Maggie's Farm

The AMA backs the PelosiCare monstrosity? Fine.

1. The membership was never consulted.
2. I quit. And I will not be alone.

Is Medicine still a vocation, or has it become a technical service industry?

In my view, the Internists, Family Practioners, and Psychiatrists are maintaining the core of the medical priesthood. Many other devoted docs as well.

Just a note to the White House PR jokers: Docs do not wear white coats outside of work settings. Nowadays, they sometimes wear them in the office, and usually during hospital rounds (but increasingly less so).

I never heard of a Doc wearing a white coat in a public setting. It's absurd. Those Docs in DC were used. They are tools. I doubt that any of them are practicing Docs.

I have been pondering a post on the topic of sex and male and female sex drives for a while -and what people do with those drives, but what I want to say has not crystallized for me yet.

In the meantime, our friend Villainous has a thoughtful piece on the subject: Should women withhold sex?

Polanski is on record as claiming that all guys "want to f- young girls." Perhaps some do, but guys with young daughters tend not to approve of the notion: the idea tends to make them go load their guns. Althouse wonders about the pedophilia of Hollywood types.

I would just like to offer the comment that, from a psychological standpoint, desire for 13 year-old girls is not really pedophilia. In the past, 13 year-old women routinely married and, without spending time on a search, I wonder how many girls in NYC get pregant at 13? I'll bet it's many. 

No, the issue is not whether men (or women, for that matter) are sometimes attracted to young people, or whether 13 year-olds can be sexy witches, or whether 44 year-olds can be drawn to young females.

The issue is the law. Forcible sex, and sex with the underaged, are illegal. Admittedly the latter is rarely enforced when the guy is underaged too but, regardless of our sexual inclinations and fantasies, or our opinions about every law, we all implicitly agree to obey the laws by virtue of our citizenship - or to accept the consequences like the adults we are presumed to be. That's Adulthood 101.

Rape is illegal. Everybody knows that. We used to hang people for it. It has never been in fashion, to my knowledge. Until now.

There is no doubt that humans tend to, or prefer to, think in metaphors. Much of it is laziness, I think, and some of it is how our brains try to work efficiently. We have posted on this subject in the past.

We use metaphors to make the unseen and unseeable feel real, so we can handle it and talk about it. However, metaphors can just as easily be deceptive and misleading as they can be illuminating: it depends on the integrity and intent of the creator of the metaphor.

Psychologists try to take on metaphor - with, of course, the tools of their own metaphors. You end up with towers constructed of layers of metaphors. These are often termed "theories."

Why this flu has taken up as much hysterical bandwidth as the hysterical global warming hysteria is beyond me. I guess media needs exciting "content" - just as we do here.

But this seems ridiculous. It's just a flu, for heaven's sake. It's not airborn AIDS or plague.

For my excitement, a good new Bolognese recipe works very well.

Rescuing types, and loyal, good-hearted - if somewhat tolerant and often obsessional Boy Scout types of guys are often attracted to Borderline and Narcissistic women. These gals are often sexy, smart, exciting and romantic, and will idealize a fellow - until they don't anymore. That's when the s hits the f, and their hero begins to look like either a monster or a poisonous worm to them.

They split, project, and externalize in order to maintain some sort of acceptable and coherent sense of themselves. Broken and destructive people with lots of anger, through no fault of their own. Bad genes, bad life, bad luck, or whatever.

From Dr. Helen's post, her excellent interview with the author of Walking on Eggshells: Advice on how to cope with the Borderline in your life.

One of the most common consultations I see with men is about marriages with women with significant personality disorders. My usual first impulse is to say "Save yourself." My second is to want them to not take any sh-t from them. Then things get more complicated - especially when there are young kids.

My general advice to young men: Feel free to date them, but do not marry a Borderline or pathologically Narcissistic woman, unless you plan on its being only a temporary connection, because they will crush you and your spirit (unless they get good help - and learn to love instead of to idealize and split, destroy, and hate. It is tough, though, for anybody to acknowledge their grievous flaws).

Thanks to Dr. H for this good and useful (I will use it) video.

Borderline men are a whole different topic, which I will not get into now.

(Photo is flocking blackbirds. I do not know where BD found that image.)

A while ago, we posted some throw-away comment about human tribalism and the relative comfort most people fell, most of the time, with their own peeps. Ah, here is was:

Skin and ethnic diversity damages "social capital," harms society. Yes, OK, but it's not the skin or the ethnic: it is the different cultures that cause the issues with trust, familiarity, and comfort. Everybody is more comfortable around their own peeps, because they know what to expect and know where they're coming from. We consider that to be wholesome, natural, and intelligent tribalism.

