Maggie's Farm

A quote from Dr. Laura (my bolds):

People don’t actually “grow apart” in relationships. They simply stop taking care of each other. They stop waking up and looking at their spouse with gratitude and awe. They stop finding ways to make that person happy that they are married to each other. They stop behaving as though they love that person with their last breath. They basically stop being the kind of person they themselves would want to come home to.

And then I find myself thinking "Who the heck would want to come home to face themselves?"

From Bowman at New Criterion's Ain't Gonna Study War No More:

In the media’s view, everything must be over-determined by circumstance — or the mistakes of the Bush administration — so that acts of terror become like acts of God, both in their causes and in the limited and ad hoc way they demand to be dealt with. Insofar as questions of war and peace arise, it is only by way of demonstrating that war must be thought of as a struggle to understand the other side — the unspoken assumption being that there is always a way to get the enemy to stop fighting by understanding and sympathizing with him and without having to defeat him in battle — as the old, unmentionable honor culture would once have insisted. Got that?

PC makes some hatreds privileged and deserving of "understanding," and others not so.

There are people who hate me purely because they have learned of my conservative/libertarian political views. Real, venomous hatred, despite the fact that I believe myself to be a friendly, kind, thoughtful, reasonably attractive, socially appropriate, and relatively warm person with a respectable pedigree and well-bred manners.

Truly, and trite as it sounds, some or even most of my best friends are Liberal-ish, and I have never hated anyone for their political views. In social situations, it doesn't even register with me. 

I do not understand this hatred, but I admittedly have never spent much time trying to understand it either. It does hurt my feelings, though.

Yes, I am voting for Scott Brown today, and not just because he is a hunk.

A book: The Importance of Fathers: A Psychoanalytic Re-evaluation

About the documentary: “In Search of Memory: The Neuroscientist Eric Kandel”  A wonderful fellow.

Alcohol myopia. I recently learned that alcohol doesn't just induce disinhibition (duh)and one-track preoccupations, but it also exaggerates inhibitions: scared drunks are more fearful of danger than the sober - when they are reminded of it. Who knew?

Scott at Powerline asks "Where have all the grown-ups gone?" Diana West has a new book, coming out soon: The Death of the Grown-Up: How America's Arrested Development is Bringing Down Western Civilization.

It's a subject that has been on my mind for quite a while - the phenomenon of perpetual psychological adolescence in us decadent and pampered Americans - so I will look forward to seeing what she has to say about it.

I hope she will mention that the post-war worship of youth, which culminated in the late 60s and 70s, provided social permission, if not incentive, for adults to continue behaving like kids. Even college, once the domain of the serious, has become an extension of high-school. Given the human temptation for regression, and the joys of youth when compared with the rigors, duties, sacrifices, and responsibilities of adulthood, it's no wonder that people welcome the socio-cultural invitation. Every psychiatrist and psychoanalyst in America, and probably in Europe, is well-aware of this. And so are our politicians, who feed into it - and feed on it: Take care of me, Mommy and Daddy Government.

Powerline has a blurb from Ms. West about the book.

Photo: These mill workers in Georgia around the turn of the century were probably more mature than some of the 40 year-olds I see these days. Yes, I am in favor of children working. All of mine did. I did, too - and it was not "fun." However, I had time to work on my tennis too.

I have been thinking quite a bit about Sociopathy (aka Antisocial Personality, aka Psychopathy, aka in the young "Conduct Disorder") lately. People without a conscience who view others as objects of gratification or as tools to be used. I have missed the diagnosis several times over the past few years, to my regret. Many experts are known to miss it until something happens to wave the red flag in front of your face.

It's not just an important diagnosis for us shrinks to make: it's important for everybody out in the world. 2-3% of humans probably have enough sociopathic traits to be of concern in life. It's a strange partially genetic adaptation. Some end up as leaders and moguls, many end up addicts, dead, or in jail. Sociopathy knows no economic, cultural, or ethnic boundaries.

What is this "condition"?

It's a tricky thing, sociopathy. It has been well-described from many points of view. We analysts often think of it as being based in an absence of empathy - an inability to experience others as other than as objects to be exploited, used, predated upon, etc. An inner coldness and calculatingness towards others, but not to be confused with obsessional personalities who simply protect their emotions, and not be confused with those with immoral or amoral impulses - everybody has those.

