Maggie's Farm

The author of the piece about the famous long-term study of Harvard students from college to old age says that George Vaillant has demonstrated little more than that an ability to adapt predicts an ability to adapt. From Their Right Stuff -The evolution of the Harvard guinea pigs:

As with orthodox Freudianism, there is a hedonistic bias to the ideal of maturity that the study proclaims. To blossom is to shed “rigid” attitudes. There is nothing more contemptible than an “inhibition.” Perhaps you think that, in a free society, in-hibitions are good since they spare us from having to submit to others’ pro-hibitions. But if that is how you think, you will find this book’s system of values un-intelligible. Vaillant sees evidence of one Episcopal minister’s maturation in the way “he had put aside absolute convictions about faith, morality, and authority in favor of a new appreciation of their relativity and mutability.” If this book has a hero, it is a meathead named Boatwright, who says, “I don’t give a damn if I’m remembered for anything. I’ve enjoyed my life and had a hell of a good time.”

I am sorry to say that the socio-cultural bias is a darn shame. My profession is half-good at defining problems, but terrible at defining relative health. Everybody has at least one problem, and having problems is normal.

Everybody struggles with problems. As CS Lewis reminded us, bear that in mind whenever you meet somebody. Therefore be kind (but always be alert to predators).

Is "fairness" just a nicey-nice word for nursery school teachers? From Asma,  In Defense of Favoritism:

The old folk wisdom that group closeness comes from opposition to others is not borne out by recent data. Nor is the old developmental story that we all start out as egoistic Hobbesians, who slowly learn to care for others. Affective neuroscience research on early-childhood bonding suggests that, as mammals, we probably start out as emotionally glued microcommunities (family and tribe) before we become autonomous ego-driven creatures. Favoritism, not egoism, is probably the primal value system.

In short, favoritism or bias toward your group is not intrinsically racist, sexist, or closed-minded. Privileging your tribe does not render you negative or bigoted toward those outside your tribe. And to top it off, we're now beginning to understand the flexible nature of our ingroup favoritism—it doesn't have to be carved along bloodlines, or race lines, or ethnic lines. Psychological experiments reveal a whole range of criteria for ingroup bias. For example, test subjects have been shown to award higher payoffs to arbitrary ingroups, like people who just happen to share the same birthday as the test subject. And ingroup bias can be demonstrably strong when subjects share allegiance to the same sports teams, and so on.

and

If our high-minded notions of retributive justice have roots in the lower emotions of revenge, then why should we be surprised if fairness has roots in envy? I have no illusions and feel entirely comfortable with the idea that fairness has origins in baser emotions like envy. But most egalitarians will find this repugnant, and damaging to their saintly and selfless version of fairness.

A good, provocative essay about human nature and our need for tribal affinities.

Dr. Robert Michels discusses the future of Psychiatry in an interview. A quote:

Psychiatry begins at the end of the 18th century with the medicalization of a group of people who were seen as strange by the rest of the citizens in the world. And that medicalization led to many things. One is it lead to their humane treatment. Previously, it wasn’t uncommon to see people that today we consider psychiatry patients, who’d be chained in institutions to keep them away from society.

It led to an attempt to study what was the nature of their problems, to describe them. It led to people talking to them instead of jeering at them or reviling them.

And it led to the development of more knowledge about the cause, the course and what factors might influence their disturbances. So it led to treatments. Within a 100 years those treatments were beginning to be…quite effective. We learned that some of them suffered from diseases we could cure.

At the turn of the century before this one…in nineteen hundred … a third of the patients in mental hospitals in this country suffered from the complications of infectious diseases. We largely cure those now so you don’t see them these days. We have some new infectious diseases. But we’ve pretty much cured the old ones that causes psychiatric problems...

I heard on the radio that residents of Bridgeport, CT were pelting utility workers with sticks and eggs (where did they get those eggs?) to "express" their disgruntlement about having no power two days after a powerful Nor'easter his their town. (It was a Nor'easter at that point, more or less, or a hybrid but not a genuine hurricane.)

