Friday, February 28. 2014
 St. Patrick's Day is the traditional time to plant snow peas around here. It's coming on March 17, and my bags of seeds are ready along with the inoculant.
As has been happening in recent years, due to the crisis of global cooling, this year it may require a snow shovel and maybe a blow torch to melt the soil to get those seeds in the ground.
It looks like one more year when the peas will be late.
Thursday, February 27. 2014
Recently, while Bird Dog was lounging in the Caribbean, I was sent to do a presentation at a conference in Palm Desert, California. Since I was a featured speaker, the conference was paying for my hotel, and as these things are typically boondoggles held at high-end resorts, I asked my wife to join me and she reluctantly agreed. It took a tremendous amount of arm-twisting, two lines of text at a minimum.
My presentation meant a day in a ballroom with 200 of my closest industry competitors. It provided a great opportunity to discuss issues at the heart of my business and I managed to deliver a 30 minute presentation in what seemed like 5 minutes. I'm still learning to present well, though I was pleased to hear my work referenced several times by the speakers who followed me.
Once I got past the fun part, it was 'boondoggle on' and the wife and I availed ourselves of the surrounding region. We took a bike tour of Palm Springs, headed out to Joshua Tree National Park and did an hour's hike up Ryan Mountain for some spectacular views. I highly recommend a visit to Joshua Tree, if you're ever in the area. It has a beauty which is very hard to describe. It may not be for everyone. I found it fascinating. I also wanted to visit the Salton Sea, but time didn't permit.
As we were preparing to leave, my wife noticed an article about Mid-Century Modern architecture in a local magazine. What caught her eye was a house owned by the Kaufmanns, a family I recently wrote about. Apparently, this family was rather innovative in their tastes. Successful in the business of retailing, they expanded the American cultural landscape by contracting with ground-breaking architects, in this case Richard Neutra. Success really does breed success. Their home in Palm Springs is considered the premiere example of the Mid-Century Modern home.
Continue reading "Mid-Century Modern Architecture in the Desert"
Tuesday, February 25. 2014
"Decisions, decisions, decisions!" This often is spoken in a mixture of ennui and smug irony for decisions such as "should I buy the Audi, the BMW or the Lexus?" But this piece is nothing like that, it is about the general confusion and questionable value of our medical establishment.
The three "decisions" are apt because the diagnosis and treatment of three major illnesses have been called into question in the past year and this is disconcerting if not alarming. If you are unfamiliar with the work of Dr. John Ioannidis I recommend you find him on the web. His view of the state of medical research is summarized as "Lies, damned lies and medical research."
The original quote actually was by the British prime minister, Gladstone: "There are three kinds of lies, lies, damned lies and statistics."
The recent study out of Canada declaring the value of mammograms in women under fifty without value is noted. One doctor at Sloane Kettering has already balked and we have yet to hear from the Susan Komen foundation. The other disqualifying report identified antidepressant medication as simply placebo with no valid clinical evidence to the contrary. As a clinician my experience does not support that position, but there are facts that are hidden from us. For example, the FDA requires two "positive" studies to approve a medication for the treatment of a condition. That there may be six negative studies is not required to be revealed to us, and, as Ioannidis points out, many of the "successful" studies measure the new product against drugs that are known to be less than effective, if effective at all.
But it is prostate cancer I want to focus on. To PSA or not to PSA, that is the question. (Excuse me Prince Hamlet.) I have learned a great deal about this question from a man whom I have known for many years and who has had prostate cancer diagnosed. There was a series of articles in the popular press questioning the need for and value of the PSA test around the time his PSA began to increase incrementally. "You will more likely die with the prostate cancer than from the prostate cancer." This is very reassuring, unless you have witnessed a patient or a relative die the excruciatingly painful death of metatstatic prostate cancer.
