Maggie's Farm

The news mills are ginning up yet another medical crisis storm these days in an effort to pave the way for gummint medical care by the same good folks who run the DMV and the post office. They seem to imagine a problem with cost, access, and insurance. Maybe we are a nation of crybabies, because we have the best medical care in the world with which to pamper our so-called precious selves.

It's time we got beyond that self-love, and cared about the Greater Good. I have a few simple, rational, Utilitarian solutions.

Cost: Cost is driven by technology and modern pharmacology, cancer treatment, crocks (people obsessed with their health), gomers ("gomers go to ground"), and futile, guilt-driven end-of-life treatment for annoying old or sick relatives. The cost of American medical care can be dramatically reduced by forbidding all cancer treatment other than Oxycontin and at-home 10-gallon morphine pumps, all medical treatment for those over 57 (the children are our future!), all CT and MRI scans, all blood tests, and all medicines other than friendly, holistic, herbal organic ones. No more vaccinations - they cause Autism. No more antibiotics - everybody knows that they make people sick. Eliminate Dermatology (just stay out of the sun, people). Eliminate Opthalmology (bad eyesight is from masturbation - it's your own fault). Eliminate Psychiatry (mental illness is socio-political mind control). Eliminate Urology (do you want a #3 gauge tube stuck up your urethra?). Eliminate Surgery - it is physical assault on comatose victims. Eliminate Neurology - it's just nerves.

Access: Doctors are like waterfront trade unions: they limit their numbers to keep their payments high enough to join country clubs, to buy boats, and to take vacations. My idea: anybody who gets a C or better in Organic Chem is automatically admitted to a government medical school. Lots of good, caring people are weak in math and chem and bio and stuff, but that's who we need more of. My medical school flunk-out rate was 18%: what a waste of talent. Plus there are too many Jews and Asians in medicine anyway, and too few people of color or of gender identity diversity. So, with this increase in the numbers of docs, fees could go down to $5 per office visit and the docs who don't like it can open dry cleaning shops, cigar shops and wine shops like they do in Canada.

Insurance:  Medical insurance is a dumb idea. Why expect your neighbor to pay your medical bills when they will be so low under my plan anyway? They will be cheaper than your garbage pick-up, your newspaper subscription, your cigarette costs, your car payment or your monthly payment for your big screen TV. (Did you ever notice how nobody complains about the cost of their TVs, computers, or Life Insurance?) Or just save your money if you want and die quietly without complaint, dude, and make space for the next generation. Too many people on the planet and, let's face it, life isn't all it's cracked up to be anyway. A vale of tears and toil, a tale told by an idiot, full of sound and fury, signifying nothing. What's the big deal about death? Didn't your parents teach you that life is a bitch?

Interesting link by our News Junkie last night re people who think of themselves as "good." That link led to Ryan Sager's The Al Gore's Fraggin' Giant Mansion Effect. A quote:

If you’re too-well-satisfied that you’re a good greenie, you’re more willing to cut yourself slack when you hurt the environment.

Call it the Al Gore’s Giant Fraggin’ Mansion Effect.

According to a new study in Psychological Science, humans engage in a process called “moral self-regulation.” Basically, we’re constantly calculating the trade-off between being able to see ourselves as good people and the cost of engaging in all that non-advantageous goodness.

You might expect that being prompted (primed) to think of yourself as a good person would make you more altruistic or moral — but, in fact, the exact opposite appears to be the case.

Read the whole thing. I have too many reactions to this to post briefly, but my first thought was that I have seen this many times. (See Obama's Earth Day flights burn 9000 gallons of fuel.) The process goes far beyond Greenieism. Many people play tricks with themselves in order to have their cake and eat it too.

The NJ summed it up perfectly: "They seem to think they get a pass because they're good." It reminds me of our recent QQQ from PJ O'Rourke: "Everybody wants to save the world but nobody wants to help Mom with the dishes."

