Maggie's Farm

A few weeks ago I took a stab at the subject of American medical care, and the relationship between patient and physician, "Providers or Physicians?"

I recently stumbled upon a better piece on the same subject by Dr. Bob in which he explains that "medical care is not a widget," and that the relationship between physician and patient is not a contract, but a covenant. Worth reading, at The Doctor is In

Stumbling and Mumbling takes a look at Dalrymple's piece on The Proletarianization of Doctors.

Indeed, the de-professionalization of physicians is happening all over the US, and not just in countries with socialized medicine. I most recently became disturbed by this when I was told that docs in a certain charity clinic that I am familiar with have been asked to punch time clocks when they come on duty.

Of course, it's all about money and power. When physicians become employees with no independent function as professionals, they can begin to lose their identity as professionals. It already happened to public school teachers when they unionized, but docs, being generally made of sterner stuff, do not fold so easily.

Fact is, this charity clinic I refer to (which has family practice/general practice, OG/GYN, dental, and psychiatric staff) is staffed by docs who want to sacrifice some of their time to the poor, but they have been told that if they all were to quit, they would be replaced overnight with docs from India and Pakistan who would not view the job as charity at all, and who have a different view of medicine that the traditional American view.

Money and power. It all began in the US when hospitals began to be run by managers instead of by doctors, in the 1970s. Hospital boards with an eye on the bottom line wanted compliant employees instead of cranky, demanding, patient-devoted docs running things.

We should have seen it coming when insurance companies replaced the line for "physician" with a line for "provider."  Provider? I am no provider. As a psychoanalyst and psychiatrist, I am quite the opposite: I am a demander, if anything. A demanding friend, whose time is worth a lot. Not a caretaker or care-giver, most of the time.

And that is why I am willing to be paid to teach, but am not willing to be paid to work by anyone other than my patients. Medicine is a fraternity/sorority, and a guild, and a priesthood with daunting responsibilities which extend far beyond the technicalities of medicine into the realms of friendship, love, the soul and the spirit. If that doesn't matter to people, they will live to regret it. 

I have never been sure how much I do want to know myself. Dr. Dalrymple went to a neurosciences conference, and wrote a nifty report. One quote:

It will not have escaped the notice of the observant that Marxism and Freudianism have become a little frayed around the edges of late, and that their adherents are reduced to recalcitrant membership of increasingly beleaguered sects. But the attraction of all-embracing worldviews that explain not only who we are but prescribe how we ought to live remains as strong as ever. Some of the neuroscientists to whom I listened at the conference implied that we were on the verge of such a breakthrough in our self-understanding, thanks to neuroimaging, neurochemistry and neurogenetics and so forth, that Man, proud Man, will no longer be a mystery to himself. The heart of all our mysteries will be plucked out wholesale, as it were; and to understand all will then be not so much to forgive all as to control all, especially our bad habits.

It would solve the terrible AIDS problem, would it not? My Way News. Plus it would solve the entire transgender crisis, and the whole patriarchy problem too.

Let's Think Progressive, Think Feminist, Think Sitzpinkler, and Think Incrementalism: Circumcision Was Just a Start!

You have to wonder what kind of wierd sadistic nut would have thought of it, and don't tell me that God really wanted that. Our God is into neither physical nor mental mutilation, I believe.

But male castration at birth - meaning the whole package -sounds like a good issue for the Left. A natural issue for Hillary. And it is multiculturally sanctified: the Moslems already take the knife to their girls. Why don't they take out the old snippers, and do it to their men too? Fair is fair.

Ed. note: That is Mr. King Cobra. A very fine animal.

My casual post on transsexuals attracted more attention than it deserved, including attention from Laura's Playground. Still, I suspect most interest is plain old morbid curiosity, like slowing down to watch as you pass an accident. "Rubbernecking," as they term it in NYC. It can seem like Coney Island side-show stuff, but so can many medical curiosities and strange ailments.

As a fairly effective and smart shrink, I feel for these people, and yet being a physician isn't all about feeling. My opinion? I dunno what to think.

A reader produced this video at YouTube: Made by Nature. Nothing nasty in it at all. We report; you decide.

I have never treated a patient with a "transsexual" diagnosis (now known as Gender Identity Disorder), and I know little about it.