Birds of a feather flock because they can interpret and understand what is going on - mainly the non-verbal messages. I participated in a medical conference in Japan about ten years ago, and I found it uncomfortable. The translators were excellent (I think) but I could not gauge the Japanese docs' reactions. Were they bored? Amused? Interested? Did they get my little jokes?  Most of them spoke some or a lot of English, but the verbal is just one piece of communication and signaling - and verbal communication is the most dishonest.

Knowing how and what to trust in others may be the most important interpersonal issue. Of course, one cannot automatically trust one's own peeps, but one can at least take their measure. That's what made me think about IFF.

IFF is the technological version of Stranger Anxiety. Clearly some stranger anxiety and wariness is necessary in life, unless one wants to go through life like Candide.

I remember once being told by somebody who "interviewed" kids for Kindergarten for a fancy private school that the kids who jumped right into the class (they brought them into a pre-K classroom) were the lower IQ, overly-social kids. The bright kids held back, watched, got the lay of the land beore they made a move. (There is probably a bell curve distribution of such traits, as in most things.)

Survival is difficult, but social interactions are maybe even more difficult. Early humans, we know, were not only violently territorial but also cannibals. 

Here's some hard evidence for the idea that the human brain grew powerful in order to deal with other human brains. It reminds me of how computerized trading programs which use automated arbitrage tactics to compete with the programs from other companies, seek constantly improving advantages in speed and subtlety. Brain vs. brain and, indeed, a form of virtual cannibalism.

Medical technology has confused the simplicity of death. One quote from the piece at New Atlantis:

...as long as the ventilator remains, that body does not look like a corpse. It remains warm, like the living, and the organs continue to do the work they have always done, albeit with the assistance of chemical interventions. Most significant and most challenging, from the point of view of common sense, is the fact that the heart still beats. The injury to the brain has destroyed the centers in the brainstem that regulate breathing—thus the perpetual need for the ventilator. But the heart of an animal—even one profoundly injured—has its own “inherent rhythmicity,” its own originative source of motion. This means that heartbeat and circulation have no absolute dependence on the brain in the way that respiration has. The heart, without any input from the brain, can continue to beat as long as its own tissue is intact.

The characteristic puzzle of the total brain failure condition, then, is this: the body remains warm and pink as blood courses through the vessels; the vital organs continue performing their work; but the human being as a whole, permanently unconscious and permanently and profoundly disengaged from his surroundings—eyes closed, making no response to pain, making no effort to breathe—seems something short of alive.

Regular readers know how much I love Stats. Peter Donnelly is wonderfully fun here: How Stats fool Juries. I don't think the lawyers understand the stats either, but you can in a few minutes. (H/t Bird Dog via the Right Wing Prof)

A quote from a fine editorial by Dr. Glenn Treisman in American Psychiatry News (free subscription needed) about psychotherapy and the problems with government medical treatment.

We live in a time when a great emphasis has been placed on individual expression and self-discovery. Neil Young once sang that “We are what we feel.” In fact, to other people we are mostly what we do, and we experience other people through their behavior toward us. The emphasis placed on feelings can easily mislead vulnerable people into believing that all behavior is acceptable if driven by feelings. My patients on the addiction treatment unit say they can’t get out of bed, when what they really mean is that they don’t feel like getting out of bed, a difference that is critically important in rehabilitation of patients with addiction(s). In order to live in a world with maximal liberty, we need a system that helps vulnerable people handle maximal liberty. This is not an unreasonable expenditure given the cost of ignoring the problem. Crime, addiction, wasted lives and untold misery are the results of ignoring the “special needs” of people with a generous endowment of feelings who have not yet learned to cope with that endowment.

Psychotherapy has been shown to help patients with many types of problems (yes, evidence-based medicine), including the one this patient had. Yet, he had not been prescribed psychotherapy of the type I gave him. Instead, he had been convinced that he could not prevent his behaviors and needed to be medicated to tolerate the stresses of life. He was persuaded that he needed to be on disability so that he would not have to be uncomfortable at work. Oddly, this works against the very premise of self-expression and self-discovery. With psychotherapy, he was able to develop and put his talents to work.

What happened? The forces at work in public sector psychiatry place pressure on clinicians to provide the kind of care this patient received. The checklist diagnostic method of the Diagnostic and Statistical Manual of Mental Disorders allowed this patient to “make criteria” for all types of problems, depending on how he felt at each interview. Each checklist diagnosis generates an algorithm of treatments that leads to one drug trial after another. The psychiatrist sees the patient for a few minutes, and then a therapist sees the patient with a set of goals for the therapy based on the psychiatrist’s checklist diagnosis. Financial pressures push the staff to spend as little time as possible on patients who require more time and skill than the average. By giving a diagnosis like bipolar disorder, the psychiatrist narrows the focus of treatment, which becomes less expensive.

Moreover, the quality of public sector health care is now based on ratings by patients, and patient complaints generate aggravation. The easiest out is to allow patients to choose both their diagnosis and their treatments. This leads to satisfied customers on the surveys. Finally, disability leads to more used resources for both the patient and the treatment system; therefore, finding a diagnosis that might establish disability, with the attendant Medicare coverage and resources, is desirable for the patient and the clinician. Unfortunately, life continues to beat the patient up, and the real satisfactions of life that come from successful relationships, rewards for productivity and admiration from others remain elusive.

The term psychotherapy includes a broad range of practices, including the cognitive-behavioral and supportive forms I used with this patient. Unfortunately, we are seeing these therapies lumped together and delivered as if they are all the same. Expert diagnosis and treatment are needed for the most difficult patients. Surgical textbooks describe standard approaches to performing particular operations. Technically, people with modest medical education could be trained to do these procedures, but if the diagnosis is wrong or if something unexpected happens during the procedure, things will turn out badly. Surgeons spend years in training to ensure an accurate diagnosis and to prepare for unexpected problems during surgery. They need to be able to feel the difference between healthy and unhealthy tissue. The same standard needs to be applied to mental health. Mental health parity should mean not only parity of reimbursement for expert treatment, but also parity of health care quality for the patients.

Is it possible for a guy to talk to a lady without checking out her boobs - or her legs?

Is it possible for a gal to talk to a man without checking out his crotch?

Are all humans sex addicts? I need answers!

People hate it when I burst their bubbles about eating habits, but facts are facts. Everybody likes to imagine that they can control their health by what they eat, but there is no real evidence for that unless you are starving to death or fat as a pig. (Ordinary American fatness has minimal health effects, but major aesthetic effects).

Here are some real facts for readers who fuss about their food. In my view, unless you are on a serious diet, anybody who fusses overly much about what and when they eat has an eating symptom. Harmless enough, but a symptom.

(Everybody has his share of neurotic symptoms. It's human.)

I will say it again: the only reason to fuss with your food is to make it taste good - and to stay skinny and fit so you look good, have endurance, and do not offend others with your unpleasant appearance.

Hey, honey. Get that beer man over here. I need a cold one or two to go with my Sabrett's.

One quote from the non-technical post at Neurophilosophy:

A comparison of the DNA sequences from the 36 sea sponge genes with the homologous sequences from humans, Drosophila melanogaster (fruit flies) and Nematostella vectensis (a cnidarian with a simple nervous system consisting of a loose network of nerves) revealed striking similarities between the genes in all four species. One gene, called dlg, encodes a crucial component of the post-synaptic density scaffold. The protein product of that gene contains a number of regions that form the protein-protein bonds that hold the scaffold together. The segment of the dlg gene encoding these binding regions was found to be highly conserved - the DNA sequences in the sea sponge gene were identical to the human sequences. This suggests that in the sea sponge these proteins interact in exactly the same way as they do in the human postsynaptic density.

Who was this Missouri newspaper columnist?

Her sensible opinions on housekeeping, marriage, husbandry, country life, and, more rarely, on politics and patriotism were expressed in a plain style, with an occasional ecstatic flourish inspired by her love for “the sweet, simple things of life which are the real ones after all.” A work ethic inherited from her Puritan forebears, which exalted labor and self-improvement not merely for their material rewards but as moral values, was, she believed, the key to happiness.

Answer and story below -

A re-post from 2007 -

A quote from a piece by Shrinkwrapped entitled The Mental Health Industry's Dirty Little Secret, with which I entirely agree (my bold):

The primary misunderstanding of Freud and Psychoanalysis, a misunderstanding that continues to be propagated by the forces of Therapism, concerns the locus of responsibility for our behavior.  Freud's greatest insight was that to a large extent our manifest behavior is the outcome of compromises among many impulses and inhibitions, most of them unconscious, which sum and move us to action.  As such, the goal of Psychoanalysis has always been to make us more aware of our hitherto unconscious motivations so that we can take more responsibility for our behavior.  Therapism does the exact opposite; it attempts to relieve us of responsibility by assigning motivation and blame to all sorts of agencies (parents, society, brain chemistry) which are by definition outside the realm of our moral agency. 