However, successful sociopaths learn to create a warm, caring, engaged, and often charming presentation of themselves to the world. Very successful and smart sociopaths learn how to live honest lives and to channel their talents, guile and wiles into honest paths.

Full-blown sociopathy is generally considered an untreatable and incurable condition. I am not convinced that that is true - but I think it requires special methods which are outisde of regular Psychiatry. Sociopathic traits are far more common than the supposed 2% of the population that are said to be full sociopaths. I am not going to write an essay on this complicated topic, but will just offer some links for those who are interested:

Wiki has a simple introduction to the topic

A classic book by Cleckley: The Mask of Sanity: An Attempt to Clarify Some Issues About the So Called Psychopathic Personality

An interesting paper: THE SOCIOBIOLOGY OF SOCIOPATHY: AN INTEGRATED EVOLUTIONARY MODEL

I have more links on the topic, but no more time right now.

I believe that we all have an immature side which wishes - or sometimes pretends - that our unwise and ill-considered actions might not have negative consequences. Some people have more of that wish, some less. Also, some people learn from bad experience better than others.

(I am not talking about neurotics who unconsciously or semi-consciously invite trouble upon themselves.)

As parents, we often have to invent consequences, eg a spanking if they run into the street, or grounding if they defy a curfew. However, the best teacher of consequences isn't parental discipline: it's Mr. Reality, aka The School of Hard Knocks.

Dr. Dobson has a brief simple discussion of the topic: Behavior and Consequences - The effective use of a powerful parenting tool

At the wonderful Hall of the Fishes at New York's American Museum of Natural History there is a preserved female Anglerfish. Attached to her is a bump with a tiny tail on it, which looks like a parasite.

It isn't. It's the shrunken remnant of a male Anglerfish. The males attach themselves to a female, and their bodies shrink away into nothing but male gonads permanently attached to the females. (You can read about Anglerfish here.)

I was reminded of Anglerfish by Kay Hymowitz's piece at City Journal, "The Incredible Shrinking Father," which takes a look at voluntary single motherhood in America and the role of artificial insemination. It is remarkable that, in one generation, something that had been considered a family tragedy is now considered, by some anyway, a "lifestyle choice."

A quote from her essay:

You’d think that we had enough problems keeping fathers around in this country, what with out-of-wedlock births (over a third of all children are born to unmarried women, and, in most cases, the fathers will fade from the picture) and divorce (the average divorced dad sees his kids less often than he takes his car in for an oil change). But these days, American fatherhood has yet another hostile force to contend with: artificial insemination. This may sound a tad overheated. After all, AI has been around, by some accounts, for over a century. And the number of kids born through the procedure each year, though steadily growing, remains quite small relative to the millions of babies conceived, as we can now say completely without irony, the old-fashioned way.

But aided by a lucrative sperm-bank service industry, an increasingly unmarried consumer base, a legal profession and judiciary geared toward seeing relationships through a contractual lens, and a growing cultural preference for individual choice without limits, AI is advancing a cause once celebrated only in the most obscure radical journals: the dad-free family. There are multiple ironies in this unfolding revolution, not least that the technology that allows women to have a family without men promotes the very male carelessness that leads a lot of women to become single mothers in the first place. And fatherless families are a delicate proposition, as AI families are discovering, since all the scientists’ technology and all the lawyerly contracts can’t take human nature out of human reproduction.

Leaving aside the fact that single motherhood accounts for a large percentage of America's poverty stats (that's another article in itself), I consider voluntary single motherhood to be the height of selfishness, immoral, irresponsible, and no favor to a kid. I do not believe that "it takes a village" to raise a family, but I do think that, for a number of practical and psychological reasons which I will not go into now, it takes two parents to do it - one of each type. A couple of sets of grandparents, and some aunts and uncles, are good too, if you can get 'em. Paid help is no substitute because blood is thicker than money.

Fortunately, we live in a free country, and freedom implies the freedom to make stupid and irresponsible choices. That is why freedom requires maturity, education, intelligence, and restraint for things to work. Being a free citizen in a free republic demands a lot from a person, and all of us have to dig deep to find the strength.

You can read Hymowitz's entire piece here.

Image: A lovely female Anglerfish

Our Editor emailed this article from the NIMH, The Teenage Brain: A Work in Progress, for my comment. It begins:

New imaging studies are revealing—for the first time—patterns of brain development that extend into the teenage years. Although scientists don't know yet what accounts for the observed changes, they may parallel a pruning process that occurs early in life that appears to follow the principle of "use-it-or-lose-it:" neural connections, or synapses, that get exercised are retained, while those that don't are lost. At least, this is what studies of animals' developing visual systems suggest. While it's known that both genes and environment play major roles in shaping early brain development, science still has much to learn about the relative influence of experience versus genes on the later maturation of the brain. Animal studies support a role for experience in late development, but no animal species undergoes anything comparable to humans' protracted childhood and adolescence. Nor is it yet clear whether experience actually creates new neurons and synapses, or merely establishes transitory functional changes. Nonetheless, it's tempting to interpret the new findings as empowering teens to protect and nurture their brain as a work in progress.

I don't think the human brain ever stops "developing" - or at least changing, as long as we are well-engaged in life and do not turn stagnant.

What I notice most in myself, as I accumulate years, is an increase in what I call mental "clarity." Who knows, maybe it comes from all that synaptical "pruning." Like when you cut back an overgrown, leggy hydrangea or lilac. My tennis court clarity has improved, too. Perhaps my ADD is getting better - or maybe I am a very slow frontal myelinator:

(a) series of MRI studies is shedding light on how teens may process emotions differently than adults. Using functional MRI (fMRI), a team led by Dr. Deborah Yurgelun-Todd at Harvard's McLean Hospital scanned subjects' brain activity while they identified emotions on pictures of faces displayed on a computer screen. Young teens, who characteristically perform poorly on the task, activated the amygdala, a brain center that mediates fear and other "gut" reactions, more than the frontal lobe. As teens grow older, their brain activity during this task tends to shift to the frontal lobe, leading to more reasoned perceptions and improved performance. Similarly, the researchers saw a shift in activation from the temporal lobe to the frontal lobe during a language skills task, as teens got older. These functional changes paralleled structural changes in temporal lobe white matter.

That might be the developmental physiology of what is often referred to as "growing up."

Why don't colleges just collect all of the grievance study groups and put them in one department. Fat Studies, Anorexia Studies, Queer Studies, Women's Studies, Hispanic Studies, Black Studies, Indian Studies, Transexual Studies, Lesbian Studies, Klutz Studies, Oppressed Studies, Ugly Studies, Not-Too-Smart Studies, Too-Short Studies, etc.

You could call it Boo Hoo Studies, and in it you could sequester everyone who expects college to cater to their narcissism instead of teaching them about bigger, better, and more important things than themselves. Baby bottles in the coke machine, over in that department.

Eventually, they will need to include one more increasingly marginalized and disenfranchised  minority in Boo Hoo Studies - Regular People Living Without Grievance. RPLWG just can't get a break these days, can they?

Editor's note: Or, to borrow the phrase from The Anchoress, could it be called the "It's All About Me" Studies Department?

A Dr. B. re-post from our long-ago archives -

"Why do I do all these things for Jim, Dr Bliss, when for the past six months I can't stand his presence and I can't even stand the way he eats? Is it because I feel guilty, or have no self-esteem?"

Guilty? Self-esteem? It's of interest to me how the morality-free zone of psycho-babble in our popular culture can obscure the persistence of the old virtues, even among those who live them.

The language of duty, loyalty, honor, self-sacrifice, endurance, perseverance, reliability, courage, self-reliance - the things Bill Bennet wrote about - has been replaced by a language of "feeling" and "guilt" in some strange and ill-informed distortion of psychoanalytic understandings.

Indeed, "my feelings" appear to have replaced the virtues to the point that "not being true to your feelings" is like a modern-day sin. And yes, I guess it is a sin - if you regard yourself as a god.

But back to my patient. I know her well enough to know that she was raised with the sturdy Mid-Western Presbyterian virtues, internalized them, and lives them. Her kindness and thoughfulness with her husband are driven by character (in the old sense of the word) - not guilt, and surely not, at the moment anyway, by "loving feelings." For her, it would not be so much "guilt" in betraying her character - it would be "failure." And not life failure, but a failure to be who she was built to be.

The point I want to make is not about my patient's psychology, or how she ought to deal with her situation. That's another subject. It's about the pop-psych assumptions that are in the air that would cause a person who "does the right thing" despite her emotions of the moment is somehow afflicted by "guilt" or some other pathology (although guilt is not a pathology), rather than being a mature person whose habits of character are stronger than her emotions.

I sometimes joke that if we were all true to our feelings, we'd all be in jail.

A few take-home points:

• Distrust the elevation of "feeling" over character. It is immature. That is not to say that we should ignore our emotions - it's just that they are not sacred, they are seldom what they seem, and they can be very poor guides to life. Contrary to popular misunderstanding, psychoanalytic thinking does not make emotions sacred: they are just surface data points.
  
• Guilt is neither a pathology nor a sin. In my experience, guilt is usually well-earned. So-called "neurotic guilt" is a psychological issue for some, but those with plenty of it never know they have it, without therapy.
  
• "Character" - meaning virtuousness, not personality type - is culturally-defined, and transmitted mainly via family with, one would hope, the support of genetics and of the surrounding culture.
  
• The only definition of "failure" I have is failure of character. We should feel like a failure when we fail in the virtues that we have been raised on - assuming that they are a worthy set of virtues. When we fail, we should repent, seek forgiveness, beat ourselves up a bit, contemplate our shortcomings, learn, and move forward.
  
• Despite the prevalence of amoral, pop-psychological language,  decent people still live, or struggle to live, according to the time-honored virtues. If they do not - keep your distance and beware, because they are "coming from a different place" and are playing by a different rule-book.

New Years Eve. Time to party hearty? Been there, done that in youth. No more. There's no point to it.

We ask our readers to please drink responsibly. Each reader is precious to us, and we cannot afford to lose one to a traffic accident.

Speaking of alcohol abuse and alcoholism, here's an interesting report on The Three Types of Alcoholism. I am not sure whether it corresponds well to my clinical experience or not. Probably not. However, this does:

The authors note that this finding supports two pathways to alcoholism: one where drinking represents a tendency to behave impulsively and seek excitement, and a second where drinking is used to relieve negative mood states and reduce behavioral inhibition.

In other words, substance addiction often - but not always - has underpinnings of either neuroticism or sociopathy. In the end, every human - drunk or sober - is a unique individual with his own basket of issues.

Probably yes.

While I am quite pleased and content with my own (first) marriage, when I talk with unhappy people, which I do all day, I am often reminded that the nuclear family is a very recent invention, that the notion of romantic love is also recent, that arranged marriages and marriages of convenience or necessity were the norms of the past, and that humans are not "naturally" monogamous - whatever I might mean by "naturally".

When you put the nuclear family together with dreams of enduring romantic love, it's a set-up for disappointment. The nuclear family, unlike the extended family (or the tribe), is isolating and does not provide a broad base of support in life. Intense romantic love, unlike plain old-fashioned strong attraction and desire, is a regressed state of mind - some shrinks half-jokingly call it a form of insanity. Not that it isn't great fun, but it gives way to reality in time, although the best marriages can rekindle the old feeling from time to time.

One thing that is probably not talked about enough is how many marriages are not founded in "true love," but instead are founded on loneliness, desire for companionship, desire for babies, desire for security, fear of becoming an old maid, friendship, desire for a social foundation, etc. This is not a bad thing, but I sometimes wonder whether the contrived and ridiculously costly fairy-tale trappings of the typical American wedding is designed to obscure those facts. Young folks these days often talk about having "friends with benefits" while they await true love, without realizing that "friends with benefits" can be one description of one kind of satisfying marriage.

But to get back on track here, yes, I believe that we tend to wish that a marriage could meet all of our emotional and physical needs. Shrinks term that a regressive, ie childish, wish - not just because it is unrealistic, but also because if emphasizes the "meeting my needs"  aspect of a relationship rather than emphasizing "how can I try to give these people (wife, kids)  a good life".

It's a truism that people thrive when they have multiple sources for emotional care, and many outlets for love and caring. Friends, colleagues, neighbors, members of clubs or churches, etc, Making and keeping good friends is not really an easy thing to do, and I don't know anyone who doesn't want one, or doesn't want another one. In fact, I suspect that one reason moms want jobs these days is because they feel isolated with their kids.

Althouse noted a NYT op-ed piece by History Prof Stephanie Coontz about the limits of marriage. Althouse comments:

The problem, in Coontz's view, is not only that we deny ourselves the happiness to be found in friendships, but also that by expecting so much from one romantic relationship, we can put so much pressure on it that it breaks. What's worse, if the marriage was our source of happiness, we have nothing.

Quotes from the Coontz piece:

A study released this year showed just how dependent we’ve become on marriage. Three sociologists at the University of Arizona and Duke University found that from 1985 to 2004 Americans reported a marked decline in the number of people with whom they discussed meaningful matters. People reported fewer close relationships with co-workers, extended family members, neighbors and friends. The only close relationship where more people said they discussed important matters in 2004 than in 1985 was marriage.

In fact, the number of people who depended totally on a spouse for important conversations, with no other person to turn to, almost doubled, to 9.4 percent from 5 percent. Not surprisingly, the number of people saying they didn’t have anyone in whom they confided nearly tripled.

The solution to this isolation is not to ramp up our emotional dependence on marriage. Until 100 years ago, most societies agreed that it was dangerously antisocial, even pathologically self-absorbed, to elevate marital affection and nuclear-family ties above commitments to neighbors, extended kin, civic duty and religion.

Read the whole thing here.

On Friday morning a patient told me that he liked to hire people who are in AA because he knows that they struggle with honesty, and take the subject seriously - and often know more first-hand about dishonesty than most.

So thanks to Assistant Village Idiot for noting a relevant piece by the always interesting Kling at TCS on the anthropological subject of "trust cues" in human relationships and especially in affiliative groups (tribes), That's Your Cue.

Are humans tribal? You bet they are. And it often makes good sense to be.

Trust cues are our ways of indicating that we are members of a group, or tribe, and that it is important for us to be a member in good standing. In a sense, my patient took AA "membership" as a trust cue, because he knows they talk about honesty all the time in AA.

My favorite example of a trust cue which is ceremonially acknowledged is the "made man" in the Mafia: the guys know they can fear and trust him because he has blood on his hands. A similar example might be admission to any exclusive club.

But trust cues aren't always rational or reliable. For example, I have a bias towards trusting the intentions of serious Christians but, as far as I know, serious Christians are as morally flawed as everyone else. I suppose I'd like to believe that we, like the AA "members," worry more about how we treat others.

Thus trust cues do not necessarily mean "trust" in a moral sense, but more "trust that we're on the same page;" that we view the world somewhat similarly, and/or that we share enough similar life experience to constitute some sort of group membership.

When I attend a psychoanalytic meeting, I know it's my "club:"  mere attendance indicates some fundamental interest in unconscious processes. When I go to my church, I know I'm with my "tribe:" we are all interested enough in Christ to show up. And, come to think about it - if you really want to see a trust cue festival, attend a Dartmouth alumni Christmastime cocktail party: you have never seen so much green conviviality since St. Patrick's Day in NYC.

What Kling does, in his discussion of Wade's book Before the Dawn, is to note the ways in which dogma (as opposed to truth) is used or abused to indicate group membership.

Wade says that the evolutionary value of trust cues is that they facilitate peaceful interactions among strangers. When I offer a trust cue, I am saying that even though we do not know one another, I am a member of a trustworthy group. I value my membership in that group, and I know that lying to or cheating another member of that group could cause me to be excommunicated from the group. Since you are also a member of the group, you can trust me not to lie to you or to cheat you.

However,

...political beliefs serve primarily as trust cues. For example, those who favor an increase in the minimum wage are sending trust cues to people on the Left, and those who oppose an increase in the minimum wage are sending trust cues to people on the Right.

The actual consequences of raising the minimum wage are rarely discussed. In other words, political debates often ignore what I call Type C arguments (from empiricism) and turn instead to type M arguments, which accuse one's opponent of belonging to an outcast group. The reason for this is that people are not trying to persuade each other rationally. Instead, they are using trust cues to indicate that failure to agree implies excommunication from the group.

It has been my view that the current fad of getting upset about global warming is a trust cue, and little more. What it actually proclaims is "I am virtuous and I care a lot, and I don't mind more government control over things." The science, and the real empirical debate, lies outside the cue structure. Assertion of tribal membership is what such political postures are all about.

Read Kling's piece here, and Asst. Village Idiot's comments here. Interesting stuff.

I discover, sometimes, that things about others which I detest are qualities of my own which I detest, reject, and attempt to disown by pinning them on others.

Although I am not a Borderline Personality, there is an element of projective identification in this. Whether in fantasy or in reality, we can mentally construct another person so as to contain, embody (or, if the person is in our personal lives, to even get them to enact) our own rejected demons. Then we can detest them or look down on them while preserving an illusionary and undeserved self-esteem.

I have learned to reflect on the qualities I seem to be most irritated by or contemptuous of in others and to do a little reality check to see whether it's more about my stuff than about theirs.

Do you find yourself doing this sometimes, as I do?

With half the world either on vacation, spaced out, "enjoying" family, skiing, lounging in the Caribbean over Mohitos and Rum Punches, or too busy digesting cookies to spare time for the intertubes, it seems like a good time to mix in some daily Dr. B. re-runs from our archives. 

This one, "A Good Spanking," is from 2007.

The proposed anti-spanking law in California has been much discussed, as here at Education Wonks. Also, Raven.The story has also been much mocked: Blame Bush notes that spanking can lead to things which are considered "disorders" in California, such as respect for authority, consideration of rules, self-discipline, and awareness of consequences.

There may be some shrinks who are opposed to corporal punishment, but I do not think that I know any. There are many situations for which I would recommend corporal punishment (eg ignoring a rule about playing in the street, or accidentally pointing a BB gun at somebody, or being sadistic with a sibling or a pet - for a few examples) and, in general, I think it is preferable to withdrawal of love or attention (ie, "time-outs," which I think are usually applied when the adult needs the break from the kid. That is, a "time-out" is a cop-out.).

In fact, I think schools ought to be able to administer corporal punishment too. I received my share, and not only did it not harm me - I think it helped me (in retrospect!). It "concentrates the mind," assists the memory, sets a firm limit, and demonstrates "tough love." A reasonable degree of anger is an essential accompaniment.

What I observe more than anything else is that defiant, obnoxious, or even "conduct disordered" kids - and sometimes just naughty kids, get sent to psychiatrists and social workers before anyone tries forceful discipline - as if growing up respectful and obedient were automatic. For many it is, but for many it is not.

Never forget that when a young adult messes with a drill sargent, watch out. When an adult messes with a cop, that adult will be taught a very firm physical lesson. When an adult breaks a serious rule, men without smiles with loaded guns will come and point them at your chest, throw you to the floor, cuff you, and lock you away in a small room with Bubba-With-No-Teeth who is big and strong and feeling lonely.

So a good whuppin', when needed, isn't really so bad. It beats humiliation by a long shot. When the rules of life are not internalized, they need to be enforced externally until they are - which for some people means never. Some fear is very useful in life to keep us out of trouble. We can be their friends later, after they grow up a bit.

Spare the rod and spoil the child. Do not listen to those who deliberately and sneakily try to conflate punishment with child abuse, and never let the government tell you how to raise your kids. In case you haven't noticed yet, the government is an idiot.

Related: Dr. Helen on kids who kill

Image: Boy being birched by teacher, no doubt deservedly, while other students observe. 1375.

A piece via Memorandum launched my brief rant about the noisy, Leftist segment of the women's movement.

Regardless of the moral issues around abortion, I have no interest in paying for your abortion. None. Nor for your IVF, your tummy tuck, your massages, aromatherapy, chiropractic adjustments, your birth control pills, or your nose jobs. If an insurance plan doesn't cover such things, too bad. The claim that insurance which does not pay for non-therapeutic abortions "harms women" is insane.

Grow up and pay for your own damn abortions, ladies - and for anything else medically-related that you elect to do which is therefore "elective."

Equating "liberation from oppression" with "wanting free stuff" is pathetic and retrogressive, replacing the good husband ideal of the past with a new sort of husband in government. Next thing you know, these women will be demanding that we buy them cars so they can drive to work.

That's not pride and confidence. That is infantile, and consistent with the worst stereotype of the weak, ditzy, incompetent female.

I believe that a man needs his good woman just as a woman needs her good man.

The moral of the story is that "movements," like non-profits - having acomplished their major goals, need to keep finding new things to do to maintain and justify their existence - and their paychecks. It is not grown-up for women - or anyone of any of the 5 or 10 or whatever "genders" - to want things on my nickel.

My apologies for bothering our readers with this on a cheery and snowy Christmas weekend. Now that I have that off my chest, we are getting ready to dress up fancy to head off to make the rounds of some Christmas parties and open houses.

Bring on the mountains of snow and the gallons of eggnog and the groaning boards! Modern women enjoy trying to meet life's challenges of all sorts, including those of excess snow and excess eggnog and excess calorie-filled goodies, as did the women of my Mom's generation. Strong women, never victimized, oppressed, or asking for pity.

And God bless our lonely military wives and Moms during Christmas. A tough job, but they can do it and need no pity and ask for none. Same thing goes for the guys whose wives are in the service.

Does that, or should that, exist as a medical diagnosis?

I doubt it, although the idea of diagnosis nowadays is rather arbitrary and designed mainly to complete insurance forms.

In light of Tiger's family problems, I have been hearing the term "sex addiction" used a lot by non-professionals and by some quasi-professionals. Rock star-types have endless temptations and opportunities for recreational sex. And so does any guy who doesn't mind going to massage parlors or titty bars.

It seems to me that pathologizing hedonistic behavior of any sort tends to diminish the fact of human choice - and moral choice. We primates are wired for sexual adventurism, but also wired for restraint and for considerate behavior.

What do you think? How many of our guy readers could resist lovely young women constantly throwing themselves at them, and licking their ear?

One interesting piece of data:

The divorce rate in America for first marriage is 41%
The divorce rate in America for second marriage is 60%
The divorce rate in America for third marriage is 73%

Lots more cheerful facts about divorce here.

I said good-bye to a fellow I have worked with on and off for over 15 years yesterday.

His wife died last winter, and he has finally decided to move to Florida to live with one of his daughter's families. Lonely. He is in his 80s. Most of his old pals in town that he worked with, grew up with, and worshipped with are dead. A sad farewell for both of us. He gave me a big bear hug. He was never a regular psychotherapy patient, but an irregularly-regular patient when things got tough.

Strong guys are not afraid of getting help when they need it.

I nursed him through panic attacks (cured them easily with medicine), a major depression after his heart attack, a major depression after the death of his wife, the suicide of one of his daughters. In the process, I learned a lot about his life. A lot about life.  It is my privilege to learn a lot about life through people's lives. Their stories enrich mine.

Today, he reminisced about his troop ship trip home from England after having been a tail-gunner - a teenager - for a couple of years in WW2 in Italy and France, and finally in Germany. He was based in Dijon for a while. "We got the news about FDR's death on the ship. Some liked him, some hated him, but he was our boss. Ship was half-filled with guys like me headed for furlough, and half-full of POWs. Why, at that point in the war, they were bringing German POWs to the US I have no idea, but the military never makes sense. That's a given when you're in the service. For my furlough, they took me from New York to Massachusetts to Miami to New Jersey before I could get home to Massachusetts. After my month furlough in the local pub, I had to spend three months down in New Jersey to get enough points to qualify for discharge."

"Doing what?" I asked. "Basically, nothing," he said. "They just had to make us wait out our time. The action then was mopping up in the Pacific." He said "It feels so long ago now that it's like another life."

He is a retired mailman who remembers horse-drawn fire trucks, played trumpet in the Volunteer Fire Department marching band for 50 years, and still sings in his RC choir and delivers food to the elderly. "I'm older than most of the people I deliver to." He was the guy who told me that flak on an airplane sounds like "a bucket of gravel being dumped on the fuselage. You get used to it after a while. We all assumed we would die, and got used to that too."

An American fellow to the bone, and one of the finest, humblest, most giving and unselfish people I have ever known. He dedicated his life, and especially his retirement, to being a good companion and to doing unto others in whatever ways he could.

Long life to you, friend, and God bless.

While lesbian feminista Democrat Camille Paglia admires Pelosi's "grittiness" and "mettle" (but detests what Pelosi has produced. BTW, we like Paglia a lot. She is the kind of person it is pleasant and interesting to disagree with, and we appreciate grit in women), Dr. Laura has another view of the world at home: The Evolution of ‘Feminism' Saddens Me. One quote:

...it’s pretty easy to make men happy.

It is remarkable that each and every one of the women who has
called my show complaining about her husband, and who was then asked
the question, "Would you want to come home to you?" has said,
haltingly, no. There it is. When women disdain masculinity and their
own femininity, all is lost for the family.

These sorts of discussions, however interesting at times, are a bit off the point. Men need to be gentle sometimes, and women need to be tough sometimes. Both obviously have these capacities. However, I think that if a woman wants to have a happy marriage she would do well to at least give Dr. Laura a listen. She understands men pretty well, and likes them for what they are.

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.