The concerns expressed, in our behalf, is that the PSA can lead to biopsies which can be painful and prone to serious complications. While I am not a urologist, I can say I have seen one man who complained of persistent pain following a biopsy. That is all. What most of the articles failed to make reference to is something called the Gleason Score, an assessment of the aggressiveness of the tumor's malignant cells. The numbers of the score range from low to high but what you need to know is that a score of Seven is at the dividing line of could be serious and is serious. Eight and up are without question serious. Without that information one cannot make sensible judgements about how to proceed and one can only have that with the prostate biopsy. You can see the circularity of this process. With that information in hand one is then given a menu of treatment choices to consider. Watch and wait, radiation, surgery - robotic and standard supra-pubic surgical removal of the prostate gland, proton beam treatment, cyberknife, aggressive sonic ablation - more than most doctors, let alone lay people, can assess when in a state of some anxiety. Every treatment brings its own list of complications and ill consequences. "5%" risk of whichever one sounds reassuring but, if it is you who experiences that ill consequence it is 100%.
And what is most important is, as my friend learned, there is no evidence that any treatment is superior to any one of the other treatments and there may never be a study to pit one against the other to determine which is best. He chose surgery and has done well now for a few years. His PSA is zero and hopes it will remain that way. So, we ponder these three conditions, each afflicting roughly 10% of the general population, and we are asked to act or not act on the basis of flawed and insufficient information. What else are we missing?
Makes you think, doesn't it?
Monday, February 24. 2014
MacDonald:
This year’s conference theme is “Vulnerable Times.” MLA president Marianne Hirsch explained the concept a few months ago: “The Presidential Forum [one among many panels on the topic] will theorize vulnerability’s complex temporalities. Discussing embodiment, poverty, climate, activism, reparation, and the condition of being unequally governed, forum participants will expose key sites of vulnerability and assess possibilities for change.”
Ahh, the wonders of the Liberal Arts and those darn complex temporalities.
Sunday, February 23. 2014
From Bottum: The Post-Protestant Ethic and Spirit of America - The new elite class of America is the old one: America’s mainline Protestant Christians in both the glory and the annoyingness of their moral confidence and spiritual certainty. They just stripped out the Christianity along the way.
He begins:
Beginning with the abolition of slavery, the bitter battles of American political life have often been fought over spiritual issues. It’s hard to know, for example, what else Prohibition was about. And yet the great moralizing and spiritualizing of American politics feels different these days, more complete, more all-encompassing. It’s as though our public life were not a political stadium in which spiritual footballs sometimes appear; rather the field itself has become religious. Our public life is now a supernatural game and our purely political concerns have been reduced to nothing more than footballs with which we happen to play that public game of spiritual redemption.
Our anxious age often seems a moment more tinged by its spiritual worries than anytime in America since perhaps the 1730s. The nation’s unconscious spirituality is splashed across our supposedly secular life.
Saturday, February 22. 2014
It was one year ago that my Mom died of complications from a hip replacement. Dad died four months later from the same thing, but he didn't really desire to live without her sparkling, upbeat, and charming company.
Editing this website has been a good distraction/outlet this past year. It's been a tough year for Bird Dog, with long-forgotten memories and regrets flooding in relentlessly. That's the way it's meant to be, I guess.
Pic is a newspaper shot of Mom at age 80 receiving some conservation award, and pic below is her car. (Indeed, she did weed all of her perennial gardens at home and at the farm in the Massachusetts hills, and found great pleasure in it. She liked to work hard and play hard, never knew the word "relax" - "too fancy" was her harshest epithet and she hated any form of pretension or luxury - and all of us kids inherited those New England Yankee traits from both Mom and Dad.)
Mom was active in her two (CT and MA) communities in more ways than I can count: socially, conservation, church, clubs, tennis groups, the Granges, government, etc. Involved, engaged, a real American citizen who took her citizenship seriously. The Farm, after all, was in her family before the Revolution but I think her ancestors were Tories. Politically-naive? My gosh yes. She wanted to believe that everybody was like her family: innocent, highly moral, God-fearing, scholarly, and with all the Yankee virtues, values, and manners. She had genteel refinement and insulated herself from the rough edges of life and from the rough people. A true subcultural WASP in the best sense. Television? No thanks. Books.
I learned at her funeral, from one of my sisters, that she had been writing a weekly gardening column for two newspapers for 25 years. Had she been younger, she might have had a gardening website.
