Maggie's Farm

Is your doctor a commodified technician, or is it a relationship? I was trained that the physician relationship was key to everything we do. Foundational. Oftentimes, when seeing endless streams of patients in charity clinics, we as young docs needed to be reminded about how important we were to them. We were reminded of our priestly role in peoples' lives, that they talked about us and thought about us far more than we did about them.

Today, many of our doctors are impersonal to us, or invisible. You have no relationship with the anesthesiologist (unless her or she lives next door), the pathologist, the Infectious Disease consultant, the radiologist, etc.  However, we do have important relationships with our hands-on docs; our Gynecologists, Internists, Pediatricians, even your Orthopedic Surgeon. Certainly Psychiatrists, who are not literally hands-on but are certainly intimate relationships.

The Importance of the Doctor-Patient Relationship (and why we can’t have it anymore)

You can have it, but it will cost you. In my field of medicine, I am a hold-out against the commodification of medical care and treatment. For me, the relationship is the key, and, in the old priestly way, relationships with my patients also sustain me and educate me in my work. That is the non-monetary reward.

So to all of you patients out there, remember to thank your docs this year. A grateful holiday card is sufficient. A holiday Cheesecake is not necessary.

And Happy Holiday Season to all. This family is heading to the north woods for snow and cold fun for a while, and our holiday festivities. God bless you all.

Have trouble identifying the point at which you have had enough food to live on? Tend to eat as if in a race, too fast or more greedily than most other people? Tempted to eat impulsively between meals? Feel that you have to clean your plate without thinking, or without sensing satiety? Want a dessert even when you are full or over-full (not counting Thanksgiving)? Occasionally conceal your eating habits out of shame? Feel bad about yourself when you know you have eaten more than you need?

These are the main signs of the fairly-common "binge eating disorder." You do not have to pathologize it - it could also be called a "bad habit," or, from a moral standpoint, "gluttony," one of the Christian 7 deadlies. A First World problem, but not as much as you would think: there is more overweight among the "poor" around the world these days than among the more prosperous. BED people eat as if on an anti-starvation feeding mission rather than at a social occasion with food as an enhancement.

Like many so-called "disorders," it is mainly medically-defined as such for insurance purposes but it is a real pattern of impulsivity or compulsivity, often manifest in many areas of functioning.  If it's a problem, it is easily addressed. There are pills for it.

What B.E.D. Looks Like in Adults

Binge Eating Disorder - Symptoms, Causes, Treatment, and Help

Grandmothers have known forever that many personality traits and styles run in families. If it is true that around 40% of basic personality traits can be attributed to genetics, the old advice to check out the parents of a person you are considering marrying makes good sense.

Personality Traits and Psychiatric Disorders Linked to Specific Genomic Locations

What it is really like to be paranoid:

I follow orders from distant galaxies, from the President, from my dead mother. The orders come from a barking dog. The TV. Email

That’s the low-grade stuff. I’m probably somewhat paranoid, a little on guard and on edge, at all times. Perhaps once a week (the tea invitation and the cocktail party) I experience paranoia severe enough that I make a note of it in my journal.

Then there’s the big stuff.

A moving and hopeful piece from the NYT: Along the Autism Spectrum, a Path Through Campus Life.

To varying degrees and for varying and not well-understood reasons, these kids, even if quite bright, do not fit in well in most settings. Their behavior and demeanor make others uneasy. While many people do not fit in well, "spectrum" people have qualitatively different challenges. It's in their hard-wiring. Many or most would like to function as normally as possible, so programs like the above offer some hope.

It's a good start, but many years and committees are needed to complete the full version.

Like many young people, I was charmed by Buber's book as a late teen. As I mature, I learned that relationships are far from binary and that all exist on some spectrum of intimacy, from zero to the excessive. Really, how many people does anybody want to be emotionally intimate with?

David Brooks somehow tries to connect the Buber view with the politics of today and produces pure silliness. "Thous at every level"? Please, enough with the sanctimony. This is politics, which is war at every level.

When I discuss fitness and conditioning, I use the categories of Strength Training, Endurance Training, General Athleticism Training, and Nutritional "Training."

Naturally, different regimens address each fitness category with some specificity but with some overlap. To get stronger, you have to stress nerves and damage muscle fibers by moving weight. For endurance training, 20 mins of intense interval exercise seems to beat out longer low-intensity aerobic cardio. All categories feed into General Athleticism which is most peoples' real goal - Fitness for whatever life brings - but we address it specifically with calisthenics and by playing recreational sports and other outdoor vigorous activities.

These categories of activity use different combinations of energy systems. Animal bodies have three energy systems, each with different purposes.Just as nerve pathways can improve with stress and challenge, cellular energy systems can be bolstered with stress. When you think about it, a fair amount of stress is good for both body and soul.