It's important to most people to view themselves as virtuous. Cheap and easy virtuousness (recycling, donating to charities, volunteering, serving on committees, etc) is often used by people, consciously or unconsciously, to excuse or to compensate for their sins and crimes (eg not reporting cash income, cutting corners, patronizing massage parlors, spreading gossip, lying, etc). In my view, honest people wrestle with sin rather than playing the "moral self-regulation" game.

How many criminals have been described as "pillars of their community,"  "great guy, always kind and generous," "everybody loved him," "a great supporter of civic causes"? Lots of them.

I am not talking about guilt-driven "conspicuous virtue" here, like the cheating guys who bring their wives roses - I am talking about the secret compromises people make internally so as not to mentally suffer from their feelings of sinfulness and hypocrisy.

I could go on and on on this topic. More later, maybe.

Photo: John Gotti, the "Dapper Don," once a pillar of his community of Howard Beach, Queens, NYC, generous donor to his church and kids' sports, and an avid recycler with a deeply caring interest in the always-Green trash-hauling and recycling biz.

I opted out of Medicare years ago. I felt morally torn about doing so, but finally my bookkeeper refused to do any more of their paperwork. That settled it.

My compromise was to institute a generous sliding fee scale for Medicare-aged folks. (My general policy is to never decline a referred patient because of money.) From a young Doc, in the WSJ:

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments.

People vary enormously in their levels of life functioning, talents, and life-mastery, don't they? Nature confers variety - not equality - because variety is essential for a species to survive when circumstances change.

You could make a graph of the people you meet by rating their functioning in various areas on a 0-10 scale:

- Social skills, personal charm, manners, graciousness, general behavioral appropriateness and adaptability, dignity and demeanor; 
- personality style and temperament;
- IQ, intellectual skills and depth, range of knowledge; 
- physical skills;
- morality and strength of character, tendency to blame or to assume responsibility, and desire to assume responsibility; 
- ability to delay gratification/impulsivity;
- coping abilities under stress, pressure, pain and strong emotion;
- sense of humor;
- emotional stability, predictability, and maturity;
- judgement, planfulness, and decision-making;
- capacity for kindness, thoughtfulness, empathy and love vs self-centeredness;
- degree of "neuroticism;"
- special talents and interests;
- reliability, and trustworthiness;
- work ethic, energy, persistence, perseverance despite fear or difficulty;
- realism vs. naivete and childishness;
- independence, ambition and initiative;
- risk tolerance, adventurousness and aggressiveness;
- curiosity and range of knowledge;
- self-discipline;
- creativeness, imagination and cleverness 

...and so forth.

Feel free to graph yourself on these items - but do not call me if you feel depressed afterwards. We are supposed to identify our weaknesses, and to work on them if we feel motivated to do so.

Most of these qualities are subsumed under what we term "ego functions." (We shrinks use the term "ego" to refer to the tools we have to mediate between our "inner" selves and external reality, not the casual, non-technical meaning of "self-centeredness.") My well-exercised shrink brain tends to measure these things about people on autopilot, even when I try to turn it off. (I also "take my own inventory" frequently with pitiless honesty, and I have my own share of frailties.)

Nevertheless, all of these factors feed into one's ability to construct a life in a free country. Yes, a life must be constructed like a building, but usually with changes along the way.

Fortunately, the world offers things for almost every person to do - and in which to excel if they wish - regardless of how their unique graph maps out. It's generally the pattern of strengths and weaknesses that matters, not the overall "score."

However, I can say, after many years of careful observation of humans, that the folks I have known with the highest overall scores have been military officers, physicians, ranchers, and investment bankers. Don't argue that with me - that's just my own limited life experience.

Many of the most interesting people I have known have very high scores in some areas and very low ones in other areas. That might be part of what makes people interesting. Perfect scores would be the most boring person in the world.

But that doesn't matter, because in America we all play the cards we are dealt, and we all get to make the most of what we have - and to try to develop where we are lacking if we want to, and we get to play out our hand in whatever way we chose, given the heavy constraints of mean old Mr. Harsh Reality (including the chance to write run-on sentences).

A repost from a couple of years ago -

This is a real American story about a true American idol. It's also a story about home-town America, which is, sadly, a disappearing way of true community life.

I met with an 83 year-old fellow the other day for a consultation. He was recovering from a heart attack from which he almost died ("I thought it was just a bad stomach ache but my wife didn't like the way I was sweating.") and a stent.

His cardiologist felt he was depressed, as often happens after serious cardiac events, especially with men.

He told me a little story, but first, a bit about him: Irish, retired policeman, living with his frail wife (a retired book-keeper) in the Boston suburb where he was born - same neighborhood and across the street from the house he grew up in (remembers horse-drawn fire engines down the block); daily Mass; in the church choir ("We sang at the Vatican in 1972 and we are proud of that."); plays trombone ("poorly") in his firehouse marching band; five attentive, devoted kids and 14 grandkids within twenty miles; does every charity thing he can find including Meals on Wheels (even though "I think I am older than most of the people I deliver to"); belongs to his local Vets organization; a WW2  Vet - a gunner in a B-26 Martin Marauder with the 320th Bomber Group of the 12th (Army) Air Force, in Italy: "When flak hit the airplane, it sounded like somebody shaking a bucket of gravel."

Says "We weren't scared. We already knew we would die in this war to save Europe, and we were sort of OK with that, but we were damn well gonna get all of the bad guys we could, first. Heck, we were just kids, looking back now, and full of beans and bacon."

His story: "I was at a wake of a friend a few weeks, ago, drinking and partying of course, and up comes somebody I knew from second grade at St. Anthony's. He says "You need to join our lunch group. We meet once a month at .... restaurant in the back room." I felt flattered to be invited, so I went. My God, I met folks I hadn't seen in years, all from the same home neighborhood - the --th Ward. About 25 guys, retired doctors, teachers, lawyers, mailmen, firemen, mostly moved out of my home parish but all still in town. Somehow lost track of them. A great joy, since so many friends still in my neighborhood have died. We took about 15 minutes to eat, and talked for two hours and had a few beers. I almost said we should meet once a week, but it wasn't my place as a newcomer. I need to stay active, Doctor, because my wife needs me. Doc, life is good, and I'd like to make a few more of these lunches before the good Lord takes me."

God Bless America. And God bless him. No, he did not need me as a shrink: I need some more of what he's got: the true American spirit. One secret: we psychiatrists are more blessed by what we get from our patients than by what we have to give.

Details altered just barely enough for confidentiality (not that he would mind, but he would be embarassed by admiration and attention) - but not the 320th BG - that is accurate.

Yesterday morning's NJ post on "Quality Care" from the WSJ was enlightening, and just gives me one more reason to stay away from Medicare (besides the fact that they pay me peanuts, and that their paperwork requirements are over my head and take more time than my patients take).

I see how government "Quality Care" works: the academic medical experts take a vote, and that becomes "Quality Care." That's not medical care: that's government policy. Forget the individual patient and his or her unique situation, forget the Doc's experience and skills and insight, forget the Doc's judgement, forget the fact that academic Docs aren't always practical, forget that next week's new data will completely alter the information at hand. Just Follow The Rules and stay out of trouble.

I have seen plenty of cases go bad in the hands of young Docs who strictly follow the rules. It's not a good example of that, but when I was a resident one of "the rules" of the time included strict limits on the use of pain-killers, even for terminal cancer patients. Didn't want them to become addicts, you know. They forgot that pain relief remains one of a handful of the greatest blessings medicine has bestowed on humanity (along with anesthesia, antibiotics - and Lexapro).

One of the best things about seasoned physicians is that they are a cranky bunch who do not take orders, who think for themselves, who feel that rules are made to be broken, and who do not like to take crap from anybody - especially anybody in "authority". Your patient comes first, or you are nothing. There is a "House" inside every Doc. In most lines of work, you can't get away with that sort of attitude.

