We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
I could discuss the topic of suicide and suicidality for days. Suicide is not one thing. It is endlessly complex, and definitely not always accompanied by clinical depression or other mental illness. Shame, guilt, loss, or anger are often prominent components, along with personality disorders, Bipolar, psychosis, and other things.
PTSD? Readers know that I tend to think that it is not a "disorder" but a normal variant. The people who put the DSM together can't tell the difference.
Some of our readers enjoy Allen's movies. I do. My first date with the future Mrs. BD was to see Sleeper. Does the man have any moral foundation? I doubt it. Talent? Undoubtably. What is wrong with the people in the film biz?
A shrink friend sent me this comment:
“Woody Allen, Mia Farrow, Dylan and Truth or truth” (Or, “Would you read this if the title didn’t say “Woody Allen.”)
“Truth is truth,” Paddy Chayefsky stated. If only analysts could have that certitude, lost in the past few decades. Truth is relative, “constructed” in the present (transference), not historically accurate. Historical truth doesn’t exist or doesn’t matter at least. Except if a child was sexually molested: then truth matters, the real thing, what happened, was she or he seduced, assaulted. No “relative” here (for truth).But not a simple matter. Let’s listen to Jean Piaget (more neutral than Woody Allen).
Piaget said that for much of his childhood, he “remembered” that when he was in the pram with his nurse as an infant, he was kidnapped. Then, some years later, his nurse revealed that he had not been kidnapped; she simply hadn’t paid attention and his pram rolled away. He still “felt” that he was kidnapped, even as he learned the historical truth that he hadn’t been.
Now, Allen and Farrow (for this is mostly a tragedy that results from their stunning animosity); their children suffer from what the U.S. Army would call “friendly fire” (about nothing which is friendly when your shot dead). Their young adult adopted daughter is cited by a columnist as an example of someone molested by her father in childhood and the aftereffects into adulthood. But, Allen cites an extensive evaluation at Yale Child Study Center at the time of the alleged molest, that showed that she was likely not molested by father. If they are to believed, if our Yale colleagues are to be trusted to some degree, then we learn at least three things.
First, the now young adulthood victim believes that she was molested; she is a victim of animosity between her parents. Second, we learn respect for the adherence between love and hate (as Freud suggested); how love turns to hate when a “divorce” occurs.
Second, Farrow, married at nineteen to Andre Previn, has such animosity to Allen that she would make enduring accusations at the expense of her children’s well-being (her older son confirms that mother told the children to turn against their father).
And third, perhaps Allen’s last word on this may be dismissed by some.
Perhaps all that is left to us at this point is to recognize that some “truths” are not so relative; ain’t important. Truth about life events can really count. When we work with children molested, helping them recognize the true events of their, to explain why they feel and live the way they do, is one significant factor in this work.
Two parents rain animosity at each other over the decades; their children are shot down in this crossfire.
Psychiatry has seen its share of damagingly-erroneous fads over the years: multiple personality, satanism, "recovered memories." It's important to learn from such fads and errors, not to hide them in embarrassment.
Every branch of medicine, and of science in general, experiences erroneous fads and false enthusiasms. Only a few years ago, the climate scientists were going nuts about global cooling, and soon, perhaps, they will do so again.
In a contemporary, and often unacknowledged, rebooting of Freud, many psychologists have concluded from such findings that unconscious associations and attitudes hold powerful sway over our lives—and that conscious choice is largely superfluous. “It is not clear,” the Baylor College neuroscientist David Eagleman writes, “how much the conscious you—as opposed to the genetic and neural you—gets to do any deciding at all.” The New York University psychologist Jonathan Haidt suggests we should reject the notion that we are in control of our decisions and instead think of the conscious self as a lawyer who, when called upon to defend the actions of a client, mainly provides after-the-fact justifications for decisions that have already been made...
Sultan's piece that we linked this morning, Our State of Police, is a stimulating one. I had never thought about these things from this angle before. One quote:
"Oppressing everyone to avoid oppressing anyone is the egalitarian ethos gone mad."
