Maggie's Farm

I have been thinking about the wishes we have about ourselves, and about how we deal with our disappointments in ourselves and our perceived shortcomings.

Here are some of the things I have heard from people:

I wish I were...

taller
shorter
more beautiful and sexy
stronger
more handsome
richer
blonde
blue-eyed
green-eyed
more outgoing
more inner-directed
more charismatic
a better athlete
smarter
better at math
more popular
more disciplined
less fearful
better at memorization
better at focusing
less neurotic
more confident
more courageous
more authoritative
skinnier
able to relax
more energetic
more knowledgeable
less naive
less cynical
less of a manipulator
more interesting
less of an asshole
less self-centered
more self-interested
more adventurous
less reckless and impulsive
less boring
darker-skinned
lighter-skinned
bigger
smaller
bigger-breasted
smaller-breasted
bigger-penised
quicker to orgasm (women)
slower to orgasm (men)
younger
bigger-assed
smaller-assed
better at (fill in the blank)

The list could go on and on. It is not human to be too pleased with oneself unless one is delusional on some level. God, and our Moms, and Mr. Rogers might like us just as we are, but we generally do not.

Why would we? Love would not be as special, as miraculous, otherwise.

What would the world be like if we could all design ourselves - besides being filled with rich 6'3" guys with 3-foot johnsons and rich 5'6" skinny blondes with perfect - but generously so - boobs? All with 160 IQs and charming personalities.

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."

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.

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.

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.

There's a fine line between the two, but I don't know exactly where it is. I looked up shabby chic, and it wasn't quite what I thought. I thought my taste was shabby chic.

Our farmhouse in NH is shabby - most definitely. Mostly stuff that was probably worn out in 1932. Everything sags, and the ancient wallpaper is stained and it peels. We like it that way. It connects us with the past.

My personal interior taste in our place in Boston runs to simple but expensive window treatments, lovely orientals, and real Chippendale (inherited). It doesn't look "decorated" or expensive, but it is. A place that looks "decorated" looks cheesy to me, like some lady from Ethan Allen came in to coordinate everything and fill the place with new crummy, poorly-built shiny stuff.

The trick to interior decor is, in my view, to look elegantly comfortable with no (visible) evidence that things have been thought through or planned - and to have stuff that you like and that you picked out over the years. Or inherited and don't have the heart to get rid of. Timeless, so it never has to be re-done.

My sense is that our Editor Bird Dog thinks that his natural taste runs towards the Yankee shabby chic, but I don't see the chic part. He calls it "country," meaning old junk. He likes old junk, as do many guys. He doesn't care, as long as it's functional and not "fancy." He is "fancy-phobic," more Queen Anne than Chippendale. He is blessed with a wife with a stronger sense of appropriateness, so their places are comfortable hodgepodges of stuff - compromises. Threadbare oriental rugs, random pleasant but not special antiques and old reproductions, tasetful but un-ostentatious window treatments, random mixes of deliberately uncoordinated fabrics, and original art they bought over the years because they liked it. Furniture that you can put your feet on and bang the vacuum cleaner into.

I wonder what our readers like to live around.

A re-post from 2007 -

A brief break from my vacation in Dark Harbor on Islesboro on Penobscot Bay (there is no cable out here, and happily no TV either. Primitive dial-up internet, but once a week is plenty for that hassle) to highlight this piece by Jonah Goldberg at NRO called "Isn't that Special?" 

I am always pleased to see folks knock the concept of "self esteem." What we humans need to aspire to is Self Respect. Self respect is hard-earned, or never fully-earned, but a worthy goal. A quote from the Goldberg piece:

These investments in self-esteem paid off royally, according to a report, “Egos Inflating Over Time.” Jean Twenge of San Diego State University and a team of psychologists combed through the answers of 16,475 college students nationwide who took the Narcissistic Personality Inventory survey between 1982 and 2006. Their conclusion: Today’s American youth are the most self-absorbed since we’ve studied the subject. “We need to stop endlessly repeating, ‘You’re special,’ and having children repeat that back,” Twenge told the Associated Press. “Kids are self-centered enough already.”

Read the whole thing - link above.

Meanwhile, we will assemble the routine lobster, corn, potato and steamer clam dinner, but with a giant pot of hand-plucked Maine mussels also, cooked Italian-style in the kitchen, with garlic bread on the side.

We'll do the lobsters, cod, potato and clams on the beach, in a sand hole on hot rocks and coals under a pile of seaweed and sand - a true clambake. We wrap the hunks of cod (salt and pepper first) in rockweed (our main seaweed up here), and it tastes much better than lobster, in my opinion.

Family-picked Blueberry cobbler for dessert. Yes, we did bring a mini wine cellar with us, and plenty of fine champagne too.

The drinks provide that instant and unearned self-esteem; the harvesting of the fine wild foods provides the self respect, Maine-style. Yes, we fished at 4 am this morning, and fetched some fine cod with clam as bait. Saw a whale, too.

Images: Upper photo is of Islesboro. Lower borrowed from our friend neoneo, because I do not do cameras on vacation.

When somebody collapses and stops breathing, make sure you remember how to do CPR. Just make sure you don't do it to some person who simply fainted, because you can be sued if you break a rib. Legal protection for Good Samaritans in the US is fading fast. Still, every citizen ought to know how to do this.

I have had to do it twice, once in a parking lot and once in church. One lived, one died.

"Positive Psychology," an intellectual fad for the masses. These people talk about "happiness interventions." It's nuts, if you ask me, but I guess it attracts research grant money. Nobody has the wisdom to tell anyone else how to be happy, and anyone who purports to do so is a fool. A commenter to that article posted this:

A lifetime of happiness no man alive could bear it, it would be hell on earth. Bernard Shaw.
Happiness is nothing more than good health and bad memory. Albert Schweitzer
To be stupid, selfish and have a good health are three requirements for happiness, though if stupidity is lacking all is lost. Flaubert

I have posted on the subject here and here and also our Do Americans expect too much from marriage? (and I still think happiness is a dumb subject. It's what I call "psycho-utopianism"). 

Funny how disparate posts can seem to come together. Our Sowell quote yesterday captured it: The universe, or reality, was not designed to make people happy. But if you are one of those people who view happiness as a sociological phenomenon, see neoneo today on dystopias.

I am more inclined to the negativity proposed in our link to Nyquist this morning. One quote from him:

Chapter 3 should be titled “The Virtue of Guilt.” If you haven’t done anything bad in recent weeks or months, consider what you presently have in mind. You are wicked by nature, so you are guilty by nature. Therefore, it is appropriate to feel guilty. Don’t let yourself off the hook. Don’t be slipshod and weak. Suck in your gut and make a new start. Guilt is the stick across your back sent to make you better. Is guilt unpleasant? It’s supposed to be, and it better be. Feel guilty often, and have plenty of regrets. People who have no regrets are dangerous. They will suck you in and suck you down.

I do not know much about what Psychologists do or study. I do know what Psychiatrists try to do, which is to relieve disability and unreasonable pain. That can be difficult enough. Worrying about "happiness" isn't my problem. I happen to be reasonably happy right now, but I will not be in ten minutes when I attack my pile of bills and paperwork.

Part 1 is here.
Part 2 is here.

I mentioned in an earlier post that a person's ability to adjust reasonably well to adult life does not necessarily depend on their DSM diagnosis (if they have one), but instead on their personality traits. Most of the personality traits we observe in people have to do with what we call "ego functions."

For just a few examples, what is their physical, mental and emotional stamina and endurance? What is their stress-tolerance, and how easily are they overwhelmed? How good are they at assigning themselves tasks and completing them? Are they reasonably honest, or connivers? What are their relationships like, and what sorts of relationships do they like to have? Are they socially appropriate? How sound does their judgement seem to be? How do they do with maintaining boundaries? How smart are they? How flexible is their thinking? How do they do with delaying gratification? Are they reliable or erratic? How self-regulating are they, or do they depend on external structures to function well? How often do they make excuses or blame? What do they want out of life? What motivates them? Do they have wholesome outlets? Are they emotionally mature? How do they view themselves, and how consistent is that with the reality?

Furthermore, what traits are out of line and give the person trouble managing life?

As I mentioned before, it is foolish to hold any standard of human perfection: I call that Psycho-utopianism. Let's just say that we are interested in a person's profile.

For the final post on the topic pf Psychiatric Diagnostics, let's take a closer look at Leo Bellak's list of ego functions, from Dr. Blatner's site which I linked last week. (It's not the best list. I wrote up a better one years ago, but cannot find it.)