When government gets involved in things, they tend to screw them up. The article's example of high blood sugars in the ICU was a perfect example. Even I, who have not cared for ICU patients for more than a decade, know that tight sugar control for critical patients is insane and dangerous. Not only that, but it doesn't matter: if the patient survives and gets healthy, a few days of higher sugars with a good margin of error will not have hurt them one darn bit. But I am a Doc with a practical mind.

Expertise always has to be taken with a grain of salt, and government-emitted expertise with a tablespoon-full. I am not disparaging expertise, which I respect enormously. I just distrust the combination of expertise with power over others: anointed experts who want power instead of simply to educate give me the willies.

Non-"experts" often have loads of common sense. We take an ancient oath, too.

Ed. note: Somewhat related: Socialized medicine: A warning from across the pond

Readers know that I am always skeptical about labelling and diagnosing people with whom I have not sat and talked for quite a while. Every time a mass murderer goes on a rampage, though, we shrinks come out of the woodwork to opine.

Our friend Shrinkwrapped discusses the Binghamton murders in terms of Narcissistic pathology. It's a good, clear description of pathological narcissism (we posted on the "Narcissism Epidemic" last week) but, in one way, I find it disappointing.

Here's the problem: the world is full of pathological narcissists. Many of them are very successful in worldly terms (if unsuccessful in relationships). Most or all of them endure painful humiliations, failures, and disappointments in life (as does everybody - but narcissists are less resilient in the face of these things and are more likely to sink into rage or depression). Assuming that SW's speculative diagnosis is correct in this case, it still has no predictive power.

Thus my speculative, highly professional diagnosis of killers - whether mass killers or not or whether narcissists or not - is that they have a screw loose. Everybody feels like killing somebody sometimes, but very few do (in Western civilization).

SW did highlight something I had been thinking of writing about anyway. He says:

The Narcissist has a damaged self.  When the environment (esp other people) support his self esteem, he does relatively well.  He may be charming and charismatic and appear to be self assured and in command of himself.  However, should the other fail him the pain of the assault on his self esteem is destabilizing. 

 True (although I would not say "damaged." I would say developmentally delayed, or genetically retarded, or something. Also, I do not understand what a "self" is despite much study on the subject). The larger point is interesting to me. Everybody has psychological frailties and weaknesses. Everybody wants the external world to compensate for those - to patch those holes and gaps.

We usually are able to find a way, to find a niche, to find supports we need (a devoted spouse is a good one - and so is some money) and, worst case, booze and drugs can paper over lots of cracks in our walls. Oftentimes, people are only made aware of their weaknesses when the external supports are removed.

I have seen many people for consultation who I believed needed psychotherapy but whose world insulated them (or who arranged a life such that the world would insulated them) from the self-awareness and the discomfort. I never try to talk people into treatment: they need to feel the need and the inner disturbance to get help. If old Mr. Reality eventually gets through to them, I know they will come back.

However, people with personality disorders are fairly well-protected from Mr. Reality: they live in worlds of their own imagination. Instead of finding a way to make the world work for them, they just invent a world that suits them - and live in it unless or until it unravels.

Daily rule #1 in life is to answer this question: What have you done today to make your spouse happy?

"We have to face facts."

Do we?

There is a common and normal human capacity to both know and not know something at the same time. Maybe it's politics or maybe some recent patients that got me thinking about the avoidance of reality - a maneuver which falls far short of the defence we call "denial" (which itself can also be entirely healthy at times, but often not).

I notice this in myself. For example, I noticed that I have not opened my last 2 quarterly 401-k statements. I know it's ugly inside those envelopes, but I see that I have avoided facing the facts squarely. It's avoiding the sharp pain, while tolerating the dull, nagging pain in the back of my mind. Besides the sharp pain, it's also avoiding whatever difficult or impossible decisions might or should be made.

I consider it to be a character flaw in myself - a weakness - but not a fatal one. Many of us dodge facing painful, pride-injuring, disappointing, or bias-challenging truths about ourselves or about reality and how reality works. I am in good company, but I do not approve of it.