Of course, we are talking about the sorts of insoluble problems that arise in a non-totalitarian society, problems rooted in the many "flaws" in human nature. Another quote:
The left can't fix the social problems that, in some cases its welfare state helped cause. It certainly can't fix those that predate its intervention. Its efforts are all the more hopeless because it attributes the cause to its usual suspects of capitalism and intolerance so that it never addresses the problems, instead it uses people from failed societies as ammo in a cultural war. The right's tactics temporarily contain the worst of the violence, but not its expansion or its causes.
No society or culture can be conflict-free, nor can even any family or tribe or anything. We must be humble when thinking about "solutions" of all sorts. It has been said that Conservatives like me temperamentally embrace the Tragic View of life as contrasted with utopian views, and there is something to that. It is, indeed, the story of man's fall - broken from the very start.
Editor's note: Dr. Azeff will be a regular contributor on medical topics
"Surviving Anxiety" was the cover story of The Atlantic magazine for January/February written by its editor, Scott Stossel.
One is a little flabbergasted when reading this man's story. While portraying himself as virtually crippled by anxiety in all of its forms, generalized anxiety, post traumatic stress, panic disorder and multiple phobias, he functions as the editor of a prestigious magazine which means likely conflicts with aggressive publishers and super-sensitive, if not querulous, writers. He is a writer himself and therefore a person expected to show up for promotional talks and for lectures. How does he do it? He begins his article, excerpted from his book, by describing his drug regimen for public speaking; xanax, inderal and scotch or vodka. As a clinician one is immediately tempted to take the bait and challenge the doses of his medication and balk at his use of ethanol which he acknowledges is risky at best, dangerous more honestly. From there we are led on a trip through his life and through the evolution of psychiatric treatments over the past thirty years, the good the bad and the ugly.
His first doctor who started treating him at age eleven and saw him twice a week for 25 years is roughly of my generation, I'll be 75 in a few months, Dr. L as he is called is probably in his early eighties. Analytically oriented therapy mixed with play therapy mixed with pharmacotherapy at the outset, progressing over decades to everything as it came along including EMDR and self-actualizing therapy whatever that means. One can appreciate the changes over the years as a picture of the evolution of a modality seeking a scientific framework. Just as edema was initially seen as a unitary "disease" called dropsy until science deconstructed the multiple causes of this symptom, so many of our psychiatric illnesses may be no less than psychological dropsy. I'll wager in the next ten years "schizophrenia" will be at least four different conditions of different etiology, and anxiety may follow suit as well.
But what I take away from this verbose, sometimes wry, sometimes antic, sometimes prolix piece is the transgressions of some of his caretakers. Well into Scott's treatment, Dr. L takes his father into treatment as well and uses Scott's sessions to get information about Stossel senior. The porous boundary is something we all grapple with but this is a destruction of the boundary that calls the treatment into question, perhaps from the start. After all, we may change course with a patient but usually with caution and discussion. I hope we are beyond the point of arguing that one cannot do both psychotherapy and psychopharmacology, but can one start with a classic dynamic model and wander into EMDR? Then there is the behavioral psychologist, Dr.M (both of these caretakers are "Boston" and Harvard trained and perhaps even faculty so we all must be clear that they definitely and unimpeachably know what they are doing) who determined his core problem was emetophobia, fear of vomiting, which she would treat with exposure therapy. Using the emetic ipecac which had cured other emetophobes, Stossel attempts the exposure with two doses of ipecac that produce retching and gagging but no vomiting in the course of four hours.
The next day he speaks to Dr. M who eventually relates that she was so shaken by his experience she cancelled all of her afternoon patients and spent the day at home nauseated and vomiting and taking to bed. Once again a transgression of questionable purpose. That treatment was fractured and collapsed fairly soon afterwards. We all have seen patients who are difficult to treat, who have disabling symptoms of anxiety or depression or psychosis, which are not easily medicated. How often do we ask ourselves about the possibility that the patient is consciously or unconsciously engaged in an attempt to make us feel as helpless and demoralized as he feels? Is it "blaming the patient" to weigh this possibility as a cause of intractable symptoms?
There is nothing glaringly obvious pointing to this in the story Stossel tells us and his brave walking through fire story is to be admired, but I'm just saying . . .
An annual re-post, but re-posted again because we seemed to help a number of people with this:
Forget the "Obesity Crisis." That's a crock. Abundant, good food is a blessing and a rarity in human history so it is a great privilege and luxury to be overweight. It certainly is true that, when tasty food is cheap, people will eat a lot of it and their bodies will kindly store what they don't need to survive today, to the detriment of our knees, hips, appearance, comfort, and general vigor. Trouble is, we won't need that storage tomorrow - or ever. It's like hoarding.
We can all be as fat or fit as we wish to be. It's a free country, and being fat (but not obese) isn't terrible for your health unless you are diabetic or want to be able to get around energetically. But don't listen to the Dieticians and Nutritionists. They will want you to get in shape slowly and in a "sustainable" way. In your heart, you know that will never happen. If you are bothering to read this, you just want to get in shape as quickly as you can without liposuction or use of the vomitorium.
Eliminating carbs reduces or eliminates carb craving in most overweight people over several weeks.
This can be a one- to three-month program as desired. Maintenance is another topic.
I never expect honest answers from questions about sex, substance use, or money, so I won't expect perfect honesty here.
However, in an effort to warm up this frigid winter season, here's my scientific Maggie's Farm poll question for today:
How often during a normal day out and about in the world do you think "Hmmm, that's appealing; I think I wouldn't mind having some sex with that guy or gal"?
Most of the studies he discusses avoid defining happiness, and just let people report. At issue, of course, is that as long as one is not in dire straits, happiness and contentment in life depend on non-economic factors: temperament and personality, relationships, family, hobbies and interests, etc.
There is no one "happiness." Some are most happy when taking risks, others more comfortable when they feel more secure. Material gain is not a universal goal.
I am a fan of online dating, especially for those who are out of school. There is just no other way to interview so many available candidates efficiently, with the advantage of screening them in advance.
When people get divorced, I usually recommend that a person have a coffee with at least 25-30 candidates, at minimum, before deciding to get involved with anyone. That's because the recently-divorced are usually lonely, unhappy, sex-starved; often hurt or angry or worried about the future, and generally prone to poor judgement and poor choices. However, those things may apply to many single people.
Back in 1991, the sociologist Scott Feld made a surprising discovery while studying the properties of social networks. Feld calculated the average number of friends that a person in the network has and compared this to the average number of friends that these friends had.
Against all expectations it turned out that the second number is always bigger than the first. Or in other words, your friends have more friends than you do.
Researchers have since observed the so-called friendship paradox in a wide variety of situations. On Facebook, your friends will have more friends than you have. On Twitter, your followers will have more followers than you do. And in real life, your sexual partners will have had more partners than you’ve had. At least, on average.
I always figured that it was because my friends are friendlier than I am.
Antidepressants fail to help around 70% of depressed patients on the first try.
Antidepressants are now the treatment of choice for anyone with acute or chronic symptoms of "major depression," ie anxiety, disturbed sleep, hopelessness and helplessness, self-hatred, appetite loss, irrational guilty feelings, loss of sex drive, inability to concentrate, sometimes suicidal feelings, and inability to find pleasure or interest in things. In my experience, the vast majority of patients with a fair number of those symptoms feel better with antidepressants, but, in my view, medicine should never be given without psychotherapy of some sort.
Where it gets complicated is that 1. there are many kinds of depression besides major depression; 2., the personality type, and personal strengths and weaknesses can effect the way depression occurs, and whether it occurs at all, and, 3. life circumstances have a real impact on the ability to improve depression with medicine (if your business is going bust, or your child dying with cancer, no antidepressant will make you merry).