    1. Reality Testing: This can range from  Disorientation to Distortion to Accurate Perception. Lots of seemingly normal people don't really check out their impressions of reality and operate with mild to moderate levels of distortion!
     2. Judgment. This can range from "Infantile Omnipotence"--that sense that if I want to do it, I can-- to a more sophisticated Degree of Appraisal of Consequences.  Even political leaders can lack this. Again, many of these variables are not always at the top end for many adults.
     3. Sense of Reality.  Most people sense their objective reality and can differentiate it from dream.
     4. Regulation/Control Affects/Impulses:  This can go in either the directions of being too impulsive or on the other hand, too over-controlled.  With maturity and health, people learn to vary the degrees of control, allowing spontaneity in some settings, being more low-key in others, and making the transitions smoothly, but few adults still do this very well, enjoying full spontaneity; many are all too habitually self-controlled. A few allow themselves to be excessively impulsive regarding anger, or shopping, or in dealing with sexual temptation, etc..
     5. Object Relations: What is the person's capacity to engage in a caring or close relationship, with a romantic partner, a good friend, family members, or close co-workers. Does the person tend to be excessively detached or, again, going to the other extreme, overdependent?  Do they shift among these positions, playing a lot of what Eric Berne would call interpersonal "games"?  (i.e., what used to be called "neurotic.") Or can they engage with mutuality and flexibility?
    6. Thought Processes. This variable includes not just intelligence, but also psychological states that avoid the anxiety of thinking, so they fail to engage in abstract reasoning. Or can they, instead, manage conceptual thinking?  Many people are in the middle on this one.
      7. Adaptive Regression in Service of Ego (ARISE): This is a fancy psychoanalytic term to explain the capacity to enjoy imaginativeness, the innocence of daydreaming, the freedom of the best of childhood's pretending and playfulness.  The lack of this can itself add a good deal of  rigidity to the personality.
     8. Defensive Functioning:   Some people use more mature defenses, humor, sublimation, suppression, and the like. Others tend to use more habitual, automatic, and immature defenses, sometimes even fairly primitive ones that waver on the edge (or go over the edge) of mental illness.
     9. Stimulus Barrier:  Some folks are hypersensitive, others too dense. To the extent that one is over-sensitive, what coping maneuvers are they capable of to compensate for this sensitivity?
    10. Autonomous Functioning. Aside from any emotional issues in life, how competent is the person, or free of pervasive inner conflicts, so that they're able to perform daily tasks regarding personal hygiene, communicating with others, being able to do simple or more complex work roles. Many people are pretty functional, but sometimes blocked if they're upset. Some have developed healthy--and occasionally unhealthy--abilities to resist any intrusion of personal issues on their hobbies or work skills.
   11. Synthetic-Integrative Functioning.  Some folks are fairly good in one area and terrible in other areas. How well can they manage to integrate all the other variables being spoken about here?
   12. Mastery-Competence:  Some people have  low initiative and are under-achievers. Others may have significant emotional wounds, but yet able to perform remarkably well in work, sports, and so forth.
   13. Superego Adaptation. Again, this can be too much, or too little, strongly blaming oneself, or shockingly lacking in guilt or shame, tending toward the puritan or happy-go-lucky type. More mature people are able to acknowledge errors and seek to rectify them, moving toward a more balanced type of social conscience.
    14. Strength of Drives:  Some people are more sexual than others, and in some cases this may be more extreme in either direction, from the asexual to the hyper-sexual or driven. This can be affected by hormones, overstimulation, and other factors. Another drive is the aggressive, which can be diverted into hostility, grumpiness, or more focused as competition and work. Other people are less driven, and at the extreme, "un-motivated." 

When we try to assess these things, we know that we are looking at surface manifestations, not at what is going on in depth. Like geologists gazing at a landscape, we speculate about what is underground based on what we see above ground, and then test our speculations with test drilling.

Modern Psychiatrists and Psychoanalysts often tend to focus on the "Object Relations" item, believing that, developmentally, the integration of mental relationships effects the stability and integration of the adult person (and that aberrations can be improved with Psychotherapy). I am a friendly skeptic about that, and more inclined towards the genetic basis of personality traits (which by no means implies that they are immutable).

OK, I am going to avoid depth psychology here because my purpose with these posts was to give a sense of the sorts of things shrinks think about when they evaluate somebody and not about Psychotherapy or Psychoanalysis. As for the medical students who will not specialize in Psychiatry, these sorts of methodical ways of thinking about people are quite practical, not especially theoretical, and, I believe, useful to everybody in their dealings with others.

Photo is Anna Freud, the more-or-less founder of Ego Psychology.

Heather MacDonald's fascinating report on American jails (as opposed to prisons) of today, with a cheerful visit to Riker's Island.

One of my life goals is to stay out of jail despite my dark and evil side.

Diagnostic madness in the DMS-5.

I knew they went over the edge when they began talking about Sex Addiction. Who gets to define that? These are the sorts of thing that makes people think shrinks are nuts, and damage their reputations as serious Docs. You cannot pathologize every human idiosyncrasy, desire, hobby, or preoccupation, because these are the things that make people interesting, unique, and colorful.

But for some sanity, making things out of wood leads to happiness. I have no doubt.

No signs of Wood-Working Addiction Disorder yet, but it's probably coming - right after Book-Worm Disorder, TV-Watching Disorder, Stamp Collecting Disorder, Bird Watching Disorder, and Diagnosis-Inventing Disorder.

Part 1 is here. 

(This series is a peek - a few samples - into what goes on in Third-year Psychiatry in Medical School. Very few of the students will select Psychiatry as a specialty, but all do clinical rotations through Surgery, Pediatrics, Internal Medicine, Psychiatry, OB-GYN, etc. - and further elective rotations in the 4th Year. I focused on Surgery and Orthopedic Surgery in my 4th Year. The Surgeons did their best to win me over, and almost did.)

In one of the teaching sessions, we watch a video of a half-hour intake interview of a patient in the Internal Medicine clinic, done by a third-year medical student. At the end of it, I ask "Let's list everything we now know, or might speculate about knowing, about this patient."

We go through the medical history, the patient's demeanor (what's their style? Dramatic? Passive? Grouchy? Warm? Arrogant? Sneaky? etc), physical appearance, dress, posture, eye-contact, tone of voice, nature of his interaction with the interviewer, apparent intelligence, knowledge about health issues, work history, family, special concerns, and so forth.

The students who have been science nurds and wizards are often astonished by how much information can be collected from a simple half-hour medical - non-psychiatric interview. I write it all down on the whiteboard, some as facts and some with a ?.

It usually fills the entire board, especially if I write large enough.

In Psychiatry, we have no high tech diagnostic tools - just our eyes and ears.

Moving to Psychiatry, let's assume that we are meeting with a patient in the Psychiatric consulting room - a new patient who does not require any sort of acute crisis intervention or triage. What do we want to know about this new patient right away, after they tell us why they are here?

First things first. We want to know about their general health. That is from their story, and via eyeball. (Over the years, I have diagnosed hypothyroidism, brain tumors, Lyme disease, MS, GI cancers, Parkinson's Disease, early Dementia, etc. in people who have come to me for Psychiatric help).

Then the obvious things. Their life story, their family history, their current life situation. We assume we are never getting the whole story, but we need a provisional frame for the picture. In the process of asking our questions and following up topics of interest, there are a number of other things we get from initial interviews, using our bag of tricks and our sensitive ears, which are solid data.

For some examples:

- We determine how self-observing they are, their capacity for "insight"
- We determine their motivation to deal with their problem
- We usually get a provisional DSM Axis 1 diagnosis - if they have one
- We get an idea of what their coping devices are, and when and how they fail
- We get a good idea of their IQ, their life skills, fund of knowledge, their adaptive success - what we call their "ego strengths" and level of functioning in important areas of life (eg relationships, work, avocations, etc)
- We get a sense of how they relate to others (to us, being the case at hand), rapport, relatedness, and a sense of what their personality is like, their appropriateness, manners, boundaries, attentiveness, sense of humor, etc. etc.
- We would like to be able to say something about the style of their thinking, and especially their patterns of defenses
- We would like to know how they respond to our observations and comments (eg defensive? interested? insulted? embarassed?)
- Try to assess their morality and impulse control, reliability, and any sociopathy or secondary gain, or manipulativeness (this can be difficult but, with experience, one can smell it)

(These are the sorts of observations that make some folks uncomfortable with shrinks in social settings. People are often not aware that when we shrinks are out of the office, we probably think about these things less than the average person. For us, it's work.)

The point is that the Psychiatric interview is just a variant of the medical interview, but one which usually takes more than a half hour. Sometimes, much more. With healthy patients with neurotic problems, sometimes it can take me 5 or 6 one-hour meetings just to come up with a provisional case formulation and treatment plan (if needed). With very ill patients, 3 minutes can be enough to make a triage plan (eg Agitated guy fighting with security guards and cops yelling that they are CIA trying to implant more transmitters in his brain. Easy. Get the guards to hold him down and give him IM Haldol and Ativan with a little Cogentin...and wait a while.)

What's our goal? Our goal is a thorough Psychiatric Diagnosis and a Case Formulation. In medical school, in Psychiatric Residency, and in an Analytic Institute you have to write these up as lengthy formal presentations, but at my stage you just kinda do it in your head and store it in your head, except in special circumstances.

As rank amateurs, medical students cannot be expected to do either of these in an expert way, but we require that they produce a couple of these on some of the patients they are following.

For Diagnosis, I ask the students to use Dr. Blatner's The Real Psychiatric Diagnosis (just one page) as an outline.

For Case Formulation, I ask them to use his The Art of Case Formulation.

I like Dr. Blatner's brief outlines because the focus is on portraying and understanding a patient, not just slapping a superficial label on them.

Part 3 next week.

Photo: Harvard Prof Dr. George Vaillant, author of Adaptation to Life - another of the books the students read during my course.

It looks like we are on the subject of health freedom today. What I have observed over the past ten years is that people increasingly equate insurance coverage with medical care. That's sad.

In my view, it's a pathologically infantile sense of entitlement when people expect others to take care of them. Sad, indeed when Americans can afford their cars and car insurance and computers and iPods and cell phones etc. but expect somebody else to pay their bills if they get sick.

My view is that every responsible adult needs cheap catastrophic medical coverage - what used to be called Major Medical, with the deductible of your choice. Budget into your life the costs of your kid's broken arm and annual $120 camp physical - or don't have kids. If there's a big problem, the Major Medical will cover you. Like if you have a heart attack, break your back falling off a ladder, or if your kid gets shot in the eye with a BB gun.

