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.
There are at least two main trends in Psychiatry in the US nowadays, with a large area of grey in between.
At one extreme, there are those who practice as if there were neither mind nor soul, as if there were nothing to a person but a bag of chemicals.
At the other extreme, those who practice as if there were no protoplasm and nothing but a bag of conflict and developmental/situational hang-ups.
Both extremes suffer from some form of psycho-utopianism. Most of us come in somewhere in some grey zone, in a confusing and challenging grey zone which keeps our brains working hard. A zone of ambiguity and mystery.
My close colleagues and I tend towards Dr. Levinson's view: Psychiatry’s Underground Economy. (It's not mainly about money, it's about how we think about patients.)
The Trailhead Queen was dead. At first, there was no overt sign that her long life was ending: no fever, no spasms, no farewells. She simply sat on the floor of the royal chamber and died. As in life, her body was prone and immobile, her legs and antennae relaxed. Her stillness alone failed to give warning to her daughters that a catastrophe had occurred for all of them. She lay there, in fact, as though nothing had happened. She had become a perfect statue of herself. While humans and other vertebrates have an internal skeleton surrounded by soft tissue that quickly rots away, ants are encased in an external skeleton; their soft tissues shrivel into dry threads and lumps, but their exoskeletons remain, a knight’s armor fully intact long after the knight is gone. Hence the workers were at first unaware of their mother’s death. Her quietude said nothing, and the odors of her life, still rising from her, signalled, I remain among you. She smelled alive.
The deception was made easier by the fact that in life she had never given orders or led them in activities of any kind—even though she could have performed all their tasks if she chose. She had taken the only initiatives she ever took all in a burst, at the beginning of her adult life, when she had abandoned the colony of her birth and, along with it, her mother and her sisters. First, she had spread her four membranous wings and flown into the air. There, she’d joined a swarm of flying males and other virgin queens. One of the males had caught her. He’d clamped his legs around her body, and the couple had spiralled down to the ground. On landing, he had used the large claspers at the rear end of his body to hold their genitalia together as he completed the insemination. Within five minutes, the act was finished, and the queen shook the male loose. All the sperm she had received flowed up into a special bag-shaped organ in her abdomen, where it would stay until called on to fertilize her eggs. It might last for years into the future. Each sperm was endowed with a potential life span equal to her own.
In contrast, the father of all her children was programmed to die almost immediately after the mating. The only thing that he had ever done was accept meals regurgitated to him by his sisters, as if he were a nestling bird, and wait, and wait some more, and finally take the one short flight from his home, followed by five minutes of copulation. In other words, the male was no more than a guided missile loaded with sperm, his life’s work a single ejaculation. Afterward, he was left with only one instruction, to be enforced if necessary by his sisters: Don’t come back. He had been issued a one-way ticket. He had no chance at all of survival. A delicate creature, he could not find food, or feed himself if he stumbled across some. He would die by dehydration, or crushed in the beak of a bird, or chopped into pieces by the jaws of an enemy ant, or, less quickly, pierced by the bloodsucking proboscis of an assassin bug.
To escape the same fate, the newly mated future Queen of the Trailhead Colony, full-brained and powerfully muscled, hurried to find shelter. She had to get back underground as quickly as possible. First, however, she had to take a few minutes to shed her wings. To do that, she simply bent her middle legs forward, pressed them against the base of the wings, and snapped them off. This mutilation caused no injury to the rest of her body; it caused no pain. The Queen was a parachutist who slipped her harness upon landing. Now she could move more quickly to avoid the ants, spiders, and other predators hunting around her in the grassroots jungle.
Soon she came upon an open space between grass clumps, a small clearing at the Lake Nokobee trailhead. By luck she had found an ideal site to build a nest. She began at once to dig a vertical tunnel in the sandy clay soil. Her movements were swift and precise, and within minutes she had deepened the shaft to more than her body length. This provided her some degree of protection, but she needed to proceed as quickly as possible. Her life remained in constant danger.
My impression was that the "disease" model became popular for three main reasons; 1) it made it more comfortable for the addict, 2) it made it more likely to get insurance coverage for treatment and 3) addictions do have a physiological aspect. It never occurred to me that politics had anything to do with it.
It's always been my view that difficult experiences can eventually result in painful psychological growth as often as they can result in lasting damage. It used to be called the School of Hard Knocks but I call it "Reality Therapy," and it's all the therapy most people ever get.
Psychotherapy, in it's most penetrating and exploratory forms, is nothing more than controlled psychological trauma, just as surgery is controlled physical trauma.
Many articles I read about Jihadists refer to "disaffected youth," even this one about the Algerian beheading of the French hiker.
I am sorry to say that these are not "disaffected youth" (as if they were Holden Caulfields or Benjamin Braddocks), they are deeply "affected" people from all walks of life who do not mind dying for their beliefs. They are true believers, Muslim fundies following their scripture and their religious leaders. Any efforts to psychologize them are amateurish, naive, ignorant, and Western cultural-centric.