I am not referring to an unconscious defense mechanism like repression: I am referring to a conscious and deliberate maneuver, like the suspicious wife who refuses to check to see if her husband is really at another very late business dinner. A reality-ducking means of coping.

There is a spectrum from psychotic denial and distortion (anorectics believing they look fat), to ordinary denial (I don't have a drinking problem, or I am not doing anything wrong), to repression (my brain won't permit me to think this unpleasant thought), to seeing but not believing (It just can't be!), to the sort of avoidance I am talking about (I know what is there, but refuse to look or listen because it will upset me), to the gold standard of bravely facing and dealing with facts, problems, and the limits of reality. As I say daily, Reality is the best but harshest teacher of all.

She - or he - is one tough and ruthless SOB.

Slate says that Emily Yoffe is the author of What the Dog Did: Tales From a Formerly Reluctant Dog Owner. Her essay in Slate is What is narcissistic personality disorder, and why does everyone seem to have it?

Not a bad essay for (and presumably by) a non-professional. Fact is, the whole subject is so complex that I haven't even tried to write about it: there would be so many "but"s and "if"s and "except"s in it that it would be dull reading. One quote from Yoffe's piece:

This is the cultural moment of the narcissist. In a New Yorker cartoon, Roz Chast suggests a line of narcissist greeting cards ("Wow! Your Birthday's Really Close to Mine!"). John Edwards outed himself as one when forced to confess an adulterous affair. (Given his comical vanity, the deceitful way he used his marriage for his advancement, and his self-elevation as an embodiment of the common man while living in a house the size of an arena, it sounds like a pretty good diagnosis.) New York Times critic Alessandra Stanley wrote of journalists who Twitter, "it's beginning to look more like yet another gateway drug to full-blown media narcissism." And what other malady could explain the simultaneous phenomena of Blago and the Octomom?

These days, "narcissist" gets tossed around as an all-purpose insult, a description of self-aggrandizing, obnoxious behavior.

The link for the essay is above.

That's the latest cardiovascular recommendation for brisk aerobic exercise. (It used to be 20 minutes three times a week, but new data has changed that recommendation.)

I have not asked whether 30 minutes of vigorous sex five times/week counts, but we hope it does.

For some today, and for just about everybody in the past, medical insurance was something everybody bought, just like life insurance or disability insurance, to cover extraordinary expenses. It is called Major Medical, and it is still readily available.

Over the past 20-30 years, governments, businesses, and union contracts began expanding their coverage by reducing deductibles and covering more routine things. Medicare, of course, was the model for that. During the same time, costly medical technology and new drugs were developed in a near-miraculous way, mostly in the US.

With those changes, folks began wanting "insurance" to cover their routine maintenance medical expenses instead of the things that would financially overwhelm them. When that shift was combined with the CYA style of medicine which results in $5000 work-ups for dizzy spells (fed by the ambulance-chasers), everybody expected everything.

That isn't sustainable, and will never happen. Medical technology has grown to an amazing extent, but those machines are expensive.

I have no idea what the folks in power are trying to plan for us, but I know it will be an entitlement disaster, filled with unintended consequences, that people would not be happy with. It will end up with politically-determined rationing.

Our family bought Major Medical insurance many years ago. It cannot be cancelled. It's more important than a cool car. Why everybody does not do that when they are young and healthy is beyond me, because it would seem like the logical and prudent thing to do. Over the years, we have increased the deductible so that it is quite affordable, and we keep a money market savings account specifically for medical bills to the amount of the deductible. As I recall, we began with a $2000 annual deductible, and now we finally have a dirt-cheap $20,000 2-year deductible on the original policy. It does not cover any routine or preventive medical care, which is as I think it should be. Nobody owes me medical care, in my view, any more than anybody owes me auto insurance.

We have kept this policy whether or not I or my husband had some form of insurance through work, because you never know how long you will want to keep a position - or when you will be let go.

Off-topic: Around 30% of Medicare expenditures occur in the last year of life. In other words, on failing and terminal people. Interestingly and unsurprisingly, when docs hold end-of-life conversations with these patients (as we should), the costs go way down.