It was necessary to assign police to escort the utility repairmen, who had come there from all over the country and from Canada to repair their lines.

My rhetorical question is this: Where do people get it into their heads that bad things, and bad consequences, should never happen and, if they do, that there is someone to blame? It seems like the height of immaturity to me. Who taught people that this is what life is like?

Men and Women Can't Be "Just Friends"? The age-old question is addressed in a sloppy study in Scientific American.

Humans aren't Bonobos, but in human connections there is always some sex in the air. The popularity of "friends with benefits" relationships among the youth, and now middle-aged singles - makes that clear. Lots of other things are in the air too, like competitiveness, childish emotional wishes, familial-type feelings, feelings of tribal affiliation. loneliness, delight or amusement in another's company, shared intellectual or recreational fun, exploitative aspirations, etc., etc.

My profound and earth-shaking point here is simply that human interactions and connections partake of all aspects of being ... human.

There's one thing I know for sure: Put a guy and a gal who are pals in a comfy place away from home, add alcohol, stir, and anything can happen. Alcohol numbs the prefrontal cortex.

Interviews with Nobel laureate Kandel are always stimulating. 'I See Psychoanalysis, Art and Biology Coming Together':

I see psychoanalysis, art and biology ultimately coming together, just like cognitive psychology and neuroscience have merged recently. You have specifically selected examples, which I use not to illustrate how science can enhance insight into art. Rather I use them to show how artists had insights into the mind that Freud did not have and that enriched and corrected what Freud taught us. This is what concerns me in the first third of the book. It is in the second and third parts of the book that I outline a biological approach to how we respond to a work of art...

Keller seems to have written his glowing essay about the Liverpool Protocol, How to Die, without talking to any practicing American doctors. He is writing as an advocate of Obamacare, and speaks as if American doctors won't let people die while the English people will.

If he had spoken with American doctors, he would know that most American internists do something very similar with patients whose condition is hopeless, and do so routinely. Daily. Everybody dies. American hospitals have plenty of patients with "DNR" (Do Not Resusitate) orders on their charts, and hospice units and hospice centers are common in the US.

I see two exceptions, occasionally. One is when the family or patient is adamant about "Do anything and everything." These tend to be people who don't know much. The second is with some terminal cancer patients. I have seen terminal cancer patients, with widespead metastatic disease in the ICU, dying while the latest cancer chemotherapy is still being pumped into their veins. It's pitiful.

Generally, doctors know when to give up and do not view death as an enemy. Unfortunately, Bill Keller seems to be addressing a straw man.

Keller should read this: Why Doctors Die Differently - Careers in medicine have taught them the limits of treatment and the need to plan for the end. Doctors know when they're a goner, and when their patients are too. Most docs do not offer false hope, and do wrong when they do.

Dr. Dalrymple has a post: Why Psychiatric Disorders Are Not the Same as Physical Diseases.

They sure aren't. That's why we don't term them "diseases." But it's more complicated than that. Psychiatrists address most complaints which concern the mind.

Some are caused by wiring abnormalities in the brain (eg autism, PDD, probably schizophrenia), some by brain damage (eg strokes, Alzheimers, hydrocephalus, trauma). Many complaints seem to combine brain vulnerabilities of some sort with the mind and personality of the person (eg OCD, Bipolar spectrum problems, severe depressions, etc etc). However, most often in outpatient settings we deal with complaints which appear to be "all in the mind" or mostly so (eg neuroses, personality problems, relationship problems, character flaws and weaknesses, fears and phobias, addictions - first in the mind, then engraved in the brain -, emotional immaturity, major life dilemmas, milder and reactive forms of depression, etc etc).

Dalrymple's post is about Dr. Oliver Sachs' determination not to label his symptom as a neurotic one. There is much comfort in believing that one's complaint is "physical" or, as we often term it, "organic."

In fact, many Psychiatrists today seek to over-medicalize Psychiatric complaints. Did your beloved spouse of 60 years just die? Oh, you have Depression, a chemical imbalance requiring 40 mg of Paxil daily.