Your energy systems are the Phosphagen System, the Gycolysis System, and the Aerobic Oxygen System. In a balanced Conditioning regimen of Strength, Endurance, and General, all three energy systems adapt to being stressed and, ideally, exhausted. Your body will build up those systems, over time, to meet the challenge. That is called "more energy."

For one example, the Phosphagen metabolic system can be stressed or depleted by ten heavy ball floor slams or by a 30-second full-out sprint. That system is for quick bursts of maximum power.

This site, The Three Metabolic Energy Systems, explains the basic physiology of the three energy systems with a discussion of how each is best stressed (but unfortunately that discussion only addresses things like running rather than the other exercise categories which also make specific demands on the 3 energy systems).

Exercise science is clear that the recovery phase from intense exercise is when the benefit is obtained.

Intense exercise (meaning resistance) is designed to damage and deplete nerve and muscle and to stress bones. This is why I only do each of the big exercises (deadlifts, barbell squats, pull-ups, bench press, rows, military press) once per week. (nb: Those exercises are for women too.)  5 sets of each after a light-weight warm-up, increasing weight, once a week. I do 3  of those exercises one day, 3 of them 3 days later. That is enough frequency for a strength-building or maintenance program. More is not always better.

Like most fitness-oriented people, I do auxiliary strength exercises too but those are not so essential, like arm exercises and core exercises for my tennis and my skiing. Those more focal exertions do not need much recovery.

It is generally accepted that most cardio and calisthenics do not need more than a 24-hr recovery. Hybrid programs like Crossfit deserve a couple of days of recovery unless you are age 18-25. My middle-age fitness regime is 2 days/wk of heavy weights plus a little calisthenics, 2 days of cardio intervals (25 mins only), and one or two days of calisthenics (maybe 45+ mins), depending on my sports schedule. I play lots of sports but recreational sports, and even things like mountain hiking, are not really exercise. They are for fun even if you play hard.

Recovery days for a strength-building program can and should include cardio and calisthenics, but no heavy weight on the movements which need repair.

Good recovery entails a decent amount of sleep and hydration, and an above-normal protein intake in a normal diet. Your muscles, nerves, ligaments, and bones will be grateful for that reward.

I am all in favor of tuning into the feelings of another person when it makes sense to do so. It is an act of intimacy, and builds connection with others. However, I believe that most expressions of empathy are phony. We all want to appear virtuous and caring.

Anyway, tuning in to another person's experience is no substitute for thought:  Against Empathy: The Case for Rational Compassion

I want him to be bored.

Passive entertainment does no kid any good. Go outside and play.

The highly-distinguished Drs. Paul McHugh and Lawrence Mayer have put together a major treatise directed towards the general public: Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences

It's a hot topic, mainly because it has been so politicized in recent years. As with the study of climate and weather, or research into some diseases and approaches to them, politicization is no friend to a pursuit of truth. When addressing data directly can be career-damaging or socially-damaging, scientists tend to be as human as everybody else.

During my career in mental health I have seen the societal normalization of things that I had been taught were perversions.  Except for pedophilia and sexual sadism (so far), former perversions tend to be viewed as normal variations. It has been fascinating to watch these societal shifts. It has also been fascinating to watch the once-simple term "gender" shift into an almost hallucinatory array of meanings. It seems to me that cultual shifts, in this case, have led medical attitudinal shifts, rather than the reverse.

Human sexuality is a sexy topic. 

A book of interest by Dr. George Makari: Soul Machine: The Invention of the Modern Mind

Neoteny refers to the persistence of juvenile traits, or the retardation of development. For example, it has been speculated that the domestic dog was bred (genetically engineered, as it were) as a neotenous wolf - one whose brain never matures and retains a puppy-like, submissive and thus a trainable, pliable, and friendly mentality. (All domesticated dogs were bred from the wolf, from the Chihuahua to the Huskie.)

Similarly, Stephen Jay Gould speculated that humans may be neotenous chimpanzees. On a bad day, I am quite certain that I am one. Desmond Morris wrote about it.

In fact, the human brain, face, and body demonstrate numerous neotenous traits, the lack of heavy body hair being the most obvious.

The grey matter of the human brain, in particular, shows retarded development even when compared with other apes and primates. Gene Expressions shows the data. (The transcriptome which is referred to is the messenger RNA (mRNA) which, in a timed manner, transcribes the messages from the DNA to make things happen. It's a miracle that it works.)

It is fun to speculate about what the neoteny of the human brain might imply for human development, socialization, learning, and psychology - but it's all speculation. As I have said, the human brain is an ongoing experiment.

There are many sorts of depression. Some are mostly situational (eg loss or failure), some are mostly chemical (eg Bipolar Depression), some are mostly psychological (eg a big blow to a fragile ego, or self-contempt either deserved or undeserved), etc, etc. Many or most, it seems to me, are mixtures.