The case in Germany described in Clayton Cramer's piece, in which a 12 year-old boy is undergoing hormonal treatment in preparation for surgical transformation into a "female," raises the issue. The German Child Endocrinologist says this:

"They are not freaks, nor do they suffer mental illness. They are simply trapped in the wrong bodies. That is why it is best to help them as early as possible and reduce the trauma for them and their families."

Freud made it clear, and he was right, that everyone is psychologically a bit male, a bit female, and, on some level, bisexual. Psychiatrists, and especially psychoanalysts, tend to look for the inner motives for things in general, and to view desires for external change as "externalizations." Just the phrase "trapped in the wrong body" is based on a strange premise. Furthermore, who has the body they really think they want? I was a tomboy myself, refused to wear dresses, and liked guns and sports. However, sometimes things do go awry during early development - before birth - which affect the development of the brain and thus the personality. 

I guess all I can say about this is that I'd like to imagine that there could be some "therapy" for a kid like this that would fall short of dreadful physical mutilation. I'd be willing to give it a try.

And, by the way, I do not believe you could do this thing they are doing in Germany in the US: I doubt any physician would be willing to do it at that age. Primum non nocere.

I thought that I had completed my thoughts about the Psychoanalytic meetings, but I have one more thought to briefly put on paper.

In the US, psychoanalysis is mainly a research tool. It is not, and never will be, a widespread treatment for disorders of the soul because most people cannot use it, and because people have become so dependent on their insurance which will never pay for analytic treatments. Thus it will remain an endeavor for the few, available to the few, and practiced by an elite few (mainly in a handful of metropolitan areas) - the high priests of the craft of psychological treatment.

(Incredibly, in Europe government insurances pay for psychoanalysis, but many believe that if paying for it does not hurt, it will not work. Nobody appropriately values "freebies".)

So, in the US, analysis is a benefit for the few - truly an elective procedure -  but a source of data and information and theorizing which can benefit many. We have yet to find a better method than Freud's for investigating the depths of the heart and soul.

Editor's Note: For Dr. Bliss' recent posts, just click here.

I am back home in Boston. A few final thoughts from the analytic meetings:

1. It makes more sense to speak about "engagement" in treatment than to speak about "treatment alliance" or "therapeutic alliance."

2. A capacity for self-analysis is one good indicator for the end of an analysis.

3. Is psychoanalytic theory, especially its meta-theory, little more than an intellectual crutch for the doctor?

4. Not news, but analysts are prone to all of the obnoxious and nutty human traits that everyone else is.

5. Classical psychoanalysis is for people with mainly neurotic conflicts and personality issues in the neurotic zone, but many are treating less-well put-together people with all sorts of non-classical analysis these days. I always find that interesting, but I am not sure it makes sense. Maybe I am old-fashioned, but I have an analytic tool-kit and a psychotherapy tool-kit, and they are different.

6. How come people who live a short train-ride into the city rarely do anything, but out-of-towners come in and catch a bunch of theater, the NYC Ballet (best in the world), some music, a museum or two like the Neue Gallery, etc. - and feed their souls for a year? Suburban sloth.

Finished my strenuous week in NYC with Jacques Brel is alive and living in Paris, an off-Broadway revival of the 60s hit. Some think that Brel was the greatest songwriter in world history.

I don't think that (David's psalms win the contest, for me), but they are damn good. The music and the singing are extraordinary. Plus they have kept the basics of Brel, but added a bit of appropriate stage movement. And the Zipper Theater (in an old zipper factory) is the funkiest place: you sit on old car seats. They have a bar in front, with a sign that says "Please bring your drinks into the theater."

Brel died in 1978, but he is alive and well at the Zipper. The NY Sun's review is here. The 1966 original recording is at Amazon.

Who really needs a psychiatrist? My wife tells me what's wrong with me every day, for free.

Anon.

More items from the American Psychoanalytic meeting in NY this week:

1. Confidence that antidepressants will work improves their effectiveness by around 40%. I don't know what that means, and I tend to doubt it - but that's the data. Interesting. There are still many analysts who feel that antidepressants interfere with treatment. They could be right.

2. Most psychoanalysts practice very little analysis. It's the nature of the modern world. Analysts regret it, but they feel that their rigorous and lengthy training helps them in whatever they do.