If this new study is correct and replicated, I can only wonder why it took so long to notice such a simple thing.

I have always suspected that most mental illnesses are due to hard wiring, not chemistry. The fact that medicine can help says nothing about their causes: it makes no more sense than it would to call headaches a Tylenol deficiency disorder. Given the complexity of the brain, miswiring is a common phenomenon and gives people plenty to cope with - in addition to the ordinary travails of life.

The human brain is an ongoing experiment of nature.

 From a review of three new books about the experience of madness, at New Atlantis:

Elyn R. Saks, in The Center Cannot Hold, brings to light her first intimation of schizophrenic “disorganization,” as she calls it, which occurred when her father reprimanded her for interrupting him while he was working. “Consciousness gradually loses its coherence. One’s center gives way. The center cannot hold. The ?me’ becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal. There is no longer a sturdy vantage point from which to look out, take things in, assess what’s happening. No core holds things together, providing the lens through which to see the world, to make judgments and comprehend risk. Random moments of time follow one another. Sights, sounds, thoughts, and feelings don’t go together.” This frightening slippage from normal consciousness first occurred when she was eight, and she knew she could not tell anyone about it.

and

Saks continued to function in the normal world even while she was delusional and hallucinating. “For example, I was getting my schoolwork done, and I vaguely understood the rule that in a social setting, even with the people I most trusted, I could not ramble on about my psychotic thoughts. To talk about killing children, or burning whole worlds, or being able to destroy cities with my mind was not part of polite conversation.” Sometimes she felt so crazy that she would simply lock herself in her room and turn off the lights. The only person in whom she could confide her true state of mind was her psychoanalyst, Elizabeth Jones.

Just reading the review offers a little glimpse in to what the experience of going crazy is like, along with the agonies of feeling defective, alienated from others, and shamefully stigmatized.

I assisted with an abortion one time in medical school, on my OB-Gyn rotation. I went to the bathroom afterwards, shook and sweated, and then puked my brains out. I refused to help with another abortion. Nobody minded. I delivered about 30 babies during that rotation. Scary if you get into a jam, but otherwise good fun.

Knippenberg considers the embryonic stem cell issue (an issue about which I have no particularly strong opinion), and notes the contradiction between the amoral notion of "let science do science" and the political notion of "most people want this."

I guess pols are experts at insulating their decision-making from morality and ethics. In my view, Utilitarianism, like "efficacy," is neither a moral nor an ethical posture. It's a cop-out. It's the easy way.

From Yuval Levin's Obama's False Choice:

Obama (also) chose to repeat the familiar cliché that the Bush policy was a betrayal of science. In his administration, he argued, “we make scientific decisions based on facts and not ideology.” The facts of the Bush administration’s funding of the research, its support for science funding more generally, and the emergence of alternatives to embryo destruction seem not to count. And the fact that every human embryo is a living human being seemed unworthy of mention.

Science policy is not a science: It must seek to use science to the benefit of the larger society, and also to restrain science in those rare instances when it threatens that society’s ideals. In hindsight, it seems increasingly clear that President Bush’s stem-cell-funding policy will stand as a model of how to strike a balance between these concerns. President Obama’s overturning of the Bush approach offers an unfortunate example of how fragile that balance often is.

Ed. note: Krauthammer today: Morally unserious in the extreme

It's about the pathologizing of opinions you don't agree with. Mind you, I have no problem with ending an exasperating disputation with "You're nuts. I can't discuss this with you."

But that's not a diagnosis. While I am fully aware of group and mass psychological themes, I only confer a diagnosis on those who pay me to do so. Even then, I often cannot give them a label because every person is unique.

I have more science under my belt than 95% of the folks I encounter who dispute my skepticism about AGW. But, in the world of science, the only proper attitude towards anything is skepticism. That's how it works. "Proof" is usually very elusive. We have many theories, few truths, and no Truths.