Multicultural dogma says that we must comprehend people in the context of their cultures, not in the context of our materialist, secular, and therapeutic culture.
Genetic studies suggest that these major psychotic diseases, historically grouped under one broad category, are possibly or even likely different diseases.
This is not surprising, but it is interesting. "Schizophrenia" really meant miscellaneous chronic psychosis. We have all always felt that the paranoid psychoses were a different animal. Time will tell whether this information will have any practical value.
Heard in group therapy supervision, coming from a fellow in the group who was cheating on his wife: "But you have to understand, she's the only woman I have known who really understands me."
Apparently this sad old line was met with nothing but guffaws from the group.
Doctors get used to death. As with pastors and undertakers, it's a routine aspect of life.
What are the things which most emotionally engage ordinary Americans? I think love and family, sex, God, money, freedom from government - and death. Two deathy links:
Many years too late, the MSM and the government are getting the obvious message which docs have known all along. Unless you do manual work all day and are skinny, you don't need hardly any carbs to be fit and healthy. What carbs to eat very sparingly, if at all, to be strong and lithe? See below the basic list ofthe bad things which few Americans need to thrive:
All fruit (except strawberries and blueberries). Fruit is just flavored sugar, as are fruit juices All root vegetables - potato, carrot, beet, etc etc All grains (including rice, brown rice is especially bad as is quinoa) All bread, cereal, pasta. It's junk food, but good enough for manual laborers or the starving in Africa Most dairy (eg milk, ice cream, etc. Fatty cheeses are fine, as are eggs)
Carb-produced fat on your body is the worst thing for your heart, your joints, some cancers, your sex drive, and your youthfulness, vigor, and energy. If you are skinny and fairly muscular, ignore this.
Unless you are too skinny or healthily-skinny, I suggest one to one and a half smallish meals per day, mainly meat, eggs, greens, and vegetables. Why Westerners decided three meals daily was needed is a historical mystery, and very wrong unless you were a farmer or a growing child: most people used to be farmers, who worked until they dropped and their little kids helped all day too. Being overweight was a sign of wealth, and now it sort of functions as a sign of poverty and the underclass.
OK, a sugary dessert once weekly as a special treat. Alcohol as desired. Your hunger and your stomach will shrink quickly, as will your burdensome lard.
You will feel better and more vigorous, if that is what you want. Some people want that, some do not. Our current prosperity gives us that free choice, in the Western world.
The notion that happiness is actually attainable belongs to the second half of the 18th century, as Freud pointed out. Previously there had been a general consensus that no one can be called happy until he carries his happiness down to the grave in peace. Paradiso was strictly for the pages of Dante. In Greenland, for example, the Greenlanders bought into Christianity on account of its persuasive description of pain and suffering. The vale of tears was real. And then Captain James Cook, and his French counterpart, Louis-Antoine de Bougainville, embarked upon their great voyages. Bougainville’s Voyage autour du monde (1771) seems to suggest that this journey had less to do with discovery or French imperialism, than the pursuit of happiness. What’s more, Bougainville suggests that happiness was actually found—in Tahiti.
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, wittier, and more fun than I am.
We have had a decade or two of some experts preaching that fat and salt will kill you. Many of us docs have been debunking those old claims, to little avail.
I have never met a stupid adult person. I have met plenty of ignorant people and people lacking in the curse of curiosity, but that's different. Mostly, we meet people with limited areas of stupidity: lack of self-awareness, lack of information or understanding, islands of emotionalism or impulsivity, unexamined biases, self-affirming rationalizations, etc.
"Self-esteem", "amoure propre", is a strange concept, self-respect is very hard-earned, and self-hatred, whether deserved or neurotic, is a big challenge.
I've been preaching this ad nauseam but everybody has his own food religion based on superstition, old wive's tales, antiquated misinformation, and various quackeries.
If ignorance floats your boat, then go for it and be happy with the placebo effects, but just do not pretend that it makes sense.
If your triglyceride numbers scare you or your doc, take some statins.
Eat all the carbs you want, too, unless you want or need to lose weight. If you wish to be more slim, trim, and muscular, quit the carbs and exercise hard. And, for God's sake, quit with the stupid organic stuff. It's just marketing. Marketing genius for sure, just like the people who sell water in bottles.
I don't know what practicing clinician has time to write guidelines for other docs, but guidelines are nothing but trouble. The best medical care is both art and science. Knowledge is always incomplete, patients are individuals with unique situations, and all docs have their own preferences and points of view. Guidelines end up being little more than fodder for tort lawyers and time-wasters.
Worst of all, young docs feel as if they have to follow them. Many things go wrong when practicing by the book. Medicine is an art and a science.
Confessionals like this one can sometimes help those people blessed with sunny dispositions to have some understanding of those unfortunates without such dispositions.
I am very much convinced of this effect, and would like to see the idea enter the lexicon. It's from this: 
Against happiness: