the DSM (such as "neurosis"). I can usually find a way to help people anyway, regardless of how I might label them (and often I do not bother to label them at all). Generally, the more clinical experience a doc has under his belt, and the more psychodynamically-oriented he is, the less seriously he takes the diagnostic obsessional nit-picking.
We muddle through, struggle to understand, and still are able to help lots of people in the end. A true diagnosis of a patient goes far beyond anything in the superficial DSM. For example, a real diagnosis must consider the nature and quality of somebody's "object relations," their character strengths and weaknesses, their sublimatory capacities, their defensive structure, their superego functioning, etc. etc. In other words, really knowing what a person is all about.
In my post yesterday, Dr. Frances discussed "diagnosis inflation" and "medicalization" of normal life troubles. It would seem obvious that not everybody with a problem has an illness.
However, labeling a problem as an illness does help obtain insurance coverage. That may be the whole point. This topic is discussed briefly here.
Dr. Francis, who had been an editor of the DSM 3 and Editor of the 4, and was a teacher of mine back in the day, discusses some of the current diagnostic craziness related to the DSM 5 (h/t to 1 Boring Old Man).
His talk also contains some good general comments about Psychiatric medical practice, for those who might be curious about it. Sensible fellow, and articulate without teleprompter.
I will post some more items about diagnosis this week for the two or three readers who find the topic interesting.
It often confuses me why so many in my "helping professions" are Lefties. In fact, it probably makes more sense for us all to be Libertarians at heart. Like many Maggie's people, I am sort-of Conservative-Libertarian, if that makes any sense to you.
What it means is that if people want to smoke, or to get fat and out of shape, or play with guns, or shoot animals, or watch TV or play video games all day, or do reckless or stupid things, it's fine with me as long as it doesn't cause me any personal trouble or impinge meaningfully on my family's life. Does tax-funded medical care alter that balance?
Adults make their own decisions. I don't care a whit what other people do. The main thing that bothers me, socio-politically, are those who have somehow concluded that they are my betters and believe that they have a better plan for my - and for your - life. Such people often gravitate to government careers where there is some power to be wielded. We used to term such people "cranks," but cranks have gone mainstream.
Desire for power over others is almost a sickness, or is a sort of sickness (except for parenthood). The desire for freedom for others is, I believe, a virtue. (In case you wonder, I am against the criminalization of drug use despite believing that it is a poor life plan.)
That's a fairly-consistent Maggie's Farm theme, isn't it? Experts tend to lack common sense.
How about a little government coercion to deal with intrusive, annoying, nanny state busybodies who would claim to have either a) my best interest or b) the Greater Good, in mind? The world is run by crazy people.
It's because of "jumping genes." These genes may be residues of viral genes which, over millions of years of cellular evolution, inserted themselves into the DNA of cellular forms of life.
... the pace of scientific discovery is slow. This does not mean that we need to hide every step of it from view until we get the results that we deem worthy of sharing. On the contrary, I agree with those who think that sharing at the more interim steps can only improve what we do. Yet the innumeracy, fame and fortune are forces that put such free sharing in peril by misrepresenting it as the final answer to everything. And when the answer is changed, which is not only expected, but indeed desired in scientific pursuits, the public opinion punishes science.
That’s the whole substance of the paper. Straight-ahead chemistry, exploring a possible explanation for an observed phenomenon and drawing out one tentative prediction. “Showing that it could have happened this way is not the same as showing that it did,” the author most properly concedes. He should have quit while he was ahead. What imp of the perverse induced him to add two more sentences?
Such life forms could well be advanced versions of dinosaurs, if mammals did not have the good fortune to have the dinosaurs wiped out by an asteroidal collision, as on Earth. We would be better off not meeting them.
That the “rich and powerful” are identical to conservatives and Republicans—Edsall’s assumption—is a hoary idea dear to many Democrats and essential to their self-image as the opponents of privilege. It persists even though many of the plushest and most powerful institutions of American life are in the hands of liberal Democrats: public and private universities, government bureaucra-cies, nonprofit foundations, movie studios, television networks, museums, newspapers and magazines, Silicon Valley . . . Among the fabled “1 percent,” according to Gallup, the number of self-identified Republicans is only slightly greater than the number of Democrats. As Christopher Caldwell has pointed out in these pages, political donations from 19 of the 20 richest ZIP codes in the United States go overwhelmingly to Democrats, by a ratio of four to one or more. Democrats are the party of what Democrats used to call the superrich. Only Democrats seem not to realize this.
In the U.S, the DSM boils down to three critical issues: reimbursement, reimbursement and reimbursement. It should be renamed the American Diagnostic and Reimbursement Manual, so that those who use it outside the U.S. better understand the influences behind it.
A therapy patient of mine recently sat thoughtfully for a few minutes, then exclaimed "Oh my God, I've been acting as if I really had power over all these things, as if I had the power to prevent bad things from happening."
"Yes you have," I said. "That's your good insight for the day."
"I've been doing this all my life. Am I crazy?"
"Not at all," I said. "You just discovered one of your underlying assumptions about things. We call them 'unconscious fantasies' - or we call them that until you become aware of them."
One of the rewards of my work is helping people discern their hitherto unattended-to, unexamined, "unconscious" operating principles. When these are held up to the light, it can be disorienting, humbling, and distressing for many to realize that much of their problematic or ineffective behavior has been determined by following a false map, as it were. To mix metaphors even further, to realize that they were standing on unsolid ground.
My very pleasant businesswoman patient came to the realization that one of her dominant operating principles was to keep everybody in her world, everyone she knew, safe from distress, worry, discomfort, disease, and misfortune. Not only did this principle run her ragged, but it often failed. When it failed, she blamed herself for not having done enough. The unconscious fantasy she uncovered might be called a "fantasy of omnipotence."
Everybody operates, to varying degrees, according to unconscious fantasies about themselves, others, and the world in general. Nobody is 100% in reality. Problems can arise depending on how far the hidden assumptions diverge from reality. Reality is the harshest teacher, and never spares the rod.
What are these things made of? Freud discovered/defined them, although writers and students of human nature have always been interested in the irrational consistencies of personality. Freud said that they are constructed from wishes, fears, hopes, dreams, experiences, temperaments, and especially defenses. I think that is true. During maturation, they become organized like pieces of mental software. Like the beating heart and the digesting bowel, they are part of what and who we are while operating outside our awareness.
Unfortunately, we cannot ask people what their deep operative fantasies are, because they are, by definition, unaware of them. That's where Psychoanalytic skills come in, like soul-surgeons, to try to biopsy and, perhaps, extract the problem software. However, our medical rule is primum non nocere so we try not to let the best become the enemy of the good-enough.
Fortunately, the human mind seems to have a relatively limited repertoire of unconscious fantasies, so we experts are expected to be able to identify them, in time. That's a topic for another post, maybe.
In my view, this whole DSM enterprise is one big Obsessional Disorder driven, in considerable part, by insurance requirements and by pharmaceutical companies.
Learned helplessness was what my wife and I observed then, and still do today, in social-democratic Spain. The recession, rigid labor markets, and excessive welfare spending have pushed unemployment to 24.4%, with youth joblessness over 50%. Nearly half of adults under 35 live with their parents. Unable to earn their success, Spaniards fight to keep unearned government benefits.
Meanwhile, their collective happiness—already relatively low—has withered. According to the nonprofit World Values Survey, 20% of Spaniards said they were "very happy" about their lives in 1981. This fell to 14% by 2007, even before the economic downturn.
That trajectory should be a cautionary tale to Americans who are watching the U.S. government careen toward a system that is every bit as socially democratic as Spain's.
Humans are very responsive to incentives, even to their own detriment (eg addiction).
It's not a polygraph, and complicated by left-handed and ambidextrous people and left-eyed people.
Do you know how to determine whether you are left- or right-eyed? Roll up a sheet of paper like a telescope, and see which eye you put it to. Most people have a dominant eye. Shooters care about this.
As I see it, the modern myth of true love involves these beliefs: True love is passionate love that never fades; if you are in true love, you should marry that person; if love ends, you should leave that person because it was not true love; and if you can find the right person, you will have true love forever. You might not believe this myth yourself, particularly if you are older than thirty; but many young people in Western nations are raised on it, and it acts as an ideal that they unconsciously carry with them even if they scoff at it. (It’s not just Hollywood that perpetrates the myth; Bollywood, the Indian film industry, is even more romanticized.)
I believe that "true love" is an adolescent fantasy, a psycho-utopian fantasy. All real relationships have problems and challenges. And real life presents endless problems and challenges which effect relationships lasting longer than days or months. In Western, monogamous cultures, the trick is making it work. What else do I believe? That there is no single "right person" for anybody, that humans are not emotionally monogamous, and that many people expect far too much emotional fulfillment from their spouses than any one person can provide.
I would never disparage feelings like passion, desire, "urge to merge," and "chemical attraction". These things are intoxicating. They have prevented Homo sapiens from going extinct. However, they are temporary, and often not sturdy foundations for building a life or raising a family.
Discovering that your long-term partner isn’t really the person you thought she was can be shattering. It’s not just a loss of love and a certain way of life, it’s feeling like you’ve lost your ability to see the world accurately, protect yourself, and know whom to trust. Suddenly, your marriage seems like the Matrix.
More fundamentally, you can no longer trust your ability to know what’s meaningful and what’s predatory. In case you think you’re alone, think of all the novels and films made about this phenomenon. You’ve been stripped of a pillar of your self-confidence, and you have to build yourself back up. At least you’re just searching for your self-esteem and not a one-armed man.
Nobody is who you thought they were, and vice versa.
Unthinking is the ability to apply years of learning at the crucial moment by removing your thinking self from the equation. Its power is not confined to sport: actors and musicians know about it too, and are apt to say that their best work happens in a kind of trance. Thinking too much can kill not just physical performance but mental inspiration. Bob Dylan, wistfully recalling his youthful ability to write songs without even trying, described the making of “Like a Rolling Stone” as a “piece of vomit, 20 pages long”. It hasn’t stopped the song being voted the best of all time.
I am asked to do a brief post about Disability and have been sent a couple of links. "Disability," as in our Social Security Disability welfare program, is one about which I have unpleasant feelings which some might view as cruel. I prefer to view it as Tough Love.
However, it comes from experience. The fact is that I will not consult with anybody on Disability, nor will I participate in anybody's Disability application unless they are in a coma, severely brain-damaged, or the like. Can people with (treated) schizophrenia work, be useful, and maintain some dignity? Of course they can. Every patient of mine with schizophrenia works, except for one housewife.
Here are my reasons for that, from a psychiatric standpoint:
1. Nobody with a treated mental problem is incapable of doing something useful 2. Helping a patient obtain Disability is a way of saying that you have given up on their future 3. Many people on Disability give up on making a life, and just mope around for years 4. I see people with severe disabilities working all sorts of jobs, maintaining their pride and independence 5. The scam component is huge, I believe: free money. I've seen it plenty of times. I even get spam emails weekly inviting me to fill out a form for Disability lawyers: "Find out if you're entitled." Also, lots of people with Disability seem to work off the books.
Few people have any idea of how easy it is to get on Disability these days. Here is one of the links: Workers Comp. and Unemployment
The DSM, like the Psychiatric section of the ICD-9, was developed to provide a common language to people who work in mental health. Actually, for four basic purposes: a common language, as a basis for research, as clinical guidelines, and for filling out insurance forms and disability forms.
In our daily work, many Psychiatrists do not take it too seriously but use it as a rough guideline. Unfortunately, the DSM has been over-medicalized, reified, such that everything in there is sometimes regarded as a real, discrete, "disease." Some are, some are not. In many cases, it doesn't matter, because we approach each patient as an individual human and not as a diagnostic code.
As one of my wise old mentors says, "I've never seen a patient of mine in the DSM."
The fact is that the MCAT contained, until 1977, a major component called "General Knowledge." This covered areas like history, geography, art, music, psychology, and literature, and was far too broad-ranging to possibly study for. I don't know why that part was removed.
For chocolate for baking or candy-making, I use World Wide Chocolate's site for their baking chocolate section. That's where many pastry chefs get their chocolate. There's a right chocolate for any culinary need. It's best to avoid products with under 70% cacao.
For the best chocolate candies, La Maison du Chocolat is probably the best source in the US. Their truffles are extraordinary.
It's been a giant cultural change in medicine. Half of medical students are women these days. Many of them are Asians.
Today, college men are beginning to consider it to be a chick profession. Including cardio-thoracic surgery. Heck, I even know a lady urologist in Boston. Why not?
Many of the young women I know are going into Emergency Medicine. If you walk into your local ER, you will see if full of cute young ER MDs. Women going into medicine today tend towards the areas where they can work definite hours for a paycheck, work part-time, and have no on-call duties. ER, Radiology, Dermatology. They want a regular paycheck, benefits, and regular hours, and do not want the burdens, stress, and risks of opening a private practice. And, as as a gender, I think we tend to be more comfortable with rules and protocols than men and thus make better employees. Male docs hate rules and enjoy defying them.
The culture of medicine is changing, for better or worse. The older male docs will say, in confidence, that medicine is becoming "pussified." Their old school view is that medical practice is not meant to be either convenient, comfortable, or a partial dedication, but rather more like a priesthood.