A little snobby and discriminating, perhaps, but she had good taste and she had good pals from every walk of life, and lots of them. She had a talent for connecting with people, so home always had friends and neighbors stopping by unannounced for tea or cocktails. You would never know who might stop in but it was always fun and interesting. As a kid, all sorts of people came by: old farmers, Leonard Bernstein and his "Mrs.", Robert Penn Warren, neighbors, bankers, the local Pediatrician, retired yard guys, lonely widows, the Pastor looking for a glass of Scotch and a jolly chat. Relatives looking for a warm chair by the fire and a hot toddy. Robert Frost and his family stopped by too, but I was hardly conscious then. Mom was pals with his daughter, I think, or his niece. Their two homes - town and country - were open houses, and everybody knew it. Their kitchen (with fireplace and comfy chairs) was rarely empty of people.
Ol' Rodney stopped by too, at least twice a week for a morning coffee. The autistic son of a local farmer who had died, farm sold out to developers, he rode his bike year-round all around town. Mom would let ol' Rodney do some yard work, but he would not accept payment. He just wanted connection and to be useful. Rodney was a true old-style New Englanda' with the old accent, and he never missed Sunday at church.
Mom loved her old reliable CRV and, old-time Yankee that she was, she was a cheapskate and hated to spend money on anything except her yacht club and beach club, the Metropolitan Opera, her favorite charities - and on international travel. Dad, a Yale Prof, a cranky intellectual, and a tough and intolerant SOB with a rapier wit who served in two wars and had some off-the-chart IQ and graduated from Harvard at age 17, was devoted to her happiness, and rightly so: she had spunky vitality and could fly airplanes, ski Killington, win horse-jumping championships, garden-club awards, and sailboat races. A life-long literary amateur scholar too, who could write the world's most gracious Thank-You notes. What's not to like about her except her Yankee moral and cultural sensibilities which could be rather harsh and judgemental? Ouch. Produced 5 fairly average kids, too. In their prime, my parents were pretty cool and embraced life and people in every way that they could.
A beautiful life, well-lived with lots of energy and a commitment to community. We would all like to have that said of ourselves, would we not?
"One could do worse than to be a swinger of birches." My wish is that my kids will absorb all of this family tradition.
Thursday, February 20. 2014
It isn't often a sport gets a complete makeover. Singular moments are rare, but over time the impact of certain individuals and how they play create indelible memories.
In college basketball, this was best exemplified by the Larry Bird/Magic Johnson NCAA Final in 1979. The NBA had Bill Russell and the Celtics in the 50's and 60's. When a reboot began with Bird and Johnson, Michael Jordan joined them and created an era of his own. Football experienced a similar revitalization with the arrival of the West Coast Offense and Joe Montana. Baseball has gone through multiple reboots recently, though few have had a positive spin. Steroids and strikes have had bigger impacts on the face of baseball than the arrival of a dominant player or a new method of playing the game. Sabermetrics have been a net positive, and even my interest in the sport has grown over the last 15 years because of the new math which opens a window onto what real productivity is in the sport.
I haven't watched much of the Olympics, but I've been fascinated with Ted Ligety for some time. In a sport which is usually decided by hundredths of a second, Ligety crashes down slalom courses with seeming abandon and winning by what can only be called massive margins. His dominance is of the type rarely seen in any sport, let alone skiing.
Ligety is one of those people who has reinvented his sport. I did a limited amount of downhill racing in my youth, and I remember the coach telling us the point was to find the fall line and make the course as short and fast as possible. For years, that was the formula for reaching a victorious finish, often by slim margins of a second. Giant Slalom, in particular, was usually a visual of tight turns around the gates and keeping as close to a straight downhill line as you could accomplish.
Ligety, on the other hand, takes wider turns and gets as parallel to the ground as he can. This approach has turned the US team into a powerhouse. Ligety creates power on short portions of the course where others coast briefly, and as a result he is able to smash the competition by moving rapidly, and effectively, from turn to turn. Long ago, someone told me Beckham was a geometry genius because he could figure out how to get a ball from Point A into a goal around the wall. I doubt he understood much about geometry at all, but he certainly understood how to make a ball do what he wanted it to do. Ligety, by the same measure, is a physics genius. He's determined how to turn portions of his run from potential to kinetic energy and power himself faster than others are able.
Most of the Olympics has been a bore, outside of hockey and Ligety.
Financial security is rarely obtained through routinely letting out-go be larger than in-come. Necessary exceptions, of course such as health and education. Wealth is suffering from a case of mistaken identity.
Here at Maggie's, we are convinced that a degree of financial security is a more meaningful goal than retirement. At the same time, we seem to feel that a miserly life is a sterile one and that life without skiing and boating is a wasted one. There's a balance somewhere. Even if you have some bucks in the bank, picking and choosing expenditures carefully on their life/family enhancement makes sense. In those cases, we like spending a lot to make it great and memorable. Penny-wise and adventure foolish.
I believe in creating great memories to enjoy when I'm over the hill.
Tuesday, February 18. 2014
This is the way America is supposed to be: It Takes a Certain Kind of Village - Rallying to save a beloved local institution, D.C. neighbors show what real community looks like.
A sense of local community, "community spirit" if you will, can only arise organically and spontaneously. An outsider cannot make it happen with a few rounds of Kumbaya. In my limited experience, these things are less likely to occur in wealthy communities and in God-forsaken inner cities.
I do not think De Tocqueville experienced either of those during his remarkable study of America. I suspect that most Maggie's readers are ready to serve their communities when needed. It's the Yankee spirit - do what needs to be done outside of government.
More on this topic: University Administrative Glut Worse Than We Thought:
Over the last 25 years the number of administrative employees at U.S. colleges and universities more than doubled, according to a joint study by the New England Center of Investigative Reporting and the American Institutes for Research. The ratio of nonacademic positions to faculty positions doubled at both public and private institutions. Overall, the industry has added an average of 87 administrative positions per day, a rate has scarcely slowed since the economic downturn, despite tuition increases. Even more surprising, academic institutions have added more administrative employees despite part-time faculty taking on more teaching duties than full-time professors.
Why? Who are these people and what do they do all day?
Monday, February 17. 2014
Sultan's piece that we linked this morning, Our State of Police, is a stimulating one. I had never thought about these things from this angle before. One quote:
"Oppressing everyone to avoid oppressing anyone is the egalitarian ethos gone mad."
Of course, we are talking about the sorts of insoluble problems that arise in a non-totalitarian society, problems rooted in the many "flaws" in human nature. Another quote:
The left can't fix the social problems that, in some cases its welfare state helped cause. It certainly can't fix those that predate its intervention. Its efforts are all the more hopeless because it attributes the cause to its usual suspects of capitalism and intolerance so that it never addresses the problems, instead it uses people from failed societies as ammo in a cultural war. The right's tactics temporarily contain the worst of the violence, but not its expansion or its causes.
No society or culture can be conflict-free, nor can even any family or tribe or anything. We must be humble when thinking about "solutions" of all sorts. It has been said that Conservatives like me temperamentally embrace the Tragic View of life as contrasted with utopian views, and there is something to that. It is, indeed, the story of man's fall - broken from the very start.
Sunday, February 16. 2014
Well, I certainly got your attention.
I appreciate many of your responses and found them educating, in particular those instances when having a shotgun or rifle may have prevented a home invasion or assault. I don't know of a site where these can be recorded and shared with a larger population and I am certain there would be concerns that this would be used against gun owners and individuals by some government agency but it might balance some of the anti gun arguments.
As for the stories in the media, dog bites man is not news, man bites dog is. A friend of mine who worked at CBS said the news director in New York had one criterion for the line up of stories on the local evening in news: "If it bleeds it leads." That has not and will not change. The issue of carrying firearms at all times is probably more of a regional issue. But did the retired police officer really need to have his weapon with him at a movie theater with his wife in what sounds like a peaceful neighborhood? It doesn't matter who said what to whom, it matters that back in the day in the Bronx those words might have sent fists flying not bullets. And if the other guy is too big and intimidating, stand down or at least ask yourself if your pride is worth taking a beating for.
 This is a repost:
We respect and value - with a deep sensitivity to cereal differences - hot breakfast cereals from strange, exotic, far-away cultures like Montana, etc. Here's what we like (besides English muffins):
1. Cream of the West, from Montana
2. Red River, from Manitoba
3. McCann's Oatmeal, from Ireland
Being Yankees, we are also partial to Apple Pie for breakfast (that's what it used to be made for), but you must not buy that at the store - there are some things in life you would never buy. Also great for breakfast - leftover cold pizza.
Readers know that we also love Chipped Beef on toast, but a quarter of an Apple Pie (a multicultural tarte tatin will work, too), two coffees and a couple of smokes will get anyone ready for a cold, rugged day of work in the drafty old office.