3. I always knew this, but analysts tend to be stiff, unapproachable, stern, and unfriendly people. The presentations are humorless, cold, unrelaxed, and always delivered in a wierd - can I say "hypnotic? - monotone. Very strange, given their profession, in which they are very kind and caring. And yet an analytic meeting is the coldest, most unfriendly sort of "convention" you could ever find. Nobody chats, nobody hoists a few beers at the bar - unless they know eachother already. They are totally isolated at the meeting, which is not fun at all. Even when you sit next to them, they don't acknowledge your existence. It's like an Episcopal Church. A bit schizoid. When you smile at someone and say "hi," you feel like you are intruding. I am not like that, at least since my second analysis. Will ask Nathan to try to explain this unpleasant phenomenon.

4. In semi-contradiction to the above, overheard at the Waldorf lobby bar between a somber but cute youngish analyst gal and a gal friend at 2 pm: "I need a drink or two. And then, let's go do some shopping or something. I need a break." Do not ask me what I was doing at the bar.

5. I always find it amusing that Freud never had a psychoanalysis. He said he did self-analysis, which I am certain that he did. Like any explorer, he opened many doors, and was wrong about some small things, but right about a few very big things. A hero, for certain.

6. "Self-psychology" and object relations theorizing: Just say the term "projected self-object" and I am asleep. Same goes for the words "Melanie Klein." I am outta there. This stuff is gobbledy-gook to me, and I ain't dumb. If you can't explain it to me in the King's English, forget it. No sale. Back to Charles Brenner.

Yesterday was excellent.

Dr. John Meyer did a plenary speech on re-analysis which was very fine. He particularly noted the limitations of training analyses, and the common desire of analysts to do it again, and to go further. General point: Second analyses are better than first.

Overheard in a research poster session between a Belgian analytic researcher and an American attendee, Dr. Y:

Dr Y: Have you read the work of Dr. A in France, and Dr. B. in Sweden, which are closely related to your research?
Belgian Dr: Yes I have...but who are you?
Dr Y: I am Dr. Y.
Belgian Dr: Oh, of course I know who you are. I am so pleased to meet you.
Dr Y: Have you read my book?
Belgian Dr: Yes, of course.
Dr. Y: In the English or in the German?
Belgian Dr: In the German.
Dr. Y: Good. That's the good one.

A thought clarified during a presentation by Dr. Catherine Lee on Romantic Mirroring and Erotic Transference in the Female Analytic Dyad: How come analysts tend to call it homoerotic transference when analyst and patient are the same gender, and erotic when they aren't? That's silly - it's all ordinary human love-seeking in the transference.

A new concept, generated while kidding around waiting for a discussion group to begin: We need to come up with a new diagnosis, called Normal Personality Disorder, with a DSM 4 code, for all of the people who can benefit from psychoanalysis.

Observation: From conversations, more and more analysts are doing couples work. They like it.

More later. Last night, though, dinner with Bird Dog and daughter, and some other folks, at one of my favorite NYC restaurants, Cafe des Artistes - always a special treat - and then to Spamalot, which is a vaudeville-style Bway thing which was constantly hilarious with mindless, adolescent humor with an irreverence which does not spare gays, Jews, Les Miserables, Brits, kings, heros, Vegas, Camelot, Broadway, theatrical cliches, and everything else Eric Idle could think of.

The theatrical talent available in NYC is always utterly mind-boggling - and deeply humbling. I always wonder, Who are these amazing people who can act, dance, tap-dance, sing up a storm, ham it up, and produce laughter with a single eye movement? A perfect ending to the day. "Tis only a flesh wound. Come back here, you filthy coward."

Spent all day at the American Psychoanalytic Meetings today. Very pleased to see all of the PC stuff gone. No pro-Palestinian psychology, no terror apologetics, no sessions on transgenderphobia. Of course, they had to generate a press release condemning torture, but that is just window-dressing. These folks mostly aren't Jack Bauer fans, or shooters, except me and maybe a few others. (I am opposed to gratuitous or vengeful torture, but entirely in favor of torture to extract life-saving information.) Happily, though, it's pretty much back to basics.

Had a hilarious lunch with our recently-truant Aliyah Diary author, N. Szajnberg, MD, author of two new books of psychoanalytic research, including one on Israeli soldiers, who spoke wonderfully at a morning meeting on the role of theory-generation in the history of science. Will post his books later.