Worse case, I can see a future of salaried docs happy to be working in government clinics. You patients will not like that.
Physicians, like clergy, are more comfortable with terminal illness and death than others. Routine proximity to death and dying makes it feel natural and normal instead of a great enemy. From the WSJ'sWhy Doctors Die Differently - Careers in medicine have taught them the limits of treatment and the need to plan for the end:
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.
What's unusual about doctors is not how much treatment they get compared with most Americans, but how little. Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again.
It's a rare doc who elects heroic and torturous treatments for his own terminal ailment.
Of course expensive and extensive testing is ordered, these days, partly because of malpractice. Any doc will say so. It's about CYA.
As a consequence, young docs are being trained to rely more on the tests they can order than on old-fashioned inexpensive clinical, hands-on evaluation and diagnosis. Thus a vicious cycle begins. And it's all free, because "insurance pays for it." So you get the patient's family in on it too: "Doc, we want you to do every possible thing and do every possible test to check out Granny." Is that an argument a physician wants to have?
No doctor enjoys being on the witness stand answering the question "So, Dr., you elected not to order a CAT scan for Mrs. Jones' headache because you trusted your clinical judgement, and felt the expense-benefit ratio was wrong?"
Thus (obviously) if you are 20 lbs. overweight, your knees experience it as equivalent to an 80 lb. backpack - plus the normal effect of the rest of your ideal weight. Knees were not designed for 80-lb. backpacks 24 hrs./day. Over years, the damage increases of course until, one sad day, you finally begin to feel the accumulated damage.
...individuals who lost 10 lbs. would be subject to a total of 48,000 less pounds of pressure for every mile walked.
Walking when overweight is brutal to knees and, from the knee point of view, probably is to be minimized until losing weight. Driving is kinder. Being carried by slaves in a litter is even better because it is kinder to Gaia.
Besides trauma (eg accidents, athletic injuries, athletic overuse and related overuse as in dance), extra weight is the main cause or exacerbation of knee arthritis. It's all about gravity and the pounding your knees take with every step.
Unless the idea of knee replacement appeals to you, the kindest thing you can do for your knees (or your hips, for that matter), is to lose weight - or to be carried around town. Or, like you see in WalMart, maybe Medicare will buy you a $25,000 electric wheelchair.
Americans eat too much, and far too many carbs than is good for them. (Soon, I'll repost the Dr. Bliss diet which I follow diligently to stay under 130 - plus lots of athletics. It is essentially carb-free, except at Birthday Parties and special occasions. Absolutely no fruit allowed - fruit is sugar and a sugary dessert, and there is nothing "healthy" about it.) Here are some links about weight and arthritis.
Glenn Reynolds, with his finger on the pulse of the zeitgeist, captured something yesterday that I had been collecting a few links about, in Faith in science? Why skepticism is rising. A quote:
...while one should trust science as a method — honestly done, science remains the best way at getting to the truth on a wide range of factual matters — there’s no particular reason why one should trust scientists and especially no particular reason why one should trust the people running scientific institutions, who often aren’t scientists themselves.
In fact, the very core of the scientific method is supposed to be skepticism. We accept arguments not because they come from people in authority but because they can be proven correct — in independent experiments by independent experimenters. If you make a claim that can’t be proven false in an independent experiment, you’re not really making a scientific claim at all.
And saying, “trust us,” while denouncing skeptics as — horror of horrors — “skeptics” doesn’t count as science, either, even if it comes from someone with a doctorate and a lab coat.
There are a number of reasons it makes good sense to be always skeptical of scientific claims (as scientists are trained to be). Here are a few:
1. Careerism and greed - there is big money to be made in science these days, especially if you come up with the "right" results 2. The use of computers for data-mining - which is not the scientific method 3. The reluctance of journals to publish negative results in favor of positive results 4. The lack of scientific literacy in journalism 5. The impression that scientists often have an ax to grind and cannot be impartial about their pet ideas
There are others. Those are just for starters.
Without getting into the huge global climate boondoggle, here are just a few examples from my medical profession:
On Tuesday, a committee of the National Academy of Sciences heard testimony that the number of scientific papers that had to be retracted increased more than tenfold over the last decade; the number of journal articles published rose only 44 percent.
Ferric Fang of the University of Washington, speaking to the panel, said he blamed a hypercompetitive academic environment that fosters poor science and even fraud, as too many researchers compete for diminishing funding.
"The surest ticket to getting a grant or job is getting published in a high-profile journal," said Fang. "This is an unhealthy belief that can lead a scientist to engage in sensationalism and sometimes even dishonest behavior."