Saturday, February 15. 2014
The busy dive shop at our place. Mrs. BD wanted to dive, but didn't really have time to get re-certified. Best to do that at home before a dive trip. However, the snorkeling was excellent, and Mrs. can do a 20' surface dive easily. I can't. I can do 10', no problem, but I prefer to just float around and observe.
The weather is here. Wish you were nice.
More pics, etc, below the fold - including a pic our our suite's cool bathroom!
Continue reading "My St. Lucia photo dump, #2"
Friday, February 14. 2014
An interesting piece for you brainy readers: Scientific method: Statistical errors
P values have always had critics. In their almost nine decades of existence, they have been likened to mosquitoes (annoying and impossible to swat away), the emperor's new clothes (fraught with obvious problems that everyone ignores) and the tool of a “sterile intellectual rake” who ravishes science but leaves it with no progeny. One researcher suggested rechristening the methodology “statistical hypothesis inference testing”, presumably for the acronym it would yield.
The irony is that when UK statistician Ronald Fisher introduced the P value in the 1920s, he did not mean it to be a definitive test. He intended it simply as an informal way to judge whether evidence was significant in the old-fashioned sense: worthy of a second look.
At Maggie's we are all perennial skeptics, and we think that the average business "murder board" is far more rigorous and critical than any academic peer review. There is more at stake.
Yesterday most of us here in the Northeast spent the day digging out of yet another big snow pile. I grew up with snow, in the mountains of Pennsylvania, then four years of Syracuse nastiness. It doesn't bother me in the least, and I'm more than happy going out with a snow shovel to dig, dig, dig.
I figure you need at least 4+ inches to call off school, and at least that much to prevent me from heading in to NYC and the office. Yesterday was one of those days, with my younger son having yet another snow day and me staying home for probably the fifth time this winter.
But Bill de Blasio was having none of it. His point of view was to get the kids into school at all costs.
This is a mayor who is slowly destroying any popularity he has with voters by making decisions which are difficult to support in any way. I couldn't believe NYC schools were open yesterday, until I heard the press conference. Bill's words go far in explaining how important he feels school is. It hasn't got anything to do with education, it has everything to do with having daycare so parents can work.
"It's always a tough decision based on imperfect information."
Really? The Weather Service had said, with regularity, that it was going to be a minimum of 6 inches, Bill. They warned of potential for a foot or more. Sure, the Weather Service may be wrong about climate change, but you believe that, so surely you must have some level of trust in their observations?
"There are huge number of parents for whom the consistency of the school schedule is absolutely necessary," de Blasio said. "They are going to work, they have no choice. If they can't get their kid to school, they don't have another option. There are huge numbers of parents for whom their kid getting to school also means their child will have a good meal, and in some cases, two meals. And so, the fact is, it's a very big deal to some parents."
Ohhhh...OK, now I get it. You just wanted to make sure daycare was in session. Fine, everything is understood and all is well. I'm sure the teachers will be happy to know they are part of your daycare plan.
Continue reading "Mayor Bill Thinks School is Daycare"
 Sometimes Maggie's seems like an echo chamber because there is only one point of view, so try this one for me:
While everyone celebrates the freedom to blow your foot off or have your five year old shoot his four year old friend while playing cowboys and liberals, why are all of the news stories about men shooting other men for no justifiable cause? The retired sheriff who felt threatened by a man texting his babysitter was justified because the popcorn thrown at him had many hard unpopped kernels? The man who shot the black teenager for playing loud music in a parking lot PMWB (playing music while black) had cause because he didn't like the tunes? Please. Where are the stories of self defense? Oh, I forgot Zimmerman.
(Editor's note: If you disagree, do so kindly and explain yourself reasonably. No need to talk about deaths in car accidents. Azeff is a good-hearted guy who did not grow up with firearms in the farm kitchen, as I did. Somebody asked me the other day how many firearms I have. Between home and the Farm, I dunno, I replied. Never counted. I asked "How many hammers do you have? A hammer is a lethal weapon, just like a baseball bat. Nobody knows how many hammers they have. Firearms are just more expensive than hammers and baseball bats.")