Our trademark term "Psycho-utopianism" refers to the idea that we would all be thoroughly happy and fulfilled in life were we only given the right drugs or psychotherapy. Reality would be undone, and Eden restored.

Thus there can be a sort of conspiracy between patients and Psychiatrists (perhaps aided and abetted by the structure of the DSM and the drug companies) to view all or most complaints and symptoms as external or alien to the mind, so to speak, instead of, often, embedded in it or part of it. Part of oneself, that is.

During one of my residency inpatient rotations, we were to sit with hospitalized schizophrenics, addicts, and Borderlines for 4 hours/week. We were instructed not to attempt any "therapy" or to try to fix anything, but just to use the time to try to comprehend where they were coming from, what was going on in them, and how they were interacting with us. This was a remarkable experience in more ways than I have time or space to write.

The neuroscience craze of the 1990s grossly overpromised future clinical usefulness. My advice to the neuroscientists is to be as humble as Eric Kandel because Oliver Sach's hysterical paralysis will never be located in brain matter just as my love for tennis never will.

Related: Was it really me? - Neuroscience is changing the meaning of criminal guilt. That might make us more, not less, responsible for our actions

Also related: Googlizing Neuroscience

I touched on some of these topics recently in Psychiatry’s Legitimacy Crisis

The neurosciences were the sexy new frontier in the 1990s, but popular writers often offered the impression that any basic science of the central nervous system might have clear implications for understanding the workings of the mind.

From the article of the above title:

The idea that a neurological explanation could exhaust the meaning of experience was already being mocked as “medical materialism” by the psychologist William James a century ago. And today’s ubiquitous rhetorical confidence about how the brain works papers over a still-enormous scientific uncertainty. Paul Fletcher, professor of health neuroscience at the University of Cambridge, says that he gets “exasperated” by much popular coverage of neuroimaging research, which assumes that “activity in a brain region is the answer to some profound question about psychological processes. This is very hard to justify given how little we currently know about what different regions of the brain actually do.” Too often, he tells me in an email correspondence, a popular writer will “opt for some sort of neuro-flapdoodle in which a highly simplistic and questionable point is accompanied by a suitably grand-sounding neural term and thus acquires a weightiness that it really doesn’t deserve. In my view, this is no different to some mountebank selling quacksalve by talking about the physics of water molecules’ memories, or a beautician talking about action liposomes.”

Use the Force: How Magicians Can Control Your Decisions - Our choices are often not as independent as we would like to believe.

It is certainly true that we frequently deceive ourselves about the rationality and the intent of our choices. As easily as we may deceive ourselves, we are easily deceived too. The article explains some of the tricks magicians use to "force" our "free choices."

In Psychiatry today there is much discussion, debate, and confusion about diagnosing the varieties of serious mood or attitudinal instability (ie instability which is life-disrupting in some significant way).

It's not your grandfather's Bipolar Disorder anymore. The numbers of people labelled as "Bipolar spectrum" has increased dramatically, for better or worse, in recent years. It may be "diagnosis creep," or it might be better understanding. A complicating factor is the overlap between Bipolar Spectrum problems and Borderline Personality, discussed here, where flips in attitudes towards relationships (eg idealization and devaluation) can be prominent in both (along with volatility, grandiosity, hypersensitivity, rage and paranoia).

All of this mess can be treated. I have become a fan of Lamictal for mood instability and attitude shifts which do not rise to the level of full-blown Manic-Depression but which are well-outside the normal moods and shifts of daily life. Lamictal plus confrontational psychotherapy, and maybe an antidepressant.

Here's Hornbacher's book, Madness: A Bipolar Life

I often wonder what such peoples' lives (mostly women) were like before modern treatments. Not too good, I suspect, in the absence of a loyal spouse.