Among others at lunch at the Cafe St. Bart's - Philly's Dr. Elio Frattaroli, author of Healing the Soul in the Age of the Brain. Given his interests, I told him to give One Cosmos a look-see. Nathan claims that Elio's is the best book every written on psychotherapy.

My questions for our lunch-time informal panel:

1. Does anyone really believe our metapsychological theories? (I think not)
2. Do psychoanalysts overvalue the "inner life"? (I think yes, but they undervalue the spiritual life)

This is getting a tad technical, but this was Anna Ornstein's reply to my question about an apparently narcissistic patient in analysis whose narcissism turned out to be a transference resistance against an oedipal transference: "It must have been pseudo-narcissism." Hmmm.

The session I most wanted to attend was Dr. Bob Michels moderating about a case of organizational pathology presented by Dr. Dick Munich. Sold out, with barely standing room in a 100 degree room. Even Dr. Kernberg, my supervisor and boss many years ago, had to stand squeezed, leaning on a table and unable to see the discussion panel. Somebody could have had the grace to give Otto their seat at the table. Very disappointed, but by that point, I would have keeled over had I stuck around.

Overall, a good day to re-center on the basics: process, transference, resistance, defence, assessment, etc. And, for fun, the role of theory in practice. And, again overall - what a bunch of scary smart, literate, thoughtful, kind folks.

The NYT reports that 51% of American women are living without a spouse.

What are the socio-culturo-politico-psycho-biological consequences of this trend? Besides, of course, expecting the government to fill the role - which it surely will, in once sense anyway, which I will not say here.

But, love and comfort aside, who takes out the garbage and replaces the washers in the faucets?

It actually crossed my mind - as a random notion, not as a plan - to try to live-blog the meeting, which is this week in NYC, as always, at the Waldorf. Of course I am going, as a good excuse to spend a week in NY, see a bunch of shrink friends, and visit with my baby brother and his wife. Definitely catch an Otto Kernberg talk, and any panel with Bob Michels on it - smartest guy I ever met.

And Bird Dog has planned a dinner and theater too Friday night, so that's a good deal.

But I quickly realized that hardly a soul on earth would be interested in these meetings. If they were anywhere but NY, I wouldn't go. So no blogging about it, unless something truly absurd comes up. Which it will.

One of the pleasures of getting into this blog world a bit is seeing, with my own eyes, how many bright people there are out there who see things the way I do. For a Boston person, that's consoling enough, but to find people in my general profession - which tends very liberal and pacifist, if not intellectual/passive - who have arrived by similar paths to a somewhat shared current thinking is plain wonderful.

If we are all wrong, at least we can be wrong and stupid together. I am thinking of such psychologically-minded folks as Neo-neocon, Shrinkwrapped, Dr. Sanity, Assistant Village Idiot, and SC&A.

And One Cosmos. Gagdad Bob's thoughts on Thomas Sowell's recent piece is an example of the kind of applied psychological take on things that gives me delight. One quote:

What most seems to annoy leftist intellectuals about the free market is that, not only is it something that they cannot control or understand, but it accomplishes its task much more effectively and efficiently than the most brilliant person -- or group of people -- ever could. Sowell cites a famous essay which pointed out that no single person knows enough to produce so much as a single lead pencil. That is, "there is no single individual anywhere who knows how to grow the wood, mine the graphite, produce the rubber, and manufacture the paint." And yet, no one need ever worry that there won't be enough pencils, so long as we don't interfere with the process: "Complex economic processes cause all these things to be done and coordinated by a wide variety of people, just in order to produce something as simple as a lead pencil. Multiply that by a hundred or a thousand when it comes to the complexity of producing a car or a computer."

Indeed, it takes a village to make a pencil, but not an African village, and not a village in Afghanistan or in the jungles of Ecuador. A special kind of village, with certain kinds of values and motivations and cultural structures, knowledge, interests, and freedom of opportunity.

I especially enjoy the famous pencil example because, as you may recall, Henry David Thoreau's family made their money from their pencil factory. Henry worked there for a while, and apparently made some significant improvements in the manufacture of the Thoreau Pencil, until he decided that he didn't want to work on Maggie's Farm no more, and decided to be a writer and a public intellectual, living off his family's money.

In addition, of course, the pencil was the original keyboard. Quill pens must have been terrible to write with, and I am sure they scratched the heck out of the monitor screen.