I'll try to keep it brief. The generic term "depression" runs the gamut from the heavily-inherited form that occurs in Bipolar Disorder (which is probably a brain-wiring abnormality), to the grief-like depressive reactions to life-events, especially loss, which occur in vulnerable people. In between are sad-sack people with chronic mildy depressed mood, and many people with chronic mood problems due to personality disordersor neurotic problems. My point is that there is not one "depression". The word refers to a group of symptoms, not a diagnosis.
Because depression is not a unitary phenomenon, different forms require different treatment approaches, whether psychotherapeutic or chemical, but the research says preferably both for severe depression.
It is not widely understood that the new SSRI antidepressants are not "mood elevators." They have no effect whatsoever on people without depression, which is why they are never abused.
I will have to follow-up with a Part 2 later, because this is getting too long, according to our blog rules. "Short and sweet." But some subjects are complex and nuanced, as our esteemed French Senator likes to say.
She points out the (rather obvious) practical and economic advantages of committed relationships. I can't imagine handling all of the complexities of life without a partner.
"Science has become an international bully." I doubt that I will change my mind about this being the best essay of 2014, by Yale's computer scientist David Gelernter: The Closing of the Scientific Mind.
It's about subjectivity, mainly - being human, and a defense of Nagel in part. The essay is so rich and deadly-serious that it cannot really be taken in in one reading, and it is difficult to select a representative quote so I'll post a random one:
The dominant, mainstream view of mind nowadays among philosophers and many scientists is computationalism, also known as cognitivism. This view is inspired by the idea that minds are to brains as software is to computers. “Think of the brain,” writes Daniel Dennett of Tufts University in his influential 1991 Consciousness Explained, “as a computer.” In some ways this is an apt analogy. In others, it is crazy. At any rate, it is one of the intellectual milestones of modern times.
How did this “master analogy” become so influential?
Well, because we derive our metaphors from the world around us. Freud's first metapsychology was modeled on the steam engine. The essay deserves study. Take a Ritalin and dig into it.
Another:
Many scientists are proud of having booted man off his throne at the center of the universe and reduced him to just one more creature—an especially annoying one—in the great intergalactic zoo. That is their right. But when scientists use this locker-room braggadocio to belittle the human viewpoint, to belittle human life and values and virtues and civilization and moral, spiritual, and religious discoveries, which is all we human beings possess or ever will, they have outrun their own empiricism. They are abusing their cultural standing. Science has become an international bully.
Nowhere is its bullying more outrageous than in its assault on the phenomenon known as subjectivity...
Samizdata found this gem by Rauch in The Atlantic. A couple of quotes:
"Introverts may be common, but they are also among the most misunderstood and aggrieved groups in America, possibly the world."
and
"Do you know someone who needs hours alone every day? Who loves quiet conversations about feelings or ideas, and can give a dynamite presentation to a big audience, but seems awkward in groups and maladroit at small talk? Who has to be dragged to parties and then needs the rest of the day to recuperate? Who growls or scowls or grunts or winces when accosted with pleasantries by people who are just trying to be nice? "
From the Editor of The Atlantic, Surviving Anxiety - I've tried therapy, drugs, and booze. Here’s how I came to terms with the nation's most common mental illness:
I wish I could say that my anxiety is a recent development, or that it is limited to public speaking. It’s not. My wedding was accompanied by sweating so torrential that it soaked through my clothes and by shakes so severe that I had to lean on my bride at the altar, so as not to collapse. At the birth of our first child, the nurses had to briefly stop ministering to my wife, who was in the throes of labor, to attend to me as I turned pale and keeled over. I’ve abandoned dates; walked out of exams; and had breakdowns during job interviews, plane flights, train trips, and car rides, and simply walking down the street. On ordinary days, doing ordinary things—reading a book, lying in bed, talking on the phone, sitting in a meeting, playing tennis—I have thousands of times been stricken by a pervasive sense of existential dread and been beset by nausea, vertigo, shaking, and a panoply of other physical symptoms. In these instances, I have sometimes been convinced that death, or something somehow worse, was imminent.