Brendan O'Neill at Spiked reports on the disease of Anthropogenic Global Warming Denial. One quote:

This weekend, the University of West England is hosting a major conference on climate change denial. Strikingly, it’s being organised by the university’s Centre for Psycho-Social Studies. It will be a gathering of those from the top of society – ‘psychotherapists, social researchers, climate change activists, eco-psychologists’ – who will analyse those at the bottom of society, as if we were so many flitting, irrational amoeba under an eco-microscope. The organisers say the conference will explore how ‘denial’ is a product of both ‘addiction and consumption’ and is the ‘consequence of living in a perverse culture which encourages collusion, complacency and irresponsibility’ (1). It is a testament to the dumbed-down, debate-phobic nature of the modern academy that a conference is being held not to explore ideas – to interrogate, analyse and fight over them – but to tag them as perverse.

"Eco-psychologists"? May I conjecture that these people are nuts?

Comments from Common Room:

Moral vices prosper by dressing themselves as virtues. Niceness presents itself as benevolence, but is often merely an evasion of hard decisions that the realities of human nature require. And it has spread throughout our societies because it is often popular with voters. The road to hell, it is said, is paved with good intentions, and so is a good deal of democratic politics.

and

In our compassion, we have confused egalitarian 'fairness' with justice, and we have created a monstrous sense of entitlement.

Wherever standards are destroyed and merit is redefined, a sense of entitlement necessarily follows. This is true in any aspect of society. In the field of education, it manifests itself in the demand by students for high grades when they are not earned.

And this has resulted thousands of defrauded young people who graduate with diplomas they cannot read, apply for jobs they cannot do, and are forced to remain in minimum wage jobs forever, because they cannot read, write, or perform basic computations.

I have heard employers and managers commonly remark that "so and so doesn't have the DNA for this job." It's well-known by now that many, if not most, temperaments, talents, personality traits and tendencies have a genetic foundation. With overdetermined things like political attitudes, one might expect those foundations to be obscured by life experience, education, and personal growth.

But they aren't, entirely. Wilson discusses in City Journal. A side point he makes, which I feel is well-taken, in reference to Adorno's famous study of the authoritarian personality and Bouchard's further work on the topic. He says:

In his study of identical twins reared apart, Bouchard concludes that right-wing authoritarianism is, to a large degree, inherited—but he says nothing about the Left. This omission is puzzling, since as Bouchard was studying twins at the University of Minnesota, he was regularly attacked by left-wing students outraged by the idea that any traits might be inherited. A few students even threatened to kill him. When I pointed this out to him, he suggested, in good humor, that I was a troublemaker.

Yet if you ask who in this country has prevented people from speaking on college campuses, it is overwhelmingly leftists. If you ask who storms the streets and shatters the windows of Starbucks coffee shops to protest the World Trade Organization, it is overwhelmingly leftists. If you ask who produces campus codes that infringe on free speech, it is overwhelmingly leftists. If you ask who invaded the classroom of my late colleague Richard Herrnstein and tried to prevent him from teaching, it was overwhelmingly leftists.

He gets it. I never understood the equation of "Right" with Libertarian/Conservatism either. His essay, The DNA of Politics, here.

It is curious how Darwin, evolution, and inheritance is ignored by the rabid Lefties. Unless God is involved. The wacko Left is ever on the march.

It's the birthday of Charles Darwin. I'd like to highlight this very observant fellow's most original work, The Expressions of the Emotions in Man and Animal.

That book has been a gold mine for students of human behavior, and is the foundation of sociobiology.

I will stick to my decision to avoid pathological labelling of those with whom I disagree. BUT I can never stop wondering that it is that causes people to become passive in the face of a threat to one's way of life - assuming it is meaningful. This is surely abnormal, because our species could never have survived with a "roll over and give up" instinct.

In recent history, we have seen those who were reluctant to stand up to the Japanese, the Germans, the Russian Soviet empire, the North Vietnamese/Chinese - and now the Moslem assault, in its various forms, on the West. I did a post about Better Red Than Dead in the past, but I cannot find it in our archives.

Is it a psychological issue (eg masochism, which implies a sexual excitement in being dominated - or an enacted suicidal impulse), is it plain cowardice, is it a kind of hatred for one's own culture or nation? Or is it really just a unicorn and rainbow dreaminess about life (which I tend to view as a psychological defence based in denial of the hard and often cruel reality that people pursue their interests)? I have seem much of the latter, especially in women and in young men who haven't really worked yet. Cases in point:

Brits to Pakistanis: Please don't hurt us

David Thompson: Assume the position

Psychoanalysis has known for 100 years that our conscious minds aren't in charge most of the time, and writers and grandmothers have known it forever. Indeed, we humans flatter ourselves when we imagine that they are.

For one example, Overcoming Bias discusses how social cues guide our decision making beneath our conscious awareness:

...the MIT group has identified a handful of common social signals that predict the outcomes of sales pitches, the success of bluffing in poker, even subjective judgements of trust. These signals include the `activity level', effectively the fraction of time the person speaks; their `engagement' or how much a person drives the conversation; and `mirroring', which occurs when one participant subconsciously copies another's prosody and gesture. ...

Humans lived in social groups long before language evolved, and the language function presumably exists on top of a more archaic brain system for non-linguistic social signalling. ... Apes, chimpanzees and other primates - our close evolutionary cousins - lack anything like our facility for language, yet still lead sophisticated social lives through displays of power, meaningful noises and facial expressions.

The post correctly concludes:

Our conscious minds are more PR folks than CEOs of our total minds.  We are much better at explaining than predicting ourselves.  So the first step to wisdom is to realize how little we know about why we do what we do, or why we think what we think. 

Around every New Year's Day, or, if I procrastinate, sometime before the end of January, I tend to do a little personal inventory.

I know what I am pretty good at: my work, raising kids, being a wife, being a friend, skiing, shooting, tennis, golf, sailing, reading, and a few other things too. But I force myself to take time to focus on the things I am bad at. I wonder whether they are amenable to improvement, or whether they are hopeless.

As one grows older, more flaws and weaknesses move from the "Maybe Improveable" into the "Hopeless" category. The reality of one's limits sinks in by repeatedly bumping into reality, one's identity clarifies itself, and one's humility deepens.

Here are just a few of the things I stink at, and which have been contemplating this January:

Being a leader. I am a natural born non-leader. Not a follower by any means (in fact, a lousy follower too), but utterly lacking in leadership skills or talents. When I say "Follow me!" nobody follows. And when somebody else says "Follow me!" I say "Wait a minute, and let me think about it."

Being an executive. I am terrible at running things, and the things I get involved with running only work when the others take initiative. I am terrible at making organizational decisions except at the most elementary level, and I am a complete retard with office politics. I care enough, but I can't make things happen. Plus I detest going to meetings. They make me squirrely.

Paperwork. I derive no pleasure or satisfaction from getting it done, and, despite years of determination, I find myself still making excuses to avoid it.

Writing. I give plenty of talks and lectures, and do that well enough to convey information. I have plenty of ideas and things I think are worth writing about, but I lack the talent to write in memorable or engaging ways. I am at my best speaking off the cuff. And it's not that I dislike writing. I like to write things. I just never like the way it comes off on paper. Dull and pedantic, even when I try to write casual. That's partly why I do not post more regularly here. I am never even half-satisfied with what I put on paper. I have written a number of posts for Maggie's, read them the next day, said "That's lame," and pushed "delete."

Phone calls. Unlike most women, I hate the phone. I avoid the phone. Basically, I will not make phone calls except under duress. I cannot get over this flaw. Maybe it's because I spend my days talking to people, but that sounds like an excuse. Anyhow, email is what makes my life function nowadays.

Everybody at Maggie's has seemed too busy to do much writing of his own this past month or so, so we have been throwing up link posts without adding much to them. I am in the same boat at the moment.

Ars Psychiatrica on The Impossible Profession

Eric Kandel on the biology of psychotherapy

Neoneo on long-term psychotherapy.

Photo of Freud demonstrating his tobacco-inspired analytic technique via Neoneo.