‘Feminist Progress Right Now Largely Depends on the Existence of the Hookup Culture.’  A quote:

...to a surprising degree, it is women—not men—who are perpetuating the culture, especially in school, cannily manipulating it to make space for their success, always keeping their own ends in mind. For college girls these days, an overly serious suitor fills the same role an accidental pregnancy did in the 19th century: a danger to be avoided at all costs, lest it get in the way of a promising future.

I doubt that it is widely true that young women have become the sexual exploiters and predators, but I know it is true to some extent. 

I wonder what our readers have observed.

Some of both, like most things in life. The Science of Poker:

There are many people who hate math but are great poker players, but there are hardly any players who lack the people reading abilities and still manage to be good poker players,” said Vonk. “Mathematical knowledge can to a large extent be replaced by intuition and experience. After a player has played a million hands of poker, even if he does not know the math at all, he will have a decent feeling about when it is profitable to draw to a flush and when it is not.”

That said, knowing the math means you can acquire this kind of knowledge much more quickly, and those skills can give an edge in very rare situations that don’t often occur in a poker game. “To be a great player, you need both!”

We're in Maine with iffy internet, lots of fish chowdah, clam chowdah, mussels steamed in white wine with garlic, wild blueberries, corn on the cob, and no hurricanes.

Where are our readers this week?

Can you say "no" to your kids? We do it, and have done it, every day. It's one simple syllable. Learning limits is a painful part of growing up but we all get past it in time. As we shrinks like to say, "Reality sucks." It is also beautiful, and so much of life is free, no charge.

The real achievement in life is not in saying No to one's kids, but in saying No to oneself. We call it "internalizing" the limits of reality and coming to peace with them. Who, at times, would not chose to be a kid again?

McCloskey's books were among my favorites as a kid, and favorites of my kids too. Make Way for Ducklings! Blueberries for Sal! It's real New England Yankee, Maggie's Farm stuff.

Swimming in Maine? It is not for the weak. You have to have the Right Stuff. Failure is not an option. Ya gotta join in.

Deirdre McCloskey on The creepy new economics of pleasure. A quote:

...nowadays there is a new science of happiness, and some of the psychologists and almost all the economists involved want you to think that happiness is just pleasure. Further, they propose to calculate your happiness, by asking you where you fall on a three-point scale, 1-2-3: “not too happy,” “pretty happy,” “very happy.” They then want to move to technical manipulations of the numbers, showing that you, too, can be “happy,” if you will but let the psychologists and the economists show you (and the government) how.

On a long view, understand, it is only recently that we have been guiltlessly obsessed with either pleasure or happiness. In secular traditions, such as the Greek or the Chinese, a pleasuring version of happiness is downplayed, at any rate in high theory, in favor of political or philosophical insight. The ancient Chinese sage Zhuangzi observed of some goldfish in a pond, “See how happy they are!” A companion replied, “How do you know they are happy?” Zhuangzi: “How do you know I don’t know?” In Christianity, for most of its history, the treasure, not pleasure, was to be stored up in heaven, not down here where thieves break in. After all, as a pre-eighteenth-century theologian would put it—or as a modern and mathematical economist would, too—an infinite afterlife was infinitely to be preferred to any finite pleasure attainable in earthly life.

And

Ominously... happiness studies have been diverted into an applied science. The happiness measurers very much want to direct us and are itching to engineer a happy society. They do not know what they are talking about, but are very willing to put “policies” about it into practice anyway. In a finely argued but erroneous book of philosophy, for example, Daniel Haybron a few years ago made a case partly on the basis of the new science of happiness against what he calls “liberal optimism,” or the belief since the eudaemonic movement and the bourgeois revaluations of the eighteenth century that “people tend to fare best—and pretty well at that—when empowered to shape their [own] lives.” He doubts it. But on what basis, since psychology is singularly ill-equipped to yield such doubt? As Haybron himself points out, tests on college kids do not range across enough experience. History is more to the point. Of course people make mistakes about their lives, and sometimes spend their lives badly. But as even Haybron acknowledges, the liberal experiment since 1700 has yielded gigantically better lives in every sense for a constantly increasing number of us. Haybron, and many of the elite critics of how other people spend their time on Earth, is an admitted pastoralist and disdains the sick hurry of modern life. Yet is he himself not living a happy life, which his ancestor around 1800—who in any case died in childhood and childbirth—did not?

It's a major essay. As I have said here many times, "happiness" cannot be defined in an applicable way beyond simple-minded gratification, but unhappiness is easy to recognize. It's everywhere.

He viewed this as a narcissistic issue because the distress comes from looking in the mirror, as it were, and seeing a pimple.

What it is about is that we want all of "us" to think exactly like us - that is, perfectly, and the "others" be damned - who cares? Until the "others" give us big trouble.

Freud's psychoanalytic "movement" was repeatedly fractured by such things. Pioneers advanced into the human unconscious, and focused on different aspects, and fought and lost friendships over it. In the end, Freud was usually correct, because he had the courage to tell the often-unpleasant, unpopular, and uncivilized truths about deep human nature.

Of course, the narcissism of small differences often applies to politics. But my best joke on the subject concerns religion:

I was walking across a bridge one sunny day, and I saw a man standing on the edge, about to jump. I ran over and said: 'Stop. Don't do it.'
'Why shouldn't I?' he asked.
'Well, there's so much to live for!'
'Like what?'
'Are you religious?'
He said: 'Yes.'
I said. 'Me too. Are you Christian or Buddhist?'
'Christian.'
'Me too. Are you Catholic or Protestant?''
'Protestant.'
'Me too. Are you Episcopalian or Baptist?'
'Baptist.'
'Wow. Me too. Are you Baptist Church of God or Baptist Church of the Lord?'
'Baptist Church of God.'
'Me too. Are you original Baptist Church of God, or are you reformed Baptist Church of God?'
'Reformed Baptist Church of God.'
'Me too. Are you Reformed Baptist Church of God, reformation of 1879, or Reformed Baptist Church of God, reformation of 1915?'
He said: 'Reformed Baptist Church of God, reformation of 1915.'
I said: "Die, heretic scum," and pushed him off the bridge.

"It's not broken, but it's not as good as it's gonna get." It's about the brain, not the mind, from a somewhat evolutionary viewpoint. The Teenage Brain: Dr. Jay Giedd of the National Institute of Mental Health.

There's a lot in there, and in the lecture too. I do not agree with some of it.

In the LA Review of Books, Andrew Scull on All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders.

It's a good summary of what has been going on in my field these days. One quote:

This reliance on symptoms, and on the simplistic approach of counting symptoms to make a diagnosis, creates a bogus confidence in psychiatric science. Such categories have an element of the arbitrary about them. When Robert Spitzer and his associates created DSM III, they liked to call themselves DOPs (data-oriented persons). In fact, DSM’s categories were assembled through political horse-trading and internal votes and compromise. The document they produced paid little heed to the question of validity, or to whether the new system of categorizing mental disorders corresponded to real diseases out there.

I enjoyed our post yesterday, How stories confer value upon material things.

It seems to me that stories confer value, or at least meaning, generally. Not just to objects. The brain is a creative machine, as Eric Kandel says. We indeed live in stories: stories about ourselves, our families, books, movies, songs, legends.

My work is all about stories. I rarely worry about objective truth during my workday unless I am concerned about being lied to. My concern is with psychic themes and subtexts.

In my non-work life, I care a lot about truth and rebel against self-serving "narratives" presented to me in advertising, by politicians, or anywhere else. As a shrink, I have a pretty good BS Detector.

In my field of study, work, and interest, the wonderful Roy Schafer made a major contribution to the field by highlighting the analytic attitude towards the patient's story. He noticed that the life story, and the day's story, changes as maturity and insight develop. Donald Spence's Narrative Truth And Historical Truth condenses many of these themes.

Politicians, activists, and the like have learned the power of narrative from the Psychoanalysts and the authors, and bent its power to the dark side. Propaganda no longer has simple big lies. Now it has whole stories which appeal to emotion for self-serving purposes, usually money, and/or power over others.