In my view, most people with a depression need some sort of psychological intervention or help, and many benefit from medicine unless the medicine completely sweeps things under the rug that ought to be addressed. Depression is a non-specific phenomenon, like pain. It is, in fact, mental pain. Sometimes, mental agony.

Interesting article about Ketamine ("Special K" as it is sold in nightclubs). If it's one more tool in the toolkit, great.

Professor explains the rise of ‘precious snowflakes’ – cites narcissism, over-nurturing

The Prof is hopelessly naive about human nature. In looking at human behavior, one must always be alert to the aggression and power-seeking. There is no sensitivity or hypersensitivity in these kids. They are manipulative bullies, "crybullies" as they are called. It has been stunning for me to watch real educated adults take these infantile tactics seriously or to be intimidated by them

Or perhaps they don't take them seriously, but are happy to find an excuse to do what they themselves wanted to do anyway. In any event, there is no innocence in the PC circus.

Related, Declining Student Resilience: A Serious Problem for Colleges - College personnel everywhere are struggling with students' increased neediness.

My response to that is that, if infantile or regressive behavior is rewarded, you will get more of it. That is regardless of age. If adult behavior is rewarded, you will get more of that. And as the man said, higher ed is not day-care.

The New York Times recently ran an op-ed declaring that being psychotic is “enriching,” and arguing against involuntary treatment of the psychotic. 

That is nonsense. There is nothing redeeming about acute and agitated psychosis. Indeed, we do not usually commit psychotic people to hospitals unless they present some sort of danger. The US is not the Soviet Union. In the US, there are many quietly psychotic people out there refusing treatment or help. That is a tragic thing, but it's a free country.

Another tragic fact is that our ability to treat schizophrenia is very limited. We can usually help with acute symptoms and provide various support systems if they are accepted, but we can not fix the disease, which is chronic. The good news is that we are now excellent at treating the psychoses of Bipolar Disorder. With cooperative patients, it's as close to a cure as is possible.

It is overrated. 

The placebo idea has a long history, back to ancient Greek medicine. However, in my experience the placebo effect, such as it is, seems most powerful in the ignorant and the suggestible. Hence the enduring popularity of quackery like naturopaths and homeopaths.

While it remains true that modern physicians often recommend treatments with marginal effects, those marginal effects are likely not imaginary.

A book: The Revolutionary New Science of Exercise and the Brain

How Exercise Shapes You, Far Beyond the Gym

I believe that life is deepened by physical, spiritual, emotional, social, and intellectual stress. Added as a bonus: discovering one's limitations. Doing what we "feel like doing" tends to be a dead end in life, paths of least resistance. Doing what we don't feel like doing can be amazing. A quote:

.. .the author Charles Duhigg, in his 2012 bestseller The Power of Habit, calls exercise a “keystone habit,” or a change in one area life that brings about positive effects in other areas. Duhigg says keystone habits are powerful because “they change our sense of self and our sense of what is possible.”

I posted on the topic of posture a few months ago.  Here's more:

Posture Affects Standing, and Not Just the Physical Kind. Rightly or wrongly, your posture is taken as an index of your self-respect and self-confidence.

Posture Training

A healthy distrust of experts, especially government experts, is a good trend. Government "expertise" is always contaminated by politics (eg the Ethanol scam). Caveat emptor.

A review of how government food advice got it all wrong and gullible citizens ate it up. They went high-carb, low fat, no red meat, etc all to either zero effect or by getting fat. A quote:

As the threat of communicable diseases receded, public medicine began to turn its attention to treating and preventing health problems that weren’t germ-caused, such as chronic heart disease and strokes, the death rates for which seemed to be soaring after World War II. Some observers cautioned that the apparent increase might be the result of diagnostic advances, which had improved doctors’ ability to detect heart ailments. This possibility, however, failed to deter the press and advocacy groups like the American Heart Association from declaring the arrival of a frightening epidemic.

Related, Drafter of U.S. Dietary Goals Was Bribed by Big Sugar to Demonize Fat - Newly released historical documents show
the Sugar Research Foundation paid scientists to blame fat and
cholesterol, not sugar, for coronary heart disease.

That is a major but unknown scandal. Think of all of the gullible Americans who avoided "red meat" and "animal fat" over a generation, for no reason at all.

It has been known, probably since humans were human, that many personality traits are hard-wired in the genes and that much of development consists of a gradual revealing of those traits in the same way that physical characteristics are gradually revealed. Thanks to the miracle of the human cerebral cortex, some learning and adaptation occurs but the hard-wired things remain present even if hidden by adaptive maneuvers (eg covering up shyness or hypersensitivity).

Long before you could express yourself with words, you were giving away the signs of your adult temperament. Christian Jarrett explains how.