44% is not very good. More on that story: Can Most Cancer Research Be Trusted? - Addressing the problem of "academic risk" in biomedical research
...yes, Wall Street may have a significant percentage of self-serving, ruthless, and manipulative psychopaths and almost psychopaths. And, yes, this fact might be of considerable importance in assessing the "moral fiber" of an investment bank. Whether this is a new phenomenon, though, is a separate question. And, in the current zeal to castigate Wall Street, let us not lose sight of the fact that about one out of every 100 people is a psychopath and 15 out of every 100 people are almost psychopaths. They are husbands, wives, doctors, lawyers, teachers, and store clerks.
And they are a lot closer to you than Wall Street.
Silver views psychopathy (aka Antisocial personality) as a spectrum, from little to lots. That fits my life experience and my professional experience. When I encounter "almost sociopathy", I term it "antisocial traits." The world of finance, indeed, has no monopoly on sociopathic traits. I suspect the world of politics has far more, proportionately.
An interesting feature of antisocial traits, like narcissistic traits, is that their owners tend not to know they have them. People who worry about having them probably don't have much of it.
Besides "social media," it's interesting to me how others keep in touch with their old friends, how they reach out and make new friends, and, in general, how they keep their interpersonal lives alive, vibrant, and stimulating.
Readers know that I like to host parties at home, both formal and informal. Even if it isn't a time to have deep, intimate conversations as one does in other settings like in restaurants or clubs, it's a way of letting people know that that you view them as a part of your life that matters. That is an important signal to send to people (assuming that they care).
I know the Bird Dogs like to host formal dinners, and especially big semi-formal multi-course game dinners for 25-30, but that sounds like work to me. Sounds like a holiday effort, but they seem to be used to doing it joyfully and without much expense, and take it in stride.
At my house, we are partial to hosting semi-stuffy formal dinners for 12 at least monthly from October to March (why else have a formal dining room?), and casual family clambakes, barbecues, pig roasts, or the like in the summertime. Sometimes in the winter it is good to host a decadent after-church brunch with champagne and bloodies, with a guy making omelettes to order, and bacon n' sausage n' pancakes. A big brunch at home is not an expensive party, and people love to come in the winter for good cheer with the fireplaces blazing. People have been known to get good new jobs at our get-togethers.
Every few years, I think it's a good idea to find an excuse to throw a big cocktail party or Christmas party and cast a wide net of hospitality. Inviting people into your home, however humble, means a lot to people. Doing those things right, of course, can be a little bit costly but makes life much more fun.
I enjoy people. If I don't do it, who will?
Friends of ours, recent empty-nesters, have come up with another idea which I like. They term it "Suppertime." Once a week, they just call a couple to join them for an ordinary supper on the kitchen table after work. A cocktail by the fire first, of course. Nothing fancy, no big deal, just a visit for an hour or two at most. Salad and spaghetti, or a grilled ribeye and mashed potatoes, or whatever, and some fruit for dessert.
It turns out that I am afflicted not just with pharmacological Calvinism but with mindfulness skepticism as well. For while I believe, in theory, that learning to coolly regard my anxiety as a purple, hairy monster I could stash in my tote bag, as Mennin suggests, might steady my pulse on sleepless nights, I am suspicious of any cure that requires more effort and expense on my part and more hours away from my work and my family. In this skepticism, I am like my anxious peers. “We go through rough patches, and we do things that make us feel better,” says Lisa Colpe, an epidemiologist at the NIMH, with the vocal equivalent of a shrug. A lot of people with anxiety would simply prefer to live with it; they know that when it becomes unbearable, the drugs will be there.
A cure isn’t what the PR executive with the occasional Klonopin habit wants. “My own personal experience is that there’s a healthy level of anxiety, and I don’t believe ‘healthy’ is the absence of anxiety,” she says. “I live in a world that puts unreasonable demands on me, and sometimes I need help. I wish I could do it without the pills, but I can’t.”
A therapy patient of mine recently sat thoughtfully for a few minutes, then exclaimed "Oh my God, I've been acting as if I really had power over all these things, as if I had the power to prevent bad things from happening." 
How the ‘love myth’ is preventing Americans from finding true love
"Sometimes thinking is a bad idea.
It's been a giant cultural change in medicine. Half of medical students are women these days. Many of them are Asians.
Each 
Besides "social media," it's interesting to me how others keep in touch with their old friends, how they reach out and make new friends, and, in general, how they keep their interpersonal lives alive, vibrant, and stimulating.