It is a small step from such thinking to enabling and encouraging the government to tell people how to live, how to raise their children, and how to think.  As Neuroscience enlarges our understanding of the biochemical and physiological underpinnings of behavior, those who have done so much to diminish moral responsibility will be in a powerful position to mandate proper thought.  The dangers are real and growing.

He goes on to quote Christina Hoff Summer and Sally Satel's Therapy Nation:

We reject the presumption of fragility and challenge the dogma of self-revelation; it exposes the folly of replacing ethical judgment with psychological and medical diagnosis, save for instances where individuals are severely mentally ill. We believe, in other words, that human beings, including children, are best regarded as self-reliant, resilient, psychically sound moral agents responsible for their behavior. For, with few exceptions, that is what we are.

Read the whole thing. Also, good comments on that essay at Dr. X.

As for myself, I have grown weary of trying to explain how psychoanalytic theories have been misunderstood, and how superficial understandings of analytic theories have been misapplied. Yes, psychotherapy can be a very useful tool - sometimes a life-saving tool - but it is neither a religion nor a cure-all.

On the same topic, SC&A asks whether we are all nuts in discussing One nation, Under Therapy.

The women of the world owe a giant debt of gratitude to Hungarian physician Dr. Ignaz Semmelweiss.

Mocked and ridiculed by the experts, he was correct that puerperal fever, which killed many mothers, was somehow spread by doctors and nurses who did not disinfect their hands.

The germ theory of infectious disease had yet to be explained in the 1840s, but he was a practical doc, not a theorist.

Our Editor wanted me to post this draft of a reminiscence about my wonderful boarding school (which will go unnamed), so here 'tis:

My boarding school had a required 4th form - sophomore - course we called "Shit He Wants Us to Know," which we labelled "Shwuk." Real name of the course was something like: 4th Form Required Headmaster's Course. That's where I got my love for stats, and lots of other things.

Besides How to Lie with Statistics - and a week on Liebnitz (who amazed him), the course also involved reading about half of the Bible - with a focus on Samuel - he made it great fun - and Moby Dick, plus one Shakespeare play which changed every year - and whatever else our Headmaster thought any person educated in his school ought to know. The history of Baseball, the history and chemistry of plastic, wood, and cement, Aristotle's Poetics, and how sails and windmills supposedly work. It also included the math of the Parthenon's design (those guys knew the keys to perspective way before the Renaissance), and every tiny detail of The Last Supper - including a discussion of the meaning of cannibalism in religion up to the symbolism of the Mass.

His class was like a real Intro To School. He was a Brit, an Anglican priest with an apparently blissfully affectionate marriage to a beautiful, reserved, distinguished lady who occasionally did book reviews for the NYT and The New Republic, and who loved to shoot grouse in Scotland. They were both shooters. They had four Ivy League boys, who, as I recall, who did extremely well forging their paths in life - at least one of whom returned to the private school world after making bags of bucks on Wall St. Another went to Yale Theological Seminary after Harvard College. I forget the others.

About The Last Supper, I remember him saying something like this "Would you eat human flesh, if cooked properly? Would you? Humans used to do it every chance they got. The Maoris called it "Long Pig" in the south Pacific because it tastes like pork. So they say. They made a feast of it when they were able to spear an enemy tribe in the jungle. Well, many claim you do it every week, if you are a believer, in Communion. In some spiritual sense, I do consume this human flesh too, but from a hunger of the spirit, not the hunger of the flesh. How wonderful it is that we reach back to stone age times for our most powerful ideas to nurture us. Drink this, this is my blood, shed for you. That is powerful stuff, ladies." And then "Now, Miss Bliss, tell us why Leonardo has Christ pointing to a glass of wine, and the what and why of the emotional reactions of the people at this Passover dinner. It's not a great painting, nothing to be nervous about - just a too-famous picture by a hugely talented mind. Explain to us what Leonardo might have had in his mind - besides wanting to get paid - when he painted this scene on the wall of the refectory. Begin on the left side." He was good fun, and there was always a twinkle in his eye.