Thursday, February 13. 2014
Tomorrow, I will have one 3 lb. steamed lobster, with home-made cucumber cole slaw, home-made potato salad with vinaigrette. Bottle or two of Oregon Chardonnay. And I will make a Trifle, all home-made (except I bought the pound cake at the supermarket). Bottom layer of pound cake soaked with rum, then drizzled with raspberry jam. Then a layer of homemade custard. Then a layer of cut-up strawberries, plus raspberries and blueberries. Then whipped cream, and then decorated with semi-sweet chocolate shavings and raspberries. Hope she likes it.
We have an English Trifle bowl like the one in the photo somewhere. I can't find it. It's somewhere buried in the basement pantry, A mere trifle to please She-Who-Must-Be-Obeyed.
 Photo: This German lass was with us on a hike to the hot springs waterfall. She's a zoo manager from outside Hamburg, was visiting with her grandparents.
Many of our readers travel far more than we do, for business, recreation, adventure, or relaxation.
The BD family tries to strike a good balance of around 3 weeks of vacation per year plus some number of long weekends and as much work time at the Farm as we can do. Brit acquaintances think that is insane workaholism, but I just laugh. Work is good for the soul, I tell them. Man's Fall, and all that. We Maggie's Farmers tend to be self-employed, so there is no such thing as "paid vacation time." (No "sick days" either, which remarkably means that one is never too sick to work.)
Mrs. BD and I will admit that we are a sort of travel snobs. We like boutique places, tenudos, etc., with local flavor and no commercial feeling - eg no Sandals or chain hotels like Four Seasons - and have only stayed in a high-rise hotel once (the Southampton Princess, on our honeymoon).
Here's today's travel tip: Always pack a few plastic trash bags. They're good for stashing dirty clothes and wet clothes, and I always stick one in my pocket when hiking to protect the camera if it rains.
St. Lucia gets direct flights - not necessarily daily - from NYC, Miami, Atlanta, Toronto, London, Manchester, and Hamburg. Our little resort, (Anse Chastenet), far from the mass market area around Castries is in southern St. Lucia, has only 35 suites/cabins, and there were Americans, Canucks, Germans, and lots of Brits. One Swedish family. There were a few obvious honeymooners (Anse Chastenet is on many lists of most romantic destinations), and a few families with kids.
A few more pics and random info below the fold -
Continue reading "St. Lucia Travelogue, Part 1, with a small photo dump "
A photo for a snowy day. Daytime temps 79-82 F all year, nighttimes cooler, a gentle trade wind most of the time. Water temp last week was a pleasant but not bathtub-hot 79 degrees F: comfortable but refreshing, and perfect for swimming laps of the beach which is what I tend to do. If you plan to snorkel or dive for a few hours, a shortie wetsuit is not a bad idea but I do not like wetsuits.
You can leave your stuff on this beach for hours all day while swimming, snorkeling, kayaking, etc - camera, watch, wallet, pocketbook. Nobody will touch your stuff. We left our stuff there every day.
Quite pleasant, but I do love our snowy winters. Today's snow is a beaut. Wish I were at a ski place instead of letting this good powder go to waste. If I find time, will take the pup on a snowstorm walk. Few cars out today in the blizzardy conditions - just Mexicans with their plow trucks.
Wednesday, February 12. 2014
 We took a two- or three-hour hike each day of our trip. That doesn't sound like much, but it's mountains so it's uphill all the way. Sore legs.
We took one jungle birding hike with Mano, who knows all of the plants, trees, and birds. His granny was a herbalist, so he picks all sorts of leaves and makes you eat them for health. Why not?
He gives his walking stick a bath in the sea each evening to keep it happy. "Happy, happy, tank God for dis day" is the Caribbean mantra, isn't it?
Had we more time, I would have done some serious birding, but we saw many of the common critters. Some, of course, are our northern summer breeders in their wintertime vacation home.
We also saw a bat cave filled with thousands of fruit bats. At dusk, the fruit bats zipped through our little porch and filled a night-blooming tree outside the dining room, sucking nectar and pollinating the blossoms. Remarkable creatures for sure, and a wondrous sight.
My list below the fold, for those interested.
Continue reading "Casual Birding on St. Lucia"
My Mom fell through ice once, rescuing her doggie who fell through a thin spot of ice on a pond. Luckily, her feet reached the bottom so she was able to carry the pup and break through ice to the shore. She was alone in the woods at the time. She jogged home to try to stay warm, took a hot shower, and had a couple of hot toddies. She and the pup were just fine after a while.