Propaganda, whether commercial or political, now appears as manufactured story-lines. "Truthiness," and all of that. Mark Twain: "A lie can travel halfway round the world while the truth is putting on its shoes."

The solipsistic fallacy is that there is no truth, just psychological truth. While that is often the Psychoanalytic approach to the soul and mind of a patient, when applied to the real world it becomes insane, and possibly dangerous.

Video here. Makes sense to me.

The very good Whittle video we posted this morning revealed that government in the US provides an average of $65,000 annually  in funds, "benefits," and entitlements to poor families in the US. (Little or none of this is counted as income in calculating US poverty stats, as far as I know, nor, of course, does it take into account off-the-books cash income which seems pretty common these days.)

That's roughly the yield of a $2 million trust fund invested at a safe 1-3%, if my assumptions are correct. It's not a hard sale to convince people to vote for their own $2 million trust fund delivered by magic unicorns.

(The current fad for easy Disability and food stamps - anybody can get these things right now and I receive calls daily asking me whether I do Disability forms - is a whole new arena for free stuff, but a different topic. No, I do not do Disability forms on principle because I believe everybody is capable of dignity and self-respect. Speaking of cash, I have been offered good hard cash to fill them out for people in the last couple of years. On the phone "Doc, I'll pay you $1000 cash to complete my form for me.")

I have had plenty of experience with trust fund people, and am even fortunate enough to be the recipient of a very modest one myself, far less than $2 million in capital due to generational dilution. While some use their trust fund luck for productive purposes, many, it seems to me, lead relatively unproductive if not decadent, purposeless, and unstructured lives. People with meaningfully-sized trust funds, and families on the dole, have more in common with eachother than either has with the middle class.

As we often say here, real life is scary and challenging for almost everybody else. I am not convinced that that is a bad thing. It's the nature of real life and helps bring out the best in us. People spend money for lottery tickets just to enjoy the momentary fantasy of security and ease. Security and ease are infantile fantasies in this world which presents one problem after another.

Here's a piece on the psychology of dependency which echoes some of my own views: Infantilizing Leftist Morality

Progressivism, in the Marxist and post-Marxist forms that have been swallowing the world for a century, is, in its methodology, nothing but the moral infantilization of mankind. It seeks the establishment of a population dominated by the childish fear of facing the world alone. Its pretty slogans are all variations on this theme. From "Workers of the world unite" to "It takes a village," the message is always the same: you can't face this "dog-eat-dog" world without the safety of the herd, which means without material security provided by political force. An all-powerful mother government must always be there to protect you from the ever-present monster, which is just life itself. And such security is not "charity"; it is your right. You are entitled to it, as any child is entitled to his parents' protection.

Today's ever-expanding "entitlement mentality" is literally shamelessness elevated to the status of a moral code. Progressivism has created an entire euphemistic vocabulary to justify the unabashed demand that others sacrifice their liberty to save me from my childish fear of facing life as an adult. "Positive rights," "social justice," "redistributive justice," "creative individuality," and so on, are all part of the leftist lexicon of cowardice.

Read it all. My view is that every American kid is born with a trust fund: their body, mind, soul, opportunities, and the remarkable free culture at hand. Amazing gifts which are rare on this planet. With all of that, nobody needs to lead a life which wastes his talents and capacities, or neglects his spiritual development.

I should add that I have no problem with trust funds per se (and have doubts about the whole idea of inheritance taxes too, which hit small family farms and businesses but never the very wealthy. America should welcome and ecourage family wealth-building, which reduces dependency). Similarly, I have no problem with the safety net for the very poor and/or dysfunctional. I do find it remarkable that American poverty benefits net out higher than the average American worker's income, which, like a good-sized trust fund, can be a perverse incentive for the weak in spirit. That's a shame, but people make their choices and not all Americans, unfortunately, have absorbed the American "Can Do" attitude.

Governments are marketing the "You Can't Do" attitude. It sells.