It has been a wonder to me that so many folks in the mind and soul-treating professions are so non-freedom-minded, when these professions are designed to free people from their inner demons which restrict their taking on life freely, cheerfully, and energetically, in the way they see fit, and taking their own chances and making their own choices - in free societies. Freedom is what they are all about, and why psychoanalysis and psychotherapy are never permitted in totalitarian states.

Does every human have a slavish, dependent side to them? Of course. Many days I wish to be nothing but a pampered pet, with a simple life - except I'd be bored in 40 minutes and begin doing something I wasn't told to do. The wonderful possibility is the possibility of governing oneself according to aspirations for higher levels of maturity and autonomy. And that, Dear Readers, is a culture-specific aspiration, rooted in Protestantism; in the notion of "every man his own King," (and every man his own priest as well).

And, with the keyboard, "every man or woman his own pamphleteer," like the wacky Sons of Liberty, pasting our visions of freedom to the walls of the alleys of the world, hoping some passerby will stop and read.

On the same subject, see our recent Liberty, Who needs it?, or, even more recently, Give me Liberty or Give me Health. 

Equality is for farm animals. While Orwell remains one of my political guiding lights, Huxley really nailed the danger of "well-intentioned, rational" soul-crushing tyranny in Brave New World. Pure, soul-less logic requires tyranny, as the wise Plato said. 

Our blogging shrink friends remember that psyche means "soul," not mind, as Bettelheim made so clear in Freud and Man's Soul. The soul needs space!

I will conclude today's rambling sermon with a Dylan quote from My Back Pages:

A self-ordained professor's tongue
Too serious to fool
Spouted out that liberty
Is just equality in school
"Equality," I spoke the word
As if a wedding vow.
Ah, but I was so much older then,
I'm younger than that now.

The blogworld, and the media, are preoccupied with the elections. 90% of regular folks, however, are not.

It's just as well. There is such thing as an unwholesome preoccupation with political issues, as there can be with anything else.

There is reason to believe that people are more motivated to vote against someone, than for someone. Anger and hatred are powerful human motivators, and everyone is cynical about politics and politicians except the youth - who don't know any better.

So it's smears and fears season. AKA "silly season." Everybody enjoys voting in national elections, but mid-term elections tend to bring out the most engaged, and the most emotional, which brings out the lowest human impulses - and in the political world, that is lower than whale poop.

Thus the theme for both parties is "crank up the emotion." In mid-terms, in which many registered voters do not even know the names of their Reps, or even their Senators, "Get out the vote" is the name of the game. Get warm bodies into the voting booth, and room-temperature bodies if that's all you can get.

Is this election more important than any other? Probably not, because I do not think it will have any effect on the war against Islamofascism (Americans will never put up with dhimmitude.).  Every election is important, though.

Isn't it funny how, when your team wins - it's "The people have spoken," and when your team loses, it's "The people are brainwashed morons"?

May the best team win. Just do me one favor: before you pull that lever, make sure you know where Nancy Pelosi stands on the issues of the day -because that is who you are voting for or against, ultimately. The Speaker, the Whip, and other leadership run the show. The Reps are just little soldiers, and if they don't play ball, they won't be able to bring the pork home for their re-election.

The old Soviet doctors from the Serbsky Insitute for Social and Forensic Psychiatry seem to be up to their old tricks, but to a much lesser extent than in the Soviet days of the "reformist delusion" diagnosis.

Still, Russia seems like a country which is comfortable with authoritarianism in all of its forms. Story in WaPo.

Every psychiatrist has had this experience with a patient, if not with themselves: someone feels down and despondent for a week and doesn't know what they might be reacting to until reminded, or until they remember, that it's the anniversary of a death, a loss, or anything emotionally painful or damaging.

We call these "anniversary reactions." (Sometimes I joke that the true "anniversary reaction" is how a wife responds when hubbie forgets their wedding anniversary.)

The human mind has a lousy sense of time (or we wouldn't be checking our sundials and calendars all day long,) and the human unconscious has none-to-little. The past always is part of the present, and vice versa. Time, psychologically, is a sort-of higher-level cortical illusion...or something.

My smartest supervisor in analytic school would say, of patients in psychoanalysis (as opposed to psychotherapy), "When they talk about the past, they are talking about the present. When they talk about the present, they are talking about the past. And they are always talking about the transference."

Thus the usefulness of anniversaries is to highlight, and bring into the sunlight, things that have been lurking beneath our attention - whether fine things or awful things.

In the case of 9-11, we hardly need a reminder, since the war of fundamentalist, militant Islam against the infidel continues across the globe, with daily reminders in the news. Still, it is a good idea to mark it because so many of us experienced 9-11 as personal, and as an unwelcome reminder, to us self-involved, semi-decadent, material-worshipping, and complacent Americans, of the existence of evil in the world, on a large scale. 

It is a good refresher course in Evil: people who do not know you, and to whom you have done nothing, desperately want to kill you, even if they die in the process. It isn't sick - it's plain old ordinary evil which destroys innocence, crushes good intentions and good cheer, and pursues the death of innocent strangers in the name of a prophet and a god.

So, like Pearl Harbor Day for another generation, we will all remember our 9-11s today, whether we want to or not. It's a scar that will never, and should never, fully heal. With some things, this "healing" thing is over-rated, and only means pushing things into a past which, for the human mind, does not really exist.

It is psycho-utopianism to imagine that pains entirely go away. Humans do not work that way, and it is for the best that we do not, or we could not really learn, or grow with experience. Often, the tough lessons of life have to hurt, and life is not all about "happiness," except for the most superficial and foolish. There are deeper wells...

Our pains and sorrows and angers and memories are a big part of what and who we are: in this case, the horror of what man is capable of doing to his human brothers and sisters. Since Eden, every generation, and every person, loses their innocence.

Dr. Wayne Fenton dedicated his life to taking care of the sickest of psychiatric patients - the chronically psychotic, the most difficult patients to whom to be of help, and was killed by one of them.

Thankfully, it is a rare event in our work. But it is entirely unpredictable, like suicide. In medicine, unpleasant surprises happen. It's part of the job, and there is no way to be prepared.

Wayne was doing God's work. Like any sort of chronic patient in medicine, these folks never really get better, but they have reasonable hope to function in the world, to a degree, if they take their medicine, stay in the shallow end of the pool, and if they follow advice. Big "ifs." Psychotic people can be dangerous, and not just dysfunctional.

It's a damn shame. Oddly similar to Steve Irwin's tragic death. Whoever this patient was, I know Wayne cared about him a great deal, and wanted him to have a life. However, he has proven himself to be too dangerous to be out in the world.

Assistant Village Idiot, a blog which in temperament is quite similar to Maggie's Farm (as is YARGB), literally stole a chapter from my as yet unpublished book in their recent piece on "The Vice of Tolerance."

Read it. My comments:

"Tolerance" in its PC form is usually manifest as administrative or even legal threats against specific "intolerances," in a "thought police" format. Thus the moral authority of official "tolerance" is undone by its own intolerance and use of force of some kind. College campuses and large corporations are two places where such nonsense is rampant. I can guarantee you that if you hang a Confederate flag out of a dorm window, someone will come knocking, but a Hezbollah flag - no. Or it would be OK for a Moslem teacher to bring her Koran to school with her, but no Bible for the Christian teacher. So "tolerance" is a euphemism for selective intolerance, and is surely a vice, at at least a politically-motivated scam, of some sort.

How is it dishonest? Because there is no valid underlying principle. The charge of intolerance can be directed in any chosen direction: it can be directed towards someone expressing something, or it can be directed towards someone who is "insensitive" to someone who is "offended" by something, or it can be directed against the "offended" who is, by definition, "intolerant." For example:

A teacher wears her cross necklace to school. An atheist kid's parents complain to the Principal. They Principal tells the kid that she can wear a "Proud Atheist" button to school if she wants. OK - you could direct the charge of intolerance to the teacher, who is "indifferent to offending". Or to the kid, who is "intolerant" of the teacher's "culture and beliefs," or to the Principal, who could be charged with "creating a culture of intolerance."  Take your pick. Just charge anyone with it that you do not want to tolerate.

This notion of "tolerance," seems to be a subset of a fashionable  "tolerance ethic" which attempts to turn traditional ethics and judgements upside-down by glorifying the refusal to discriminate (judge) about much of anything: quality, morals, behavior, taste, manners, intelligence, fund of information, depth, maturity, curiosity, energy, thoughtfulness, right vs. wrong, good vs. evil, correct vs. incorrect, personality type, selfishness, humor, honor, refinement - all of the things that need to be assessed whenever we encounter another human and might need to deal with them in some way. Note that I refer to individual characteristics - classes of people are not in my vocabulary, because they mean nothing to me: gay, black, brown, white, old, young, ethnic, etc - I don't care much about those surface items. They are stupid and meaningless distinctions for most purposes.

AVI makes several good points, so you should read it all. One is that tolerance is a Christian virtue. No, not at all. (Everyone has a divine spark, but that doesn't mean that I want their spark near my life.) Another is the point that tolerance is a passive virtue - if it is a virtue. Indeed. It requires no behavior and no action, and, in fact, it is indistinguishable from indifference.

The list of things I will not tolerate in my life would be fun to write, but negative, and there would not be enough space here. The same goes for the list of things I welcome into my life, which would be more of a pleasure to write down. All I will say is that I will not tolerate enforced "tolerance," poor manners, arrogance, lying and manipulation, ignorance, and poor grammar (except on blogs, which are generally colloquial speech, dashed off in a spare moment).

Somehow this link was forwarded to me for comment. It makes the highly newsworthy and earth-shattering point that Christians are a lusty crew.

50% of Christian men are addicted to porn, it says. (What they did not discover is that 99% of Christian men are addicted to sex, and require it on a regular, if not twice-daily, basis.)

What bugs me about the piece is that it implies that Christians ought to be pure from sexual desire and interest - or at least from non-marital desire. That very idea is nuts, but I do know from whence it comes: it comes from a thread running through Protestantism (and Roman Catholicism, before that), that our desirous and loving hearts should be fixed on God and His Kingdom, not earthly delights.

Of course, fantasy and action are entirely different things. Porn, like art, books, etc., is just assisted fantasy. Adults, Christian or otherwise, are expected by others to regulate their behavior, but whether and how they regulate their fantasy life is their own, personal decision.

The use of the word "addiction" is peculiar. I think, for an interest that is so hard-wired. Do guys have an "addiction" to staring at gals' breasts?They do tell me that they can't help it, so I never show cleavage at work.

I wrote a piece on internet porn a while ago (porn is the #1 use of the internets). I have looked at a bit of it, and have been struck by the generous anatomy of the fellows who do this, but it's not my cup of tea, and I find it undignified and sleazy as hell, but I think it's fairly harmless. However, when any person's behavior is compulsive - whether it's porn, or blogging, or watching TV, or computer games, or anything - it's usually an escape from something, or from some emotion. Therefore, what is interesting to a shrink is not the object of the compulsion as much as the question of what is being avoided.

I am obviously not a pastor, but I say that there is room for both earthly and spiritual delights in this life. As animals with a divine spark, we must pursue both as best we can, while ordering, regulating and directing our life as it is - as it has been given to us - as best we can.

Note: That is not me. Our lusty Christian Editor added the charming photo - not for pleasure, of course, but only to get attention.

Yes, the UCC is one of the bees that is always in my bonnet.

Before our most recent post on the mainline churches even disappeared from our front page, we get this nonsense (h/t, Israpundit) - a quote from an exchange with UCC Canada:

All this to say, Mr. Weiner, that Israel is being so greedy and greedy in such a nasty and murderous way that we find ourselves very sympathetic to the Palestinian complaints about such behaviour. Please read our press statement. We are also working for the survival of Israel in peace and security with internationally recognized borders as much as for the same future for a Palestinian state. Israel, however, seems bent upon a brutal acquisitional policy that offends Palestinians and the whole Arab world. If we do nothing, we can expect the growth of terrorist cells here in Canada and everywhere else. Why should we be immune to this horror when we disregard the horror that Israeli policies visit upon Palestinians every day of their lives. I can witness to that and so can many others.

You challenged us, Mr. Weiner, but now it’s your turn. We are sick and tired of the pro-Israeli government lobby in Canada telling us what to understand about the ’security’ issues of Israel. We are fed up with the biased press that focusses on one abducted Israel soldier and not on the numerous unreported assassinations and abductions of Palestinian citizens whose human rights are daily violated. Israel is out of control.

I am not ready to claim that the UCC, and their friends, are anti-Semitic, but they sure don't have any sympathy for Israel. And they have more sympathy for Jihadists and the like than they do for our Christian president who took an oath on the Holy Bible to protect us from their attacks.