How to Survive Falling Through the Ice: An Illustrated Guide
A reader mentioned this post: The Nanny State Didn't Show Up, You Hired It
He makes good points. My main hobbies are shooting and hunting, boating, skiing, and hanging out in NYC pubs with pals and gals. Each can be dangerous to some degree. I am heading out to Big Sky tonight for 6 days of off-trail reckless tree skiing with old skiing pals, risking life and limb in deep powder. It's more dangerous than smoking.
We will have a blast, and drink lots of beer too. My theory is that safety is for pussies but, since I have a little sense, there are some things I just won't do. Cave scuba diving is one of them. I can handle fear, but cave diving scares me too much. Once was enough, at 65 feet. A very cool experience, though, and I am glad I did it.
Risk is the zest of life.
Tuesday, February 11. 2014
Editor's note: Dr. Azeff will be a regular contributor on medical topics
"Surviving Anxiety" was the cover story of The Atlantic magazine for January/February written by its editor, Scott Stossel.
One is a little flabbergasted when reading this man's story. While portraying himself as virtually crippled by anxiety in all of its forms, generalized anxiety, post traumatic stress, panic disorder and multiple phobias, he functions as the editor of a prestigious magazine which means likely conflicts with aggressive publishers and super-sensitive, if not querulous, writers. He is a writer himself and therefore a person expected to show up for promotional talks and for lectures. How does he do it? He begins his article, excerpted from his book, by describing his drug regimen for public speaking; xanax, inderal and scotch or vodka. As a clinician one is immediately tempted to take the bait and challenge the doses of his medication and balk at his use of ethanol which he acknowledges is risky at best, dangerous more honestly. From there we are led on a trip through his life and through the evolution of psychiatric treatments over the past thirty years, the good the bad and the ugly.
His first doctor who started treating him at age eleven and saw him twice a week for 25 years is roughly of my generation, I'll be 75 in a few months, Dr. L as he is called is probably in his early eighties. Analytically oriented therapy mixed with play therapy mixed with pharmacotherapy at the outset, progressing over decades to everything as it came along including EMDR and self-actualizing therapy whatever that means. One can appreciate the changes over the years as a picture of the evolution of a modality seeking a scientific framework. Just as edema was initially seen as a unitary "disease" called dropsy until science deconstructed the multiple causes of this symptom, so many of our psychiatric illnesses may be no less than psychological dropsy. I'll wager in the next ten years "schizophrenia" will be at least four different conditions of different etiology, and anxiety may follow suit as well.
But what I take away from this verbose, sometimes wry, sometimes antic, sometimes prolix piece is the transgressions of some of his caretakers. Well into Scott's treatment, Dr. L takes his father into treatment as well and uses Scott's sessions to get information about Stossel senior. The porous boundary is something we all grapple with but this is a destruction of the boundary that calls the treatment into question, perhaps from the start. After all, we may change course with a patient but usually with caution and discussion. I hope we are beyond the point of arguing that one cannot do both psychotherapy and psychopharmacology, but can one start with a classic dynamic model and wander into EMDR? Then there is the behavioral psychologist, Dr.M (both of these caretakers are "Boston" and Harvard trained and perhaps even faculty so we all must be clear that they definitely and unimpeachably know what they are doing) who determined his core problem was emetophobia, fear of vomiting, which she would treat with exposure therapy. Using the emetic ipecac which had cured other emetophobes, Stossel attempts the exposure with two doses of ipecac that produce retching and gagging but no vomiting in the course of four hours.
The next day he speaks to Dr. M who eventually relates that she was so shaken by his experience she cancelled all of her afternoon patients and spent the day at home nauseated and vomiting and taking to bed. Once again a transgression of questionable purpose. That treatment was fractured and collapsed fairly soon afterwards. We all have seen patients who are difficult to treat, who have disabling symptoms of anxiety or depression or psychosis, which are not easily medicated. How often do we ask ourselves about the possibility that the patient is consciously or unconsciously engaged in an attempt to make us feel as helpless and demoralized as he feels? Is it "blaming the patient" to weigh this possibility as a cause of intractable symptoms?
There is nothing glaringly obvious pointing to this in the story Stossel tells us and his brave walking through fire story is to be admired, but I'm just saying . . .
|