I want to know what the Dems want to cover with their grand plan to "reduce" medical costs:

Will they cover Reike, massage therapy, homeopathy, acupuncture, chiropractic, crystal therapy, therapeutic touch, late-term abortion, breast enhancement, plastic and cosmetic surgery, hopeless chemotherapy and radiation therapy, eye movement therapy, light therapy, Chinese herbal medicine, hypnosis, social workers, bunion removal, in vitro fertilization, elective Psychoanalysis, alcohol rehab, penile implants, heart transplants, high colonic cleansings, liposuction, ingrown toenails and toenail fungus, Native Indian Soul Renewal, and liver transplants?

And do you want politicians making these decisions for you?

Me? I want the government 100% out of medical care and medical choices, because they have no idea what they are doing. No more of a clue than they know how to run GM - or the corner candy shop. I know what my private family policy covers. I chose it, I pay for it, and it's cheaper than the family's car insurance.

What the heck does the government have to do with these decisions, anyway?

Ed. note: We will post each of the 3 parts on the next few Tuesdays. I think you can learn something about what Shrinks think about from this series.

These posts are bits from a short series of presentations which I give to medical students during their required Third Year Psychiatry rotations. Which is to say, it is more or less directed to the general public but oriented towards general-physicians-to-be.

(Very few of these medical students will choose Psychiatry as a career, given all of their choices. More of them will chose Radiology than Psychiatry - wherein they will have plenty of fun and much to learn but never even have to talk to a patient at all - or Dermatology, wherein they will never have to be on call for the hospital. However, most will select Internal Medicine for their internships, which itself is a path to other specialties. FYI, all American-trained Psychiatrists do internships which include Internal Medicine or Pediatrics, plus Neurology, and get Board certification from the American Board of Psychiatry and Neurology.)

My presentation is not about making specific diagnoses (that comes from other Profs) - it's about the preliminaries: how all Docs can think about their patients, if they want to, and how shrinks think about their patients.

It's partly meant to be a corrective to the often-stated idea that the DSM is any gold standard of diagnosis, and it is meant to encourage young docs to think about their patients' lives, not just about their diagnoses - whether psychiatric or otherwise. And if I can interest them in the sorts of things shrinks think about, and gain some appreciation for what shrinks do, so much the better.

My presentation is based on the idea that, in the end, the job we shrinks get paid to do is to figure out what interferes with a person's ability to make a reasonably mature and effective adjustment to life if they wish to do so, and to try to reduce pathological mental pain, impairment, and anguish (but not healthy pain, worry, and anguish, like guilt, regret, sadness, realistic anxiety, or grief).

It's not to try to make people "normal," because "normal" doesn't really apply. People are wonderfully different, each with his own unique fingerprint of strengths, weaknesses, neuroses, interests, abilities, ego strength profile (about which more later), etc. In fact, unusual characters are a fine addition to the fabric of life.

I usually end my first session with a case example, for example, of a 42 year-old patient with hypertension coming in for a routine follow-up with his internist or GP. He has been prescribed 20 mg of Coreg/day for a month, and his systolic BP is 170 (had been 180 at his last visit).

I do my rapid-fire Socratic shtick. I ask them "So, Doctor, what do you want to know about this guy?"

"Is he compliant with the meds?" somebody wonders.

"Compliant!" I say. "What is he, your servant?" "Isn't the right question whether he is concerned enough about it to take the pills every day? Whether he can afford the meds? Does he need your free samples? Whether his life is too disorganized to do it? Whether it's the right medicine or the right dose? Or whether he even cares?"

We go on like this for around ten or fifteen minutes, and end up constructing a picture of a middle-management sales guy who is recently unemployed, divorced with two kids, mildly depressed, worried about money and alimony and child support, living in a small rented condo with rental furniture on take-out junk food and Chinese food, with some tendency for denial because he feels overwhelmed, with some deterioration in his self-care since his divorce made worse by the lack of structure and discipline in his unemployed life. His BP is the least of his concerns, but he does want to maintain a good relationship with the Doc, who he views as a friend and as a caring emotional support.

You rapidly move past the notion of A Case of Hypertension to the uniquely human and individual. It's good fun for all of us, and a good break for them from the fascinating but mechanistic details of caring for the renal functions of unconscious gomers in the ICU. It's about the art of doctoring, not medical science. You cannot do medicine "by the book," because each patient is his own book.

Then I tell them that they have just made a first step towards Real Psychiatric Diagnosis - and the real practice of clinical, office medicine as opposed to our equally wonderful technological medicine. It's about wondering "Who is this person who is asking me for help?" and not just about "What ails them?" After all, hypertension is painless, and doesn't really "ail him" at all. If you want to help this guy, all of this information about him might be useful to you.