I just think they stick to the Leftist line of the day. As I have said here before, helping individuals with their relationship with God through Christ ought to be a plenty big enough job for preachers. Understanding world affairs is the opposite of what their job is, and they tend to be a wierd combination of naive and innocent while angry and judgemental. As Laura would say, "Shut up and Sing". The whole exchange of letters is posted at Israpundit here.

Our church is SO HAPPY to have broken with the UCC. We are Congregationalists, and we make up our own minds, thank you.

I view evil as sin without guilt or remorse. I define sin more or less Biblically. Evil does exist in this world. My Leftist academic friends refuse to see it because it would mess up their world-view and they might have to fight something a bit more dangerous than golfer Republicans with pink pants, and my re-born Fundie pals (yes - academia has some closet Bible-readers) insist that the word is "Devil" with the "D", not "Evil." There is a culture gap there which will never be crossed. "Devil" implies an external force; "evil" implies a human source.

But put me in the "Believing in Evil" column anyway, even though C.S. Lewis convinced me that it makes as much sense to believe in a God as in a Devil. And I do believe in a God, although my degree of faith varies day to day. It would chart like the Dow Jones, with its long-term upward trend.

The denial of evil is dangerous. It leads naive or willfully naive folks to trust when they should not. Whenever I consult with a new patient, one of the first several things I quietly assess is their degree of what we call "sociopathy" - the strength of their conscience. Not whether they behave well, but whether they care enough in their bones about the difference between right and wrong, good and evil, integrity or deception, manipulation vs. genuine vulnerability, self-interest vs. genuine love.

It's not about how they act in public, or about what they say - successful sociopaths can be actors and good schmoozers, flattering, engaging and ingratiating, and sometimes charismatic. Those traits are red flags. Sociopathic people are rarely awkward or genuinely vulnerable. And while they are ultimately "takers" and "users," they don't want that to show, and, if they're really good, they can even make you feel good about it. They'll tell you how great you look and buy you a drink while they pick your pocket.

It is important for a psychiatrist because sociopathic people are beyond help, and we should not take their money. They don't tell us the whole story, and they shade it, distort it, provide false confessions and play other tricks. They cannnot help it, and that is the tragedy. Self before all, Self as God. Like Tony Soprano. And they find ways to justify or "rationalize" (a shrink term for justifying or excusing sin) this to themselves, or they don't even bother. Yes, they feel pain, but it's the wrong kind. There's only narcissitic pain - self-pain, or shame, or self-pity.

But, even as I write this, I see myself falling into my own trap, i.e. talking about evil as if it were pathology. It is not. When evil is strong, it is a form of spiritual death, of soul death - a thing that "chokes the breath of conscience and good cheer" and which brings pain and misery and destruction to others with it. This happens because the experience of soul-lessness, of inner hunger, of spiritual emptiness, drives people to fill the emptiness with money, power, admiration, adolescent-style nurturing, attention, a feeling of self-importance, multiple love or sex partners, "substances," etc. - always putting their image needs, and instinctive needs, first. Life as an extension of high-school. Feeling like objects, they treat others as objects too - as sources to fulfill their needs and hungers.

When I try to blend my psychoanalytic training with my religion, I view self-love as one key to thinking about evil. I don't mean ordinary vanity and conceit - I mean the hidden destructive self-interest which is easily concealed behind any number of facades, such as modest, victimized, or innocent demeanors, for common examples. Pride, envy, vengefulness, destructive or angry inner selves - these sins reside in all of us, which is why we need Christ to bail us out - but only evil can put on a real show of care.

The only thing psychiatrists have to offer to evil is prayer.

Why discuss this in The Blog? Because I think it is relevant to our view of the world, not just our personal lives. The Stalins and Hitlers and Saddams and Castros are too easy. Don't be paranoid in life - just insist that trustworthiness and decent intentions be proven, whether in world affairs or in your personal life, before you bestow the gift of trust.

And, for Heaven's sake, don't look for those good things in the world of international affairs. Just think about it for one second - who would want to be President of Russia? Or Dictator of Venezuela? The only reason I have some trust in Bush is because I don't believe he ever really wanted the job, or felt worthy of it. That is a "plus" in my book.

When I read this piece at And Rightly So, I thought it sounded like a pretty good list of reasonable family advice from a "school health teacher" - whatever that is.

Then I looked back and saw that it was her list of signs of "dysfunctional families."

See if you agree.