Even when not actively afflicted by such acute episodes, I am buffeted by worry: about my health and my family members’ health; about finances; about work; about the rattle in my car and the dripping in my basement; about the encroachment of old age and the inevitability of death; about everything and nothing. Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu. At various times, I have developed anxiety-induced difficulties breathing, swallowing, even walking; these difficulties then become obsessions, consuming all of my thinking.
It's a vivid description of what we used to call Anxiety Neurosis but now term Generalized Anxiety Disorder. Stossel says that nothing has helped him except for moderate use of Xanax and/or alcohol. He has concluded that he just needs to live with it, if not to embrace it.
81% of kids have a mental disorder? "Everybody has Psychiatric symptoms."
The point is, you need a diagnosis for your insurance. Even if you're a troubled normal neurotic, we'll stick a label on you as a favor to you. Dr. Alan Francis, et al (h/t, Boring Old Man)
Asperger's Syndrome has been removed from the DSM and folded into Autism Spectrum. I'm not convinced that people with Asperger's-like symptoms have anything in common with what was traditionally termed Autism, and my suspicion is that Asperger's is just a normal human variation which, a while ago, might have been termed "slightly eccentric."
The DSM is ultimately an instrument for weakening human resilience, self-reliance, fortitude, and resolve. It turns human beings into mechanisms, deprives their conduct of meaning, and makes them prey to entrepreneurs of human misery. The authors, one could say, suffer from PNOD—psychiatric nosology overvaluation disorder—the criteria for which are as follows:
A: The grandiose belief that all human weakness can and should be divided into valid diagnostic categories.
B: At least two of the following: a firm and unshakable belief that all human distress arises from malfunctioning serotonin metabolism; a firm and unshakable belief that functional MRI scans will soon teach humans how to live; a firm and unshakable belief that the seven deadly sins have been scientifically superseded by psychiatric diagnoses.
People joke about how bitchy and cranky, if not downright hostile, many women become around menopause. Bitchy, cranky, and raging may drive family members and friends away, but are not depression in themselves. On the plus side, sometimes, women become much more horny as their estrogen lowers in proportion to their testosterone (yes, women's bodies do produce some of that).
What qualities do people look for in elected (or unelected) leaders? The question applies to all areas of life, not just politics.
What qualities stimulate people to "follow," or choose, a leader? Among others, physical presence, ability to speak, self-confidence, and reliable decision-making play important parts, but some of it is difficult to express. This post stimulates the discussion: What is the "Presidential Presence"?
One component of it, perhaps not a large one, is a person's aptitude for being a target of positive transferences. That, plus the power, is what transforms an employee of the citizens (ie a politician) into something that seems special, probably too special. After Washington, my favorite President was Coolidge.
When it comes to politics in the modern era, one part of it is simply celebrity. "Charisma." TV, video, and film create celebrity, as in "famous for being famous." What qualities support that? Why does anybody listen to, or pay attention to, celebs?
A “disorder” is a socially constructed label that describes a set of symptoms occurring together and its associated behaviors, not a real entity with etiological homogeneity. Labeling emotional problems “disordered” assumes that happiness is the natural homeostatic state, and distressing emotional states are abnormal and need to be changed. A diagnostic label can help improve communication and understand maladaptive behaviors; if that label is reified, however, it can lead to assumptions that the etiology, course, and treatment response are known. Proponents of the diagnostic psychiatric nomenclature have acknowledged the dangers of over-pathologizing normal experiences of living (such as fear) by way of diagnostic labeling.
That's what I've been saying for years, but she says it better.
I never expect honest answers from questions about sex, substance use, or money, so I won't expect perfect honesty here.
Antidepressants fail to help around 70% of depressed patients on the first try.