The only political science was Plato's Republic and Burke's Reflections. Oh, a bit of Locke too. We all had to shoot rifles and shotguns, and learn the basic physics of ballistics. We learned renal physiology, because he though the kidney was a miracle in its ability to make sea-born creatures like us capable of maintaining ocean levels of salts under our land-dwelling skins.

We took a bus to West Rock (same geological formation as the Hudson Palisades) to learn Triassic paleontology and geology. Nothing superficial, he made us dig into it - with real shovels. A serious Christian (he wanted us to know Jesus, but he did not try to convert anybody because he assumed many or most of us were religiously-rebellious teens anyway). He loved Darwin and his Expressions of Emotions in Man and Animals - we had to read it along with modern research on the topic. And Orwell's Politics and the English Language.

Class met twice a week in small groups of around 15-20, around a circular table. It was the best and perhaps most demanding course I ever took in my entire education. The volume of reading would be incredible to kids today. The guy was interested in everything - Adam Smith, baseball pitches, kidneys, aviation, chlorophyll  - and he treated it all as an adventure and infected most of us with his curiosity about everything. His attitude was "Let's figure this out" because he never claimed to be smart. Never "This is what it is."  For him, everything was "What the heck is this?" - whether a butterfly, Hamlet, Freud, God, Newton, or ballistics.

Plus, through this course, the Headmaster got to know each one of us personally, and he was one shrewd dude to do that. No slacker escaped his gaze, and committed slackers were sent packing for good, because he did not believe in offering treaures to those who did not wish to partake in treasure-hunting. If your mind wandered, he would say "Miss Bliss, I Will Throw No Pearls Before Swine. You can day-dream later, or you can do it at home with your Mommy and Daddy if you want." Then he would make you stand and try to explain what he had been talking about. Tough. Love. Loved life and loved people. A lifetime role model.

I recall there was no hiding in his classes. He just said "Stand and deliver, Miss Bliss. You have one generous minute. Tell us everything you know about the Bernoulli Effect." There was no paper and no exam: all based on class performance. That's the great potential of private schools: you can demand performance. And he had a school to run, so could not be bothered with reading puerile or stolen papers. He wanted to know what you had to say for yourself, and he only gave one "A" per group. For that A, he'd write you a gracious college recommendation.)

You cannot be a powerfully inspiring teacher without being a natural learner who assumes his own stupidity. His unique course followed his inquisitive nose, and the model remains with all of us. He did not teach so much as share his enthusiasm and curiosity, but you had better have the answer about how kidney tubules handle sodium concentrations - with the math: he had a talent for integrating things, from the biochemical level to the math to the culinary - he gave us his favorite recipe for steak and kidney pie with his method for not making it smell like a urinal as part of his sessions on the kidney. According to his interests, he would alter the course a bit each year.

It was his personal introduction to the life of the mind, to a life of curiosity. Doing this course was his great joy in life, probably a greater joy to him than his little old farmhouse in Greece.

Did we make fun of his enthusiasm? Of course. Young people do stuff like that. It means nothing.

----and her two sisters were educated at home by English and French tutors, in the royal India tradition, as well as in Switzerland and in India. Her family had a house in Belgravia in London, where she later attended the London College of Secretaries.

She once recalled, “I learned shorthand, to type and to write decent letters.”

After six years of covert courtship, and defying family disapproval (he already had two wives) in 1940 she became the third wife of the maharajah, Sir Sawai Man Singh Bahadur, a renowned polo player. He proposed in the back seat of his Bentley as it circled Hyde Park in London.

A very interesting lady. h/t, Synth.

The story of Puss in Boots - the masterful servant.

Charles Perrault (1628-1703) wrote, or re-wrote, this tale, and from this tale of the deceitful, tricksy, power-seeking cat came the Mother Goose collection.

Great tales, and not just for the nursery at all.

- Should you take an aspirin, or a baby aspirin, daily or every other day to reduce your risk for nasty cardiovascular events (heart attack, stroke)? Check it out.  As I once mentioned here in the past, all male docs I know over 40 take a baby aspirin daily.

- Middle-aged women get Frozen Shoulder. Know what it is? It's not an excuse to avoid vacuuming, doing the dishes, or sex. It's a nasty thing.

- Also, I recently heard a talk about ADHD. There is a strong association between ADHD and Social Phobia, which I thought was interesting. However, it's confusing because ADHD is such a confusing pattern of symptoms since it is so commonly combined with other diagnosable problems: bipolar disorder, anxiety disorders, depression, conduct disorder, antisocial personality, etc. It's a mess of a diagnosis.