In conclusion, I warn them that the same thing applies to Psychiatric diagnostics. Some people with Schizophrenia - a dread and incurable disease - have more satisfactory lives than some addicts - a sort-of fully curable problem. People are complicated, and so, often, are their lives.

Then I command the students to read MacKinnon and Michels' The Psychiatric Interview  as their first of several readings for my series. A Psychiatric interview isn't much different from any other medical consultation with a new Internist or Family Doc, really - except no physical exam other than that of the well-informed medical eyeball (which can detect a lot).

Yes, I will interrogate them on their readings just as the Surgical Profs do with their text on the examination of the abdomen, or Neurologist Profs do with the diagnosis of stupor and coma (or, as we termed it in medical school, the Diagnosis of Stupor, Coma, and Death. Funnily enough, the diagnosis of death isn't always so easy).

Parts 2 and 3, and maybe 4, later. Why am I posting this? To help me collect my thoughts and to improve my presentations.

Photo is Dr. Emil Kraepelin, father of modern Psychiatric diagnosis who, among many other things, distinguished Manic-Depression from Dementia Praecox (Schizophrenia).

This is what's on my "serious book" pile this summer. A gold star for me if I finish it all:

Telling Lies: Clues to Deceit in the Marketplace, Politics, and Marriage, Third Edition - Paul Ekman

Aristotle's Poetics for Screenwriters: Storytelling Secrets From the Greatest Mind in Western Civilization - Michael Tierno

Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development - Allan N. Schore

From Dawn to Decadence: 500 Years of Western Cultural Life 1500 to the Present - Jacques Barzun. It's like 1/4 of a Columbia undergrad education in one book.

The Lucifer Effect: Understanding How Good People Turn Evil - Philip Zimbardo

Plea For A Measure Of Abnormality - Joyce McDougall

There is no convincing evidence that "healthy eating" - whatever that is (eating "organic" vegetables?) - or a "healthy lifestyle," eg exercising daily or whatever - has any beneficial effect on your long-term medical future. 

Those things might - or will - make you feel better, happier, and more functional, and nobody likes to carry 30 lbs. of unecessary lard around with them, looking like a muffin-top or worse. Nothing to do with health, though. And that is why "Lifestyle Medicine" is quackery which has been foisted on a credulous public.

One quote:

...it’s little wonder, then, that the results of every major randomized, controlled clinical trial of healthy eating and lifestyles to date have been ignored, downplayed, or explained away... or their benefits greatly overstated. As incredible as it seems, they have failed to demonstrate significant benefit in preventing chronic diseases of old age, like the big three diabetes, heart disease or cancers, or in living longer. Nor has any healthy eating intervention been credibly shown to give everyone a government-approved BMI.

Other than avoiding smoking and substance abuse, and taking our medicines, our fates are sadly not in our hands.

Carpe diem: every day could be your last.

America continues to take the subject of abortion seriously. That's a good thing, because it means we are morally and ethically still alive.

Hard cases make for bad law. Abortion is a mare's nest of conflicing considerations and motives: a Mom's right to control her fate vs. a baby human's right to life; individual freedom vs. group moral norms; a woman's instinctive striving for maternity vs. her wish for "freedom;" the human's (understandable) desire for consequence-free pleasure vs. the human and natural fact of moral limits, and others. 

I don't know about other countries, but I have never seen a woman who did not carry some guilt about her abortion(s). I consider myself lucky in never having had one, because I did some dumb things when I was young.

The pro-abortion movement has done its best, for 30 years, to try to normalize abortion. They have done this with language, by de-humanizing the "fetus" (nobody is "with child" any more); by speaking of "choice," by speaking of a woman's ownership of her womb as if a child were a homeless squatter on her property, by terming it a "d and c," and so forth.

Despite their efforts, the inner voice still speaks: the inner voice of our Judeo-Christian foundation and conscience which considers human life to be the property of God and which deplores the taking of innocent life.

People hate to feel guilt - it's painful. And people hate to feel inner conflict - it's uncomfortably confusing. Our brains struggle to suppress one side of a conflict to relieve us of these discomforts.

I do not really want to tell anybody else that they shouldn't have one done, but I wouldn't perform one (I doubt whether it is consistent with the Hippocratic oath) and I sure wouldn't have one. However, I wouldn't be surprised if I would have if I had gotten myself knocked up at 18 - when I was a selfish and frivolous person.

Thus my views lack moral and intellectual consistency. And that makes for a headache.

This post was prompted by Dr. Clouthier's America's Abortion Headache.

So asks Newsweek. (I resent the "we" in the question, because I hardly ever do those things.)

The article discusses how thin the science is of Evolutionary Psychology. It is. Whenever the issue of nature/nurture comes up, I find people making arguments which ignore two of the most basic aspects of human nature: 1. mankind's ability to adapt to almost anything and to create his own environment, and 2. mankind's obligatory social and culture-creating impulses.

It is innate to man to create cultures which reflect at least some aspects of human nature, but no culture can eliminate the beast in him. Thank goodness for that.

Thanks to Insty for letting me know about my old colleague Dr. Michael Stone's new book, Anatomy of Evil. Quote from the Amazon site:

What do psychology, psychiatry, and neuroscience tell us about the minds of those whose actions could be described as evil? And what will that mean for the rest of us? Stone discusses how an increased understanding of the causes of evil will affect the justice system. He predicts a day when certain persons can safely be declared salvageable and restored to society and when early signs of violence in children may be corrected before potentially dangerous patterns become entrenched.

Pretty to think so, but that day will never come, Dr. Stone.

Revisiting Klavan's brief video message to new college grads from a couple of weeks ago, with the great quote above.

It explains why I believe that any shrink, psychologist (or anyone in the social sciences) should be of a Conservative bent unless they have no faith whatsoever in the human spirit (in which case they should have no faith in their own, either).

It would be stupid of pharma companies not to market their new products. They have bills to pay and investors to pay. You cannot fault them for it.

As a shrink (who does not have a primarily pharmacology practice, but uses meds whenever needed), I never use the newest medicines. I let other docs find out whether they have any advantages first, or any repellent side effects.

For Bipolar, I still think good old Lithium, a salt dug out of the ground which costs pennies, is the best, safest medicine. It works.

From the NYT: New Drugs Have Allure, Not Track Record

I majored in Statistics in college (with a minor in English Lit), but my stats sophistication is a bit rusty now. But it's not so rusty that I do not raise my brow at any latest stats reported in medicine, or especially in Psychiatry - and especially genetic studies.

As Gene Expressions points out, it's partly because a p-value of 0.05, commonly used in such studies, is unrealistic for these things. It's straight out of How to Lie with Statistics, which is essential reading for all high school students.

As the man says, if there is a genetic serotonin link with trauma and depression, it has yet to be proven.

In his second post on the topic, Why are most genetic associations found through candidate gene studies wrong? he makes the key point:

For nearly all diseases, reproducible associations have small effect size and are only detectable when one has sample sizes in the thousands or tens of thousands (for many psychiatric phenotypes, even studies with these sample sizes don't seem to find much). The vast majority of candidate gene association studies had sample sizes in the low hundreds, and thus had essentially zero power to detect the true associations. By the argument above, in this situation the probability that a "significant" association is real approaches zero. The problem with candidate gene association studies is not that they were only targeting candidate genes, per se, but rather that they tended to have small sample sizes and were woefully underpowered to detect true associations.

While I find the field of behavioral genetics to be as fascinating as anything else in this world, I always read the latest gene-behavior studies with the highest skepticism. (Do I think real Bipolar Disorder has some provable genetic underpinning? Yes, I do, even though I do not think it has been adequately proven yet. But not much else genetic in Psychiatry has been adequately proven in my view. Schizophrenia maybe, IQ almost certainly, but possibly not homosexuality, or depression, or alcoholism.

The trick to getting papers published is to run your numbers so they show something. It's not rocket science if you know how to do it: just look at the climate studies. (Even Einstein fudged his math. He happened to turn out to be right, though, as far as we know today.) Science is about hypotheses, not Truth.

Many of us here have discussed how much can be learned from failure, and how relatively little can be learned from success.

Thus it is gratifying to see the child of Memphis and legendary hedge fund owner Paul Tudor Jones delivering a 9th Grade graduation address to the "Buckley Boys" in which he declined to discuss the recommended sanctimonious topic of "service" and instead spoke about the value of failure.

Good on him. Almost all of my wisdom has come from my errors and failures - whether personal or professional. Read his speech, and invite your kids to read it too.

No good deed goes unpunished.

Well, that is surely not always true, but with the economic downturn, the charity medical clinic at which I volunteer one day per week has seen a sharp upturn in lawsuits against us Docs and the clinic this year.

The medical defence lawyer we have now engaged (we have had no complaints or suits for 10 years until January 2009) tells us that we should now regard each patient as a potential enemy. (Our clinic's founding Christian philosophy is to regard every patient as a friend and neighbor.) 

He tells us that our notes must be guided by the principle of CYA (your notes are legal documents, not medical reminders as we had thought) and that every decision a doc makes contains some basis for a suit in the hands of a hungry lawyer because all medical decisions are judgement calls and every situation is unique.

He also told us that recessions tend to see more suits against doctors because more folks are looking for cash, and much more so in charity settings. Plus the tort lawyers are hungry too - but they always are. He also advised us to refuse to treat any patients with substance abuse histories for our protection - other than alcohol.

He actually said "Do not be kind. They will screw you whenever they decide to." He has been around the block a few times.

I do not like this at all. A Psychiatrist/Psychoanalyst cannot do the job under such conditions. Furthermore, I can not and will not endure any relationship in my life without mutual trust. I am considering resigning (even though I was one of the founders of the place) and finding some other outlet for my charity. Maybe prison work, where you can safely begin with the assumption that everybody is a liar and cheater and working the system - and take it from there.

My position on the Board, plus my volunteer time (all unpaid) doubles my legal liability. I just want to do my best, tithe and double-tithe my time, and avoid hassles that do not fit into my life - and legal fees that I cannot comfortably afford.

And no, I would never work for ObamaCare. Never. I did not go into medicine to be a government employee. I went into medicine to work for my patients, doing my best, with no intention of looking out for lawyers.

It's tough for doctors because we are often held responsible for people who either do not want, or do not accept, our help and advice. But, as long as their name remains on our rolls and as long as we persist in trying to be constructive, the lawyers can get us.

I have been burned several times by keeping them on the rolls in the charity clinic, only to be sued by them eventually for not doing a better job "taking care of them." What? I am not a professional mother and I do not "take care of" anybody. I am a doctor, not a caretaker and, despite the modern lingo, not a "care-giver" either.

Like all doctors,  I try to work with my patients - and do not take care of them, or I to try to bring them around to where I can work with them.

If I were more self-protective, I would not even try and would just say "I cannot help you. Good bye," but that is not my medical tradition. My medical tradition is that you are a friend to your patients, whoever they are.

Novalis presents such a case. More practical docs than I am would just throw them out of the office. However, after being punished and hassled legally several times by going the extra mile, my heart grows harder. 

Indeed, good deeds often are punished and yes, it does lead to some bitterness especially when it is performed on a charity basis. I have never been sued or hassled by a private, self-paying patient. 

Mnemosyne was impregnated by Zeus for nine consecutive nights, thus producing the nine muses. Among other things, she was a goddess of memory.

The number of muses increased over time from the original three. Poetic license and creeping specialization. I had been looking up Euterpe, the muse of music and of lyric poetry, called "the giver of delight." The muse of song, but got sidetracked on the general topic of the Muses.

I posted briefly on inspiration the other day, and we had "Sing, Goddess..." recently. It remains fascinating to me that our mental creations seem to come from "elsewhere," to the extent that we can imagine that they come from a supernatural source.

In my line of work, we say that such things come from the "preconscious" or the "unconscious," but that's not much different from saying they are gifts of a Muse.

Whenever a preacher says "May the words of my mouth, and the thoughts and meditations of my heart, be acceptable to You," he or she is echoing the classical plea to the Muses. Our civilization remains a Greek one.

This site tries to personalize the Muses.

Image is Dante Gabriel Rossetti's Mnemosyne (1881)

Kealey's talk which we posted yesterday is a wonderful revelation. It confirmed much of what I suspected in the back of my mind but never focused on or thought through. I would like to read his book.

Many things become sacred cows without any evidence for their benefit. Most famous example: the incredibly expensive Head Start program, whose benefits disappear after a year. The rug rats would be better off banging around the neighborhood or the fields and swamps, learning how to educate and entertain themselves. Just get rid of the damn TV.

These "programs" become sacred cows via their income constituencies and their penumbra of virtuousness - not their effectiveness.

The infantile fantasy of government as source of virtue is an insidious one because government is only about one thing: power, and the mediocrities who seek it and the money that accrues to it to maintain that power.

Is government funding for research little more than welfare for PhDs? Possibly. In my field, you would be amazed by the stupidity of most of the government research grants which are paid for by the taxes of modest, hard-working folks who would rather worry about their families than seek power over others. Must be fun to appear benevolent with OPM.

Cui bono?

In the Q&A, Kealey astutely points out that people seek ways to proclaim "I am a good person," and that being concerned about global warming is (or was?) today's fashionable version, just as eugenics was at the turn of the century, socialism in the 1930s, being a Dem during Reagan, and flag pins and bumper stickers after 9-11. Symbols and attitudes as effortless, non-sacrificial fashion statements.

Althouse posting at Insty on Internet Addiction.

That's the stupidest thing I have heard of yet today - so dumb it makes my hair hurt, as Imus would say. So dumb I won't even waste any virtual ink to bother to explain why.

I prefer this piece in NY Mag: In Defence of Distraction.

Editor's Note: Dr. Helen covers this "addiction" nonsense.

Shrinks debate putting Bipolar Disorder into the Psychosis category.

It's all a tempest in a teapot for me. All of our diagnoses in Psychiatry are of dubious validity. They have two purposes: 1) Something to write on an insurance form and 2) a starting point for research to find out if they make any sense.

I do not even think that Schizophrenia is a "disease" per se. It's a handle for a lot of different strange things